45 replies to this topic

[Catwoman]

Thanks Jaiho, something to discuss with the new pdoc I will see next month. 

I wonder what my best chances are SSRI wise...

 

Note that Luvox (fluvoxamine) is not technically an antidepressant in the US, just everywhere else. Luvox is just one of two meds of which I’m aware that are officially approved only for OCD in the US. And why is it so good for OCD? It’s all about the sigma-1 receptor, and fluvoxamine likes sigma-1. Zoloft is another meds that is especially effective for anxiety disorders, and it is also sigma-1 agonists.

https://www.crazymed....php/Meds/Luvox

I've been on Luvox for 1,5 years and the second time it didn't work anymore. So I switched to Lexapro (and stayed on it for 6 years). Tried it again and it didn't work anymore.
So what are my chances with Luvox? I've been med-free for about a week and it's been 7 years since Luvox....

Don't like the SSRI or the SNRI route but I need to get going with my life again...

Edited by Catwoman, 30 August 2016 - 11:07 AM.

[jaiho]

Did you ever try Zoloft?

Zoloft + Nortriptyline is one of the more common combinations, mostly because Zoloft has minimal interaction with Nortriptyline (unlike the other SSRIs)

 

I know personally, that Prozac only worked the first time i used it, then never worked again. Then it fired up with effiency i never experienced the first time adding Nortriptyline.

Same with Zoloft, it was basically a sugar pill by itself, as well as Nortriptyline by itself doesn't have much effect.

There is some really strong synergy with an NRI / 5ht2a antagonism when combined with an SSRI.

[Catwoman]

Never tried Zoloft / sertraline no. I was going to ask for this one after my initial setback a few months ago.
But my general doctor advised me to taper the Lexapro / escitalopram. He listened to my story and thought I should give mindfulness and CBT another try.
I ask my self more than once....why did I listen to him?   

I consulted a psychiatrist two months ago who specializes in OCD and he advised me fluoxetine, without the taper of escitalopram.

I also never needed augmentation with Luvox or Lexapro. They just worked very good on their own. Which made me very HAPPY   

But maybe I'll ask about memantine or try NAC first. I mean, I could manage the side effects from the SSRI's but withdrawing from them is such a p**n in the b***
 

Edited by Catwoman, 30 August 2016 - 03:46 PM.

[Quaker32]

What are your withdrawals like? What happens? 

[Catwoman]

What are your withdrawals like? What happens? 

When I dropped from 15 mg to 10 mg in one week: extremely emotional, mood swings, more depressed, crying spells, waking up with a racing heartbeat (cortisol spiking?), regular muscle twitches in arms or legs, suicidal thoughts

Dropped from 10 mg to 5 mg after a week and the same happened, maybe less severe
Edit: o and I forgot   to mention...my memory was so foggy....

Stayed on the 5mg for 6 weeks and only WD that remained were the  twitches and the light head agues. Pure O only improved during my vacation.

After 6 weeks dropped to 2,5 mg: tinnitus (quite mild), racing heartbeat just before waking up, some dizziness in the beginning and my stomach got upset faster than usual. Some muscles twitching still.

Stayed on 2,5 mg for four weeks and then stopped: mood goes up and down, Pure O still hanging around in my head almost all the time, depression, concentration problems, lack of motivation, waking up around 6 am every day with a racing heart beat, ruminating more than usual, the occasional l muscle twitch.

It's more mental than physical in my case. I still run a few miles every other day, because my body is in good shape (I also do a few yoga sessions every week). I take care of myself, watch my diet (whole grains, fish, meat, veggies and fruit every day, some sugar but not much, drink one or two cups of mild coffee, herbal teas,  don't do drugs and I'm not overweight so what more can I do?  ) The only thing I really don't do anymore is mindfulness meditation.
I take some supplements as well, but I'm not noticing much difference on the Pure O part. I've read somewhere that I shouldn't take the magnesium I recently bought. The article said that every magnesium tab which has the word 'chelate' on the bottle can make depression worse (mine says 'magnesium bysglycinate from chelate on the lable). On survivingantidepressants.org they say B-vitamins can be too stimulating when in withdrawal, so I stopped the magnesium and the B-vits as a test and now just take some omega 3 fish oils, zinc and vitamine D and I will start with some extra vit C tomorrow. 

 

Edited by Catwoman, 31 August 2016 - 04:10 PM.

[Catwoman]

Waking up got so much better the last few days...I don't wake up at 6 am anymore with a racing heartbeat...I can sleep till 7.30 quite peacefully, snoozing a bit...I feel well rested and less depressed. Pure O is always worse in the morning though.

And I fall asleep within a few minutes, I've always been a good sleeper, even without the meds. So that's not new....so I'm wondering, isn't insomnia or restless sleep or waking up way too early a symptom of low serotonin?

 

Edited by Catwoman, 02 September 2016 - 02:07 PM.

[Catwoman]

Short update on this topic:

I want to try the NAC 1200 mg sustained version. NAC does seem to work for intrusive thoughts though its not as 'aggressive' as an SSRI (of course). But there aren't any side effects either. Its not bad but I think I could do better with (other) supplements / nootropics.

As for meds...Im interested in memantine in particular and vortioxetine as well as agomelatine and I want to ask my doctor about these. Still anxious about reaching the tolerance stadium though...Also, what worries me: Everyone says the SSRI's are the way too go with Pure O and obsessive vicious circle thinking but I am looking for something which can by cycled or does make sustainable positive changes...maybe this doesnt exist yet...

Edited by Catwoman, 11 December 2016 - 09:23 PM.

[Catwoman]

Ive been on NAC sustained 1200 to 2400 mg a day for about two weeks but I dont feel much effect from it. The tabs taste awfull, even when I drink them down with a lot of water.

Anyway, starting sertraline 25 mg tomorrow, will up it after a week to 50 and stay there for a few weeks to see if it does anything. Extremely anxious that it won't work. My new pdoc was optimistic though. He said I also have the option to add quetiapine or take quetiapine as needed (???) cause it can get a thought unstuck again. Which is the exact thing I need!!!!
Potential side effects scare me. I think I should ask for abilify instead of seroquel?
He advised me to try clomipramine if sertraline fails but who is able to tolerate its side effects?? Maybe nortryptiline then...

He told me there are lots of other more exotic options to try but for now I must start with first line treatment and he doesnt want me to plan a head too much.
He even advised me not to pursue any other therapies because I am too educated about my anxiety mechanisms and obsessive patterns. I need to let go a lot more instead of concentrating on finding solutions with therapy.

Great stuff...

[JR7]

That last piece of advice he gave rang true to me, specifically with sensorimotor OCD. I noticed a drastic quality of life improvement when I focused less on a cure and more pursing life enriching activities. At first, it was a "fake it 'till you make it" time period. I was still very much aware of my fixated thought but I pressed on with life's events. I now have much longer stretches of time frames where Im focusing on things other than my sensorimotor OCD. 

Id suggest finding a protocol, integrate it into your life, then move forward with things in life not involving the OCD. Sometimes researching a "cure" for pure-O can become a mental illness in itself, especially the temporary relief from symptoms we feel whilst searching for the "cure". 

[Quaker32]

I've heard clomipramine being very effective for OCD but at a high dose. Side effects were non existent according to one person. 

[Catwoman]

I've heard clomipramine being very effective for OCD but at a high dose. Side effects were non existent according to one person. 

Well according to much other anecdotal reports I've read this medication is giving people much more side effects than the SSRI class.
It's a TCA, which means less selective. There's a bigger chance you'll gain weight or feel sedated. Escitalopram en fluvoxamine worked great for me in the past. Hopefully sertraline will do the trick as well. 

@JR7, yes, I think this is the best way to go right now. In the past there were times when I was fed up with therapy. I was in my head so much...I felt better when I wasn't doing stuff concerning my OCD. Books about mindfulness make me more agitated actually, because I feel like it's not working for me. So after such a conclusion you keep on searching, but you'll never find something that works because you want control over it. At the same time you know you can't can control it and it will only become worse if you keep fighting it.
That's my vicious circle...

I took 25 mg of sertraline just two hours ago. Feeling the same as yesterday, no weird stuff going on ;-)

[Quaker32]

Out of interest, what were these more "exotic" options?

[Catwoman]

Out of interest, what were these more "exotic" options?

Well he didn't want to talk about glumate agents just yet. I asked him about memantine, but he actually cut me off. It wasn't meant to be rude, but he said he want to try the more standard medications first because so much research has been done on them. He said he expected that memantine would become available here as well (as an ocd-treatment option) but he didn't want to look too far ahead either. 

He didn't mention medication like bupropion, MAOI's or even newer antidepressants like vilazodone (Viibryd) or vortioxetine (Brintellix). I assume he thinks that they are too new and MAOI's aren't commonly used to help with intrusive thoughts. 

It was kinda reassuring that he said we would go on till we find something that works.
In theory sertraline should work as well as the other two ssri's...hopefully I won't see this pdoc anytime soon ;-)
 

[Catwoman]

Did you ever try Zoloft?

Zoloft + Nortriptyline is one of the more common combinations, mostly because Zoloft has minimal interaction with Nortriptyline (unlike the other SSRIs)

 

I know personally, that Prozac only worked the first time i used it, then never worked again. Then it fired up with effiency i never experienced the first time adding Nortriptyline.

Same with Zoloft, it was basically a sugar pill by itself, as well as Nortriptyline by itself doesn't have much effect.

There is some really strong synergy with an NRI / 5ht2a antagonism when combined with an SSRI.

I'm on sertraline now, day 9. I started out with 25 mg and increased to 50 last Monday. My new pdoc didn't tell me if I should go to 100 mg. I've read that 50 mg is hardly a therapeutic dose and is equivalent to 5 or 10 mg of escitalopram.
I've been on 15 and 20 mg of escitalopram, dosages that really helped with getting rid of the intrusive thoughts.

Side effects...hart palpitations (though I had these before). Slight stomach upset the first day but that's about it. It does make me more anxious with more obsessive thoughts....mehhh.
No positive effects just yet...could still happen (but very very very anxious it won't).

The pdoc didn't mention nortriptyline, but wants to switch me to clomipramine if the sertraline trial doesn't work out. Curious to what he thinks about it; your experience sounds good!


This one also suggested quetiapine and that I could take it 'as needed' (never heard of it????) but he said so.
It should be really good at 'getting thoughts unstuck', is what he said. Just what I need right!!

Any (new) thoughts on the atypicals?
Aripiprazole seems an alternative?


 

[Quaker32]

how dose taking it ""as needed" work? i thought that you experience these intrusive thoughts almost constantly, but i could be wrong?

[Catwoman]

how dose taking it ""as needed" work? i thought that you experience these intrusive thoughts almost constantly, but i could be wrong?

Uhm, that's what I want to figure out myself.

These thoughts are there almost all the time, but when I'm distracted or I need to concentrate on something they aren't as persistent. When I was on my holiday with lots of sunshine and long walks they weren't there much and I felt incredibly relieved. When I don't get stressed or anxious it doesn't come back that often. So my own emotions are a big influence.

How Seroquel could help I don't really know. The pdoc said it is able to 'loosen up' thoughts that got stuck, so I'm thinking once it gets unstuck I would be able to move past it (feel relief). I assume it works longer than a few hours!