Posted by yxibow on June 19, 2008, at 5:06:18
In reply to Re: For OCD sufferers what meds have helped you. » blueboy, posted by BRC on June 17, 2008, at 18:37:35
> I think you are right I have tried everything (or at least I like to think :) the docs had to offer in the way of medication.
>
> I even have tried all the nutritional and supplements, but no luck.
>
> I think the about the only way to get a moderate to severe case of OCD under control is with the right meds and a lot of CBT therapy. But who has the time for all of that?Its true -- its hard to find time in life to do all the things that you need in a day, or weekly chores. But there is no one single pill that will eliminate OCD.
It is, for almost all people, a "hardwired" biochemical circuitry, you could say. That is why devoting some time, and I know it is hard to find it, to CBT.
It has been shown since the early 90s, that yes, that double blind PET studies with controls, taking an SSRI is as good as CBT.But there comes with an additional note -- taking an SSRI or other medication for OCD and doing some sort of CBT, even a small amount, is even better.
And finally, and I'm not saying this is your case, around 99% of OCD cases are within the OC Spectrum. But some fraction of cases come close to having a psychosis element to it -- that word is so charged for some people that I hesitate to use it -- because it isn't what one normally thinks of "psychotic".
> My retiring p-doc who is suppossed to be the best in the area I live in (they even named a hospital after him) told me point blank that you can expect to see about a 70% reduction in OCD with meds and that is if your doing good.
There is no guarantee of how much reduction in OCD -- it is subjective. Even the Y-BOCS, which is scored objectively (number amounts or yes/no for each question), is subjective from the patient (how intrusive is intrusive will naturally vary). Some wiggle room for this is built into tests, of course.And yes "if you're doing good...." As noted before, OCD is a lifelong (I don't mean a life sentence -- that is what is so important about trying CBT because it teaches tools and tricks to focus, move forward, and letting go, among other things) condition.
I would say for uncomplicated cases, and that's completely subjective as well, maybe 70%, maybe only 30%... but you can't expect to just take, e.g. Paxil and not have OCD. It just doesn't work that way. The "noise level" may go down.
Also often while SSRIs are being used initially, benzodiazepines (often Klonopin) are used short term if there is an anxiety adjustment side effect that needs to be worked out.
As for a previous posting of Atypical Antipsychotics (Neuroleptics) + SSRIs, yes -- these are used for management of difficult (or true OCD with psychotic features --- as noted, this is somewhat to considerably less than 1% of OCD cases) cases of OCD.
Typically a low dose (maybe 100mg of Seroquel, say) -- and just from my opinion, if you are hesitant about atypical APs -- I do take one for off label reasons as this, the risks of TD is about 5% per year for atypicals up to an unknown point, Seroquel probably being the lowest at around a general risk of 0.1%.
Risperdal has had the only generally known amount of cases at the moment. So if that generally evidence-based view in psychiatry gives any help to you (and I guess I am never really completely reassured myself -- how can one be -- maybe some years from now, but this is what we have in 2008), then one would probably want to stay at the low potency end.
This being {Zyprexa, Seroquel}, which also unfortunately besides fatigue and the weight gain issues [which can vary between the two for anyone] have fewer EPS (extra pyramidal symptoms) or a clinical term for side effects due primarily to APs than more potent APs.
So in conclusion, yes APs + SSRIs are one option.
I don't know what field of business you are in or how much time you have in the day -- that is your privacy and irrelevant to the conversation, but I would conclude finally, that if you can find some "sick days" or use vacation time or however you can get away from what you are doing, CBT can really improve suffering.But only take CBT from reliable sources, such as suggestions from below:
For more information, the OC Foundation, which has been around for more than 20 years, is an extremely reliable primary source for more information on OCD treatments, groups, and other subjects.
It can be found at
poster:yxibow
thread:834957
URL: http://www.dr-bob.org/babble/20080617/msgs/835410.html