![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by temoigneur on May 5, 2004, at 22:37:59
Hi chemist, I have severe OCD and some ADD it seems. I think I have ADD because years ago when I was preparing for a demanding piano examination I took ritalin, I don't think I was on anything else at the time
It gave me laser like focus for hours, then; and the sequence is hazy in my mind, but some time after I would always have very painful moodswings, and find myself crying from depression. My OCD is the masochistic type, I'm always doing things to embarass myself, to purge myself and ward off a sense of impending doom.
Currently I have a new psychiatrist and he is more than willing to try new approaches if it looks like it might hold some promise. I extra fortunate to live in Canada, where through the special access program, my psychiatrist can access drugs through the states, I'm not sure about europe, (thinking about pregabalin)
I am on 300mg Effexor, 15mg Remeron, 10mg Zyprexa and 5mg Clonazepam. Here's the thing, the zyprexa takes away my personality, and creativity. It sedates me and I feel like a vegetable.
My strategy was to ramp up the effexor to 450, go way up on clonazepam, (maybe 16mg) keep the remeron, and hopefully get off zyprexa. I was wondering if you think it might be advisable to add Adderall, I've never tried it, or even perhaps ritalin with a mood stabilizer. The way I am now I'm not getting anywhere. I was down on zyprexa to 2.5 mg for months, my anxiety was higher but I was more alert. I came off zyprexa, and my ocd came back with a vegeance, I was debilitated, I couldn't move without shouting profanities around others to purge myself.
The effexor and zyprexa are controlling my ocd very well, but I'm a vegetable, any suggestions. Thank you so much.
Posted by temoigneur on May 5, 2004, at 22:43:43
In reply to Question for Chemist; OCD ADD and Stimulants, posted by temoigneur on May 5, 2004, at 22:37:59
Hi Chemist, you must feel so overwhelmed, what a service you're rendering here, I forgot to say that I also have BAD anxiety, GAD, SP, Panic Attacks, that seem to feed into my OCD. Thank you so much>
Hi chemist, I have severe OCD and some ADD it seems. I think I have ADD because years ago when I was preparing for a demanding piano examination I took ritalin, I don't think I was on anything else at the time
>
> It gave me laser like focus for hours, then; and the sequence is hazy in my mind, but some time after I would always have very painful moodswings, and find myself crying from depression. My OCD is the masochistic type, I'm always doing things to embarass myself, to purge myself and ward off a sense of impending doom.
>
> Currently I have a new psychiatrist and he is more than willing to try new approaches if it looks like it might hold some promise. I extra fortunate to live in Canada, where through the special access program, my psychiatrist can access drugs through the states, I'm not sure about europe, (thinking about pregabalin)
>
> I am on 300mg Effexor, 15mg Remeron, 10mg Zyprexa and 5mg Clonazepam. Here's the thing, the zyprexa takes away my personality, and creativity. It sedates me and I feel like a vegetable.
>
> My strategy was to ramp up the effexor to 450, go way up on clonazepam, (maybe 16mg) keep the remeron, and hopefully get off zyprexa. I was wondering if you think it might be advisable to add Adderall, I've never tried it, or even perhaps ritalin with a mood stabilizer. The way I am now I'm not getting anywhere. I was down on zyprexa to 2.5 mg for months, my anxiety was higher but I was more alert. I came off zyprexa, and my ocd came back with a vegeance, I was debilitated, I couldn't move without shouting profanities around others to purge myself.
>
> The effexor and zyprexa are controlling my ocd very well, but I'm a vegetable, any suggestions. Thank you so much.
Posted by chemist on May 6, 2004, at 2:52:24
In reply to Re: Question for Chemist; OCD ADD and Stimulants, posted by temoigneur on May 5, 2004, at 22:43:43
well, actually, i was listening to jaco pastorious' first (solo) album, so i wasn't on-line...in the traditional sense...now, let's get started....first off, you are clearly a creative-type person, and the zyprexa does not appear to be working for you. the ritalin had some efficacy in the past, come back to that later. as for 16 mg/day of klonopin, NO DICE: unless you suffer from epilepsy (absence and/or myoclonic seizures, there may be more...), you are WAY above therapeutic levels for GAD, SP, panic, etc. if you were epileptic, you would max out at 20 mg/day. as for effexor, the standard high-end is 375 mg/day for refractory depression, with which you are not presenting. stay where you are on klonopin, dump zyprexa, keep the remeron, and consider going down on effexor while titrating adderall or dexedrine. sounds to me like your OCD diagnosis is off, and that ADD/ADHD with some dysphoria is present. i think your mood swings are due to extremely high doses of effexor and lack of a stimulant: but that is just my take. i will share with you some of my history with these meds, having been diagnosed with all the things you have been, and more (bipolar I as well as II)...the SSRIs didn't do much for me other than send me into self-destructive (don't worry, folks, it wasn't that bad) hypomanic states; the MAOI parnate was nice, until a very manic psychotic break made it clear that anti-depressants of any kind - for me - were out of the question. all the benzos and xanax were tried - and i mean almost all of the ones available in the u.s. - and finally, trileptal/tegretol/depakote/topamax/gabapentin/remeron/geodon....which leads us to now: dexedrine and xanax. this is my cocktail - it doesn't work for everybody and i'm still weird, but that's okay - and i'm sticking to it. aside from my scientific pursuits, i have a creative side (classically-trained on upright bass, over 20 years ago), which fell off with more meds. again, that's just me, but it might work for you. the zyprexa is bringing you down, going to 16 mg/day on klonopin will result in your sleeping through life, and i think that you might benefit from a stimulant (i am predisposed to dexedrine, but adderall or ritalin are good alternatives, provided that ritalin doesn't impair you as before, and strattera is lightweight, as it was originally targeted as an anti-depressant and later remarketed as a remedy for ADD/ADHD). hope this helps, please let me know, all the best, chemist....p.s. piano? composers?
> Hi Chemist, you must feel so overwhelmed, what a service you're rendering here, I forgot to say that I also have BAD anxiety, GAD, SP, Panic Attacks, that seem to feed into my OCD. Thank you so much>
>
>
>
>
> Hi chemist, I have severe OCD and some ADD it seems. I think I have ADD because years ago when I was preparing for a demanding piano examination I took ritalin, I don't think I was on anything else at the time
> >
> > It gave me laser like focus for hours, then; and the sequence is hazy in my mind, but some time after I would always have very painful moodswings, and find myself crying from depression. My OCD is the masochistic type, I'm always doing things to embarass myself, to purge myself and ward off a sense of impending doom.
> >
> > Currently I have a new psychiatrist and he is more than willing to try new approaches if it looks like it might hold some promise. I extra fortunate to live in Canada, where through the special access program, my psychiatrist can access drugs through the states, I'm not sure about europe, (thinking about pregabalin)
> >
> > I am on 300mg Effexor, 15mg Remeron, 10mg Zyprexa and 5mg Clonazepam. Here's the thing, the zyprexa takes away my personality, and creativity. It sedates me and I feel like a vegetable.
> >
> > My strategy was to ramp up the effexor to 450, go way up on clonazepam, (maybe 16mg) keep the remeron, and hopefully get off zyprexa. I was wondering if you think it might be advisable to add Adderall, I've never tried it, or even perhaps ritalin with a mood stabilizer. The way I am now I'm not getting anywhere. I was down on zyprexa to 2.5 mg for months, my anxiety was higher but I was more alert. I came off zyprexa, and my ocd came back with a vegeance, I was debilitated, I couldn't move without shouting profanities around others to purge myself.
> >
> > The effexor and zyprexa are controlling my ocd very well, but I'm a vegetable, any suggestions. Thank you so much.
>
>
Posted by Sad Panda on May 6, 2004, at 13:25:44
In reply to Question for Chemist; OCD ADD and Stimulants, posted by temoigneur on May 5, 2004, at 22:37:59
> Hi chemist, I have severe OCD and some ADD it seems. I think I have ADD because years ago when I was preparing for a demanding piano examination I took ritalin, I don't think I was on anything else at the time
>
> It gave me laser like focus for hours, then; and the sequence is hazy in my mind, but some time after I would always have very painful moodswings, and find myself crying from depression. My OCD is the masochistic type, I'm always doing things to embarass myself, to purge myself and ward off a sense of impending doom.
>
> Currently I have a new psychiatrist and he is more than willing to try new approaches if it looks like it might hold some promise. I extra fortunate to live in Canada, where through the special access program, my psychiatrist can access drugs through the states, I'm not sure about europe, (thinking about pregabalin)
>
> I am on 300mg Effexor, 15mg Remeron, 10mg Zyprexa and 5mg Clonazepam. Here's the thing, the zyprexa takes away my personality, and creativity. It sedates me and I feel like a vegetable.
>
> My strategy was to ramp up the effexor to 450, go way up on clonazepam, (maybe 16mg) keep the remeron, and hopefully get off zyprexa. I was wondering if you think it might be advisable to add Adderall, I've never tried it, or even perhaps ritalin with a mood stabilizer. The way I am now I'm not getting anywhere. I was down on zyprexa to 2.5 mg for months, my anxiety was higher but I was more alert. I came off zyprexa, and my ocd came back with a vegeance, I was debilitated, I couldn't move without shouting profanities around others to purge myself.
>
> The effexor and zyprexa are controlling my ocd very well, but I'm a vegetable, any suggestions. Thank you so much.
>
>Hi,
I would try going off Remeron for a few weeks to see what that does. Zyprexa covers what Remeron does, so the two combined would seem nearly unneccessary & likely to be additive to each other.
Cheers,
Panda.
Posted by chemist on May 6, 2004, at 13:39:01
In reply to Re: Question for Chemist; OCD ADD and Stimulants » temoigneur, posted by Sad Panda on May 6, 2004, at 13:25:44
Panda, thanks for stepping in....you have your act together with these meds....i assume you concur that 16 mg/day of klonopin is a bit high, yes? for my own edification, why the zyprexa over the remeron? and what do you think about the effexor, especially at such a high dose? all the best, and thanks! chemist
Posted by Sad Panda on May 6, 2004, at 14:11:43
In reply to thanks, Panda.... » Sad Panda, posted by chemist on May 6, 2004, at 13:39:01
> Panda, thanks for stepping in....you have your act together with these meds....i assume you concur that 16 mg/day of klonopin is a bit high, yes? for my own edification, why the zyprexa over the remeron? and what do you think about the effexor, especially at such a high dose? all the best, and thanks! chemist
>
>Hi Chemist,
Please don't over estimate my knowledge. :) I primarily know the most about AD's, because they are the drugs I am taking, so I reasearch them. I know a little about AP's because pychosis interests me & I am interestested in it's treatment. I know very little about AED's & Lithium other than what I have read here.
Here is my thinking: I suggest dropping Remeron as a test firstly because it's the easiest thing to do, altering the levels of the other three drugs is much more difficult. I suggest keeping Zyprexa because he said it treats his OCD just fine. The thing that Zyprexa & Remeron have in common is they are both H1 & 5-HT2A blockers & I think, but I'm not sure that taking both would be additive & be the cause of his excess sedation. Yes, I would say 16mg of clonazepam would be extreme. After waiting a couple of weeks to see if the removal of Remeron had the desired effect & no unforseen effects, I would then try an increase in Effexor while monitoring blood pressure, as Effexor can provide anxiety relief & may actually allow a lowering of the clonzaepam dosage.
Cheers,
Panda.
Posted by chemist on May 6, 2004, at 14:28:59
In reply to Re: thanks, Panda.... » chemist, posted by Sad Panda on May 6, 2004, at 14:11:43
> > Panda, thanks for stepping in....you have your act together with these meds....i assume you concur that 16 mg/day of klonopin is a bit high, yes? for my own edification, why the zyprexa over the remeron? and what do you think about the effexor, especially at such a high dose? all the best, and thanks! chemist
> >
> >
>
> Hi Chemist,
>
> Please don't over estimate my knowledge. :) I primarily know the most about AD's, because they are the drugs I am taking, so I reasearch them. I know a little about AP's because pychosis interests me & I am interestested in it's treatment. I know very little about AED's & Lithium other than what I have read here.
>
> Here is my thinking: I suggest dropping Remeron as a test firstly because it's the easiest thing to do, altering the levels of the other three drugs is much more difficult. I suggest keeping Zyprexa because he said it treats his OCD just fine. The thing that Zyprexa & Remeron have in common is they are both H1 & 5-HT2A blockers & I think, but I'm not sure that taking both would be additive & be the cause of his excess sedation. Yes, I would say 16mg of clonazepam would be extreme. After waiting a couple of weeks to see if the removal of Remeron had the desired effect & no unforseen effects, I would then try an increase in Effexor while monitoring blood pressure, as Effexor can provide anxiety relief & may actually allow a lowering of the clonzaepam dosage.
>
> Cheers,
> Panda.
>
>
thanks, Panda, for your rationale...i had assumed that the effexor would be problematic - it gets bashed quite heavily around here - but then again, there weren't any complaints from the poster, so i clearly overlooked a satisfied customer...fyi, i took remeron a few years back, and very briefly, as i found it to be sedating and increased my depression as a result...it seems to be a pretty common add-on, from what i'm reading on this board...after the back-and-forth over remeron, serotonin, etc. (which cleared up my misconceptions and, really, i don't want to get into shouting matches), do you think in the end that as monotherapy remeron is worth a darn as an antidepressant? all the best, and thanks for answering! chemist
Posted by Sad Panda on May 6, 2004, at 15:13:20
In reply to Re: thanks, Panda.... » Sad Panda, posted by chemist on May 6, 2004, at 14:28:59
> > > Panda, thanks for stepping in....you have your act together with these meds....i assume you concur that 16 mg/day of klonopin is a bit high, yes? for my own edification, why the zyprexa over the remeron? and what do you think about the effexor, especially at such a high dose? all the best, and thanks! chemist
> > >
> > >
> >
> > Hi Chemist,
> >
> > Please don't over estimate my knowledge. :) I primarily know the most about AD's, because they are the drugs I am taking, so I reasearch them. I know a little about AP's because pychosis interests me & I am interestested in it's treatment. I know very little about AED's & Lithium other than what I have read here.
> >
> > Here is my thinking: I suggest dropping Remeron as a test firstly because it's the easiest thing to do, altering the levels of the other three drugs is much more difficult. I suggest keeping Zyprexa because he said it treats his OCD just fine. The thing that Zyprexa & Remeron have in common is they are both H1 & 5-HT2A blockers & I think, but I'm not sure that taking both would be additive & be the cause of his excess sedation. Yes, I would say 16mg of clonazepam would be extreme. After waiting a couple of weeks to see if the removal of Remeron had the desired effect & no unforseen effects, I would then try an increase in Effexor while monitoring blood pressure, as Effexor can provide anxiety relief & may actually allow a lowering of the clonzaepam dosage.
> >
> > Cheers,
> > Panda.
> >
> >
> thanks, Panda, for your rationale...i had assumed that the effexor would be problematic - it gets bashed quite heavily around here - but then again, there weren't any complaints from the poster, so i clearly overlooked a satisfied customer...fyi, i took remeron a few years back, and very briefly, as i found it to be sedating and increased my depression as a result...it seems to be a pretty common add-on, from what i'm reading on this board...after the back-and-forth over remeron, serotonin, etc. (which cleared up my misconceptions and, really, i don't want to get into shouting matches), do you think in the end that as monotherapy remeron is worth a darn as an antidepressant? all the best, and thanks for answering! chemist
>
>Hi Chemist,
Remeron has been a great add-on for my Effexor, but as monotherapy I think it would rate about as usefull as Trazodone, Wellbutrin & Serzone, that is, it would be useless to most people, but a God send for the few people it does work for.
Hi dose Effexor I would use with caution as it is more pro-seizure than even the worst TCA Dothiepin, my personal experience with it was great until I got to 300mg, then it caused me to have bad cognitive problems. I still rate it as good, just wish I could have taken more of it.
Cheers,
Panda.
Posted by chemist on May 6, 2004, at 16:28:05
In reply to Re: thanks, Panda.... » chemist, posted by Sad Panda on May 6, 2004, at 15:13:20
> > > > Panda, thanks for stepping in....you have your act together with these meds....i assume you concur that 16 mg/day of klonopin is a bit high, yes? for my own edification, why the zyprexa over the remeron? and what do you think about the effexor, especially at such a high dose? all the best, and thanks! chemist
> > > >
> > > >
> > >
> > > Hi Chemist,
> > >
> > > Please don't over estimate my knowledge. :) I primarily know the most about AD's, because they are the drugs I am taking, so I reasearch them. I know a little about AP's because pychosis interests me & I am interestested in it's treatment. I know very little about AED's & Lithium other than what I have read here.
> > >
> > > Here is my thinking: I suggest dropping Remeron as a test firstly because it's the easiest thing to do, altering the levels of the other three drugs is much more difficult. I suggest keeping Zyprexa because he said it treats his OCD just fine. The thing that Zyprexa & Remeron have in common is they are both H1 & 5-HT2A blockers & I think, but I'm not sure that taking both would be additive & be the cause of his excess sedation. Yes, I would say 16mg of clonazepam would be extreme. After waiting a couple of weeks to see if the removal of Remeron had the desired effect & no unforseen effects, I would then try an increase in Effexor while monitoring blood pressure, as Effexor can provide anxiety relief & may actually allow a lowering of the clonzaepam dosage.
> > >
> > > Cheers,
> > > Panda.
> > >
> > >
> > thanks, Panda, for your rationale...i had assumed that the effexor would be problematic - it gets bashed quite heavily around here - but then again, there weren't any complaints from the poster, so i clearly overlooked a satisfied customer...fyi, i took remeron a few years back, and very briefly, as i found it to be sedating and increased my depression as a result...it seems to be a pretty common add-on, from what i'm reading on this board...after the back-and-forth over remeron, serotonin, etc. (which cleared up my misconceptions and, really, i don't want to get into shouting matches), do you think in the end that as monotherapy remeron is worth a darn as an antidepressant? all the best, and thanks for answering! chemist
> >
> >
>
> Hi Chemist,
>
> Remeron has been a great add-on for my Effexor, but as monotherapy I think it would rate about as usefull as Trazodone, Wellbutrin & Serzone, that is, it would be useless to most people, but a God send for the few people it does work for.
>
> Hi dose Effexor I would use with caution as it is more pro-seizure than even the worst TCA Dothiepin, my personal experience with it was great until I got to 300mg, then it caused me to have bad cognitive problems. I still rate it as good, just wish I could have taken more of it.
>
> Cheers,
> Panda.
>
thanks much, Panda....as an aside, have you been following the thread on effexor and ecstacy? have a look, this gal is about to start celexa after a long history of ecstacy use....i think your input would be of great value....all the best, chemist
Posted by temoigneur on May 8, 2004, at 14:37:20
In reply to Re: thanks, Panda.... » Sad Panda, posted by chemist on May 6, 2004, at 16:28:05
Thank you Panda and Chemist, I wrote a long response and it didn't make it to the board somehow. I was mainly wondering if I could take a stimulant with a mood stabilizer, and if that would spare me the horrible anxiety and depression Ritalin, then modafinil gave me
Thanks again.
Posted by temoigneur on May 8, 2004, at 14:59:38
In reply to Re: thanks, Panda...., posted by temoigneur on May 8, 2004, at 14:37:20
Sorry Chemist, I meant to thank you for your helpful imput, my computer's not agreeing with me these days. Thank you so much
> Thank you Panda and Chemist, I wrote a long response and it didn't make it to the board somehow. I was mainly wondering if I could take a stimulant with a mood stabilizer, and if that would spare me the horrible anxiety and depression Ritalin, then modafinil gave me
>
> Thanks again.
Posted by chemist on May 8, 2004, at 15:19:51
In reply to Re: thanks, Chemist and Panda » temoigneur, posted by temoigneur on May 8, 2004, at 14:59:38
no thanks required, only hope any suggestions are helpful.....all the best, chemist
> Sorry Chemist, I meant to thank you for your helpful imput, my computer's not agreeing with me these days. Thank you so much
>
> > Thank you Panda and Chemist, I wrote a long response and it didn't make it to the board somehow. I was mainly wondering if I could take a stimulant with a mood stabilizer, and if that would spare me the horrible anxiety and depression Ritalin, then modafinil gave me
> >
> > Thanks again.
>
>
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.