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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by greywolf on April 6, 2004, at 13:33:41
I have OCD,a little heavier on the compulsion side than anything else. It is a long-standing problem that I treated for 5 years ago for about a year, then gave up because the meds didn't seem to help.
Because I recently concluded that also trying to handle being bipolar on my own wasn't turning out to be the smartest idea I've ever had, I went back for treatment several weeks ago. Since then, we've been through a few SSRIs that were too "side effecty", then settled on Wellbutrin SR to at least address the severe depressive episodes. That increased my agitation and the intensity of a later manic period, so we added Xanax. Right now I'm on 200 mg Wellbutrin and up to 3x.5g Xanax each day. Next week I will increase the Wellbutrin to 300 mg/day. I have not seen any therapeutic benefit to the Wellbutrin, but I don't want to jump the gun so I am going to give it a full chance to work given that it doesn't have the SEs (sedation and sexual) associated with the SSRIs, and to avoid the lithium I used to take.
My concern is that during this whole time, the OCD is going essentially untreated. The Xanax may have a minimal effect on the physical twitches that interfere with my day, but it seems to achieve that primarily through dulling my senses. It does decrease anxiety, but that doesn't alleviate the obsessions/compulsions much (e.g., counting, intrusive thoughts, ritualistic behavior [like having to do everything the same way each morning or having to say a prayer the exact same way every time--and starting over when I don't--never doing things in 3s (like taking 3 napkins or using 3 dollops of shampoo) for fear that something bad will happen, constantly flipping a light switch so I don't perform the act on a negative intrusive thought, checking due dates over and over to make sure I got them right, even after I've completed the project, constantly turning back to the previous page to read the last word even though I know exactly what it is--I could go on and on, but you get the drift). Some of this is pretty funny stuff when you step back and look at the ridiculousness of it, but it's not so much fun when you're in the middle of it and can't control it.
So, right now I'm part way through an apparently ineffectual course of Wellbutrin for depression, and the OCD is stronger than ever. I don't want to combine an SSRI to cover the OCD because I can't function on the dosage of SSRI necessary to give any benefit (you name it, I've tried it: Serzone, Paxil, Prozac, Zoloft, Lexapro, Luvox). But I need to try something. Any suggestions?
Posted by snapper on April 7, 2004, at 23:47:01
In reply to Any recommendations on OCD treatments?, posted by greywolf on April 6, 2004, at 13:33:41
Greywolf, it seems like you and I and many others are in this very difficult to treat type of cluster of mental symptoms. Just a thought though, do you think that there might be a possibility that the Wellbutrin may be heightening your OCD symptoms? I say this because W. is mainly a Dopaminergic and Norep. Drug, and I make this assumption because when I was on adderall, ( which is very dopaminergic) I was obsessive as I ever remember being! Although I had to come off of adderall - I would still take it again because it is an amphetamine and while tolerance grows with these type meds they make you feel great!! Like the post on OCD and what chemicals are involved of a few days back.... There is a very bizzare relationship between Serotonin and Dopamine-I just can't help but think that there isn't a pdoc smart enough to figure this out!! I know I probably did'nt answer your question very well But I do think that the Wellbutrin might be making your OCD worse.
just my thoughts
snapper
Posted by greywolf on April 8, 2004, at 6:25:46
In reply to Re: Any recommendations on OCD treatments?, posted by snapper on April 7, 2004, at 23:47:01
Snapper:
Thanks for your thoughts. I think it's pretty clear that the Wellbutrin has exacerbated the OCD, and that's pretty much the heart of my dilemma. Wellbutrin's the only AD I've been able to tolerate because it does not have a sedating effect that interferes with my work (I write all day) or sexual SEs that interfere with my personal life. Unfortunately, I've yet to see any therapeutic effect at all, and the cost is having to use Xanax to offset the Wellbutrin, which I really don't like to do (kind of defeats the purpose if I want to stay awake).
Thus, I'm looking for some suggestions. Are you aware of any OCD specific med (not an SSRI) that can be added in with the Wellbutrin without causing the SEs I just mentioned? I don't want to give up on the Wellbutrin just yet, and giving it a full shot would be easier if a med that helps the OCD could be added in. As I'm sure you might understand, I really want to find a fix for these problems, but I also need to be productive while I'm doing it.
Thanks.
Posted by btnd on April 8, 2004, at 21:02:02
In reply to Any recommendations on OCD treatments?, posted by greywolf on April 6, 2004, at 13:33:41
IMHO good OCD treatments are: Codeine (watch out for addiction), Amisulpride, Sulpride, Ultram, Klonopin.
This is the end of the thread.
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