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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by CareBear04 on October 13, 2009, at 0:22:43
I went to a new pdoc looking for help with OCD-type issues and left with a script for Vyvanse. I got the feeling that he would have pushed it on me whether or not I expressed any need for it. I might have given the impression that some of my evening studying is not as productive as it could be since the Adderall XR wears off, but for the most part, I haven't been worried about my concentration. He had me take two tests, one an ADHD screening that I've taken countless times before and the second for OCD. I was actually surprised by how many of the items I checked under both obsessions and compulsions and I think he was too. When I handed it back, he just looked at it and said something to the extent of, "Wow, you do have a lot of things to deal with."
It's true--I've received many diagnoses, some formal and others more like observations, and I've stopped looking for names to describe what I experience. I'm most definitely bipolar, but everything else could be many things or parts of the same thing. I get panicky at times but usually just have chronic anxiety and, at this point, I'm so hooked on benzos that pdocs have resigned themselves to my being on them for life. Then there's the ADHD and OCD, and I wonder whether they're actually one complex problem. I know I just said that labels obscure more than they clarify, but can one person really have so many different disorders?
But more importantly I guess, I am hoping that people might have suggestions about how to mitigate the problem, whatever it might be called. My obsessiveness has gotten to the point that I'm unable to get anything done, to make decisions, or be very productive at all. Though countless doctors have tried countless meds to address most of the problems, but the one that has been consistently neglected is the obsessiveness. The one time I had relief was when I was put on Zoloft (for depression) and the difference was amazing. I felt like I could think clearly, make decisions, and for the first time, I was able to finish papers and exams with time to spare, turn them in, and move on. Then I was switched to Prozac for some reason (maybe because it's more activating?) and I've never had that clarity again. And the Prozac made me manic. Before Zoloft, I'd been on Lexapro and Paxil, and I've also been on Cymbalta. In part, maybe the obsessivenss hasn't received attention because I've moved around so much, moving from city to city and pdoc to pdoc. I asked my last pdoc to try, but instead of Zoloft, she insisted on Luvox since it seems to be the gold standard. But it, too, made me manic, and it also didn't seem to work. I went back on lithium, but I'm not supposed to take it long-term because I have some kidney problems and have gotten dialysis toxic several times. I didn't mention this to the pdoc today and purposely played down the mania. I gave the Luvox a try for maybe 6-8 weeks, but I had no relief, plus I was breaking out and seemed to be gaining weight. So I stopped taking it... and eventually, I stopped going to that pdoc.
I've been out of the new medication loop for awhile, so I don't know if there's anything new. But I suspect not since it doesn't seem like drug companies find it very profitable to invest in R&D for meds specifically for OCD. Why not? Maybe it's also true that pdocs tend to follow the meds, and since there haven't been new tools to get at OCD, they have little interest in trying. But for me right now, it's a very real and debilitating problem. Does anyone have any suggestions? Would really appreciate any insight or experiences.
Thanks!
CB
Posted by hyperfocus on October 13, 2009, at 0:44:47
In reply to obssessive/compulsive/perfectionistic--suggestions, posted by CareBear04 on October 13, 2009, at 0:22:43
My first bit of advice is that if your doctor refuses to prescribe something which helps you, find another one. You need to be upfront with your pdoc and say "This helped me before, I want to go on it again, what are your reasons for not prescribing it to me?" If he or she doesn't have reasons you consider valid, find another doc. You absolutely need a good pdoc who cares about YOU, on your side. If Zoloft worked for you then you need to be on it.
It's not uncommon to have multiple problems that share a common root - I'm the same way. I show symptoms of SP, dissociation, GAD, MDD, OCD. In psychotherapy you will have a chance to explore the root of your symptoms. But you still need meds to manage them.
For the obsessional problems you probably need a drug that is highly serotonergic, but it's a problem if the SSRIs make you manic. Anafranil is a TCA that's indicated for OCD. It's an older drug and has potentially more side-effects than the SSRIs but it's at least as effective as the SSRIs and possibly more. It's one of the most serotonergic drugs around. But it can also make you manic.
You could take Anafranil or also Prozac or another SSRI and try to manage the mania with Lamictal. You might wanna take Lamictal anyway if you're predisposed to mania.
P.S You are yet another person that had the treatment that was working for them stopped and replaced with something else, for no good reason. I wish one day somebody sues their doctor for doing this - it's so heartbreaking to hear.
I hope you get well.
Posted by Phillipa on October 13, 2009, at 10:43:17
In reply to Re: obssessive/compulsive/perfectionistic--suggest, posted by hyperfocus on October 13, 2009, at 0:44:47
I still don't get how anxiety and add fit together? I'd fear the stimulant would do something horrible to me. I'm also perfectionistic. Phillipa
Posted by CareBear04 on October 15, 2009, at 1:30:18
In reply to Re: obssessive/compulsive/perfectionistic--suggest, posted by hyperfocus on October 13, 2009, at 0:44:47
thanks, hyperfocus! i appreciate your advice and empathy. i've heard about anafranil, but i don't know too many people with experience on it. in general, the doctors i've seen have tended to stay away from tricyclics. for most all of them, newer is better--always. the doctor i saw the other day didn't refuse to address my obsessiveness; he just chose to address the attention (which i didn't raise as a major concern) first and said we'll deal with the other stuff next time. at least he does seem like he'll be willing to prescribe whatever i ask, especially since there are no brand new ocd drugs for him to push. any particular suggestions? of all my problems, the obsessiveness has been the most intractable, and while the others seem to be getting better, this is definitely getting worse.
thanks again for your response!
cb
Posted by manic666 on October 15, 2009, at 12:36:08
In reply to Re: obssessive/compulsive/perfectionistic--suggest » hyperfocus, posted by CareBear04 on October 15, 2009, at 1:30:18
you mentioned prozac, my illness has took many forms in my life 1 ocd, prozac curred my compultions maby if you had tried it before the zoloft, who can say what may have happened
Posted by yxibow on October 16, 2009, at 1:52:39
In reply to Re: obssessive/compulsive/perfectionistic--suggest » hyperfocus, posted by CareBear04 on October 15, 2009, at 1:30:18
> thanks, hyperfocus! i appreciate your advice and empathy. i've heard about anafranil, but i don't know too many people with experience on it. in general, the doctors i've seen have tended to stay away from tricyclics. for most all of them, newer is better--always. the doctor i saw the other day didn't refuse to address my obsessiveness; he just chose to address the attention (which i didn't raise as a major concern) first and said we'll deal with the other stuff next time. at least he does seem like he'll be willing to prescribe whatever i ask, especially since there are no brand new ocd drugs for him to push. any particular suggestions? of all my problems, the obsessiveness has been the most intractable, and while the others seem to be getting better, this is definitely getting worse.
> thanks again for your response!
> cb
What are the core issues / symptoms / obsessions / obstructions associated with your OCD?I currently take Anafranil for depression and OCD for a complex disorder.
I don't see any reason why not to try it -- yes, there are side effects. Some people have increased sweating... I may have a certain degree of it due to the Anafranil but it could also be due to other medications on board.
However, at one point -- and I still think for some people with OCD it is/was a "gold standard". It isn't a clean drug, I'll give you that, but it is probably among the tricyclics with the least NE.
I assume you've tried CBT and other forms of non-medication therapy for this particular part of your co-morbid disorders, if it is applicable ?-- tidings
Posted by pedr on October 19, 2009, at 8:53:54
In reply to Re: obssessive/compulsive/perfectionistic--suggest » CareBear04, posted by yxibow on October 16, 2009, at 1:52:39
the only med of 15 or so, excluding combos, that has touched my anxiety is Nardil. The dietary limitations are worth the relief by a factor of 1000.
Pete
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