Posted by desolationrower on December 18, 2008, at 13:51:29
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 18, 2008, at 1:21:53
> > I like to go to my appointments with a bulleted outline of what I want to talk about, although I don't have the motivation very often to make one. This time I had so much I wanted to talk about that I felt it was definitely necessary to organize my thoughts and give us any chance of getting through it all. Also, if I make one it helps me worry less that I will forget to mention something important. I am not shy about bringing things up with my doctor. I figure it won't hurt if he does know. I think he knows that I am bringing it up in order to explain my reasoning and not challenging his authority or expertise as a doctor. I am glad I have a doctor that I can do that with. It is important that I feel like we are collaborating... a meeting of the minds if you will. A few times I have told him stuff he didn't know about. After reading my paper he got out his drug book and said he wanted to "look up some things". I don't know whether to be happy or concerned about that.... He looked up stuff for quite a bit.
heh, your writing seems organised. i guess i'm not surprised.
> > Namenda, right? So do you have OCD too? What are you taking it for?
Well, my box is actually 'adementa'. I like some of these foriegn drug brand names, they're quite descriptive. HAve dementia? Take Adamenta! Or 'eldepryl.'
I don't have OCD, although when i was a kid i think i had such tendencies...i wouldn't be able to stop shooting basketball until i had some unimportant percentage, and so i'd stay outside for hours trying...also had weird obsession with imagining touching every telephone pole while riding in a car...things like that, but somehow i was able to realize this and now i have no problem cutting off these thoughts...when one is young the brain is quite flexible, it is amazing
I take the memantine as add-on to the parnate i take, to reduce tolerance to stimulant effects, to increase antidepressant effects, generally to help with inattentiveness and lack of activation...
> > I told him I was taking NAC now. It didn't seem like he had heard of it. He asked me what supplements I took. I told him fish oil and my multi-vitamin. He suggested that I try inositol. I was pleased that he brought that up himself. He said he had always wanted to suggest it, but the opportunity hadn't presented itself. I ordered some of it and will get it in a few days. Should I split it up in two doses?I'm not sure of its half-life so that would probably be a good idea. Also, be careful starting at the full dose, some people have gastro-intestinal perturbations if taking a full dose right away, although this goes away with time (i never experienced any problems). Dose splittnig would help this. It is like sugar so you can take it in your tea if that is your, uh, 'cup of tea' (i prefer a drop of milk...) or in with some lemon juice as lemonade or something like that. takes a bit to dissolve all of it.
> You said nortriptyline was shown to help an SSRI work faster for OCD. Can you send me links to the studies? I wanted to send them to my doctor.
Here is a article with numerous cites for some of the other treatments, like NAC. It appears fairly comprehensive. http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=645
For nort,
J Clin Pharm Ther. 1998 Apr;23(2):155-9.Click here to read Links
Combination of clomipramine and nortriptyline in the treatment of obsessive-compulsive disorder: a double-blind, placebo-controlled trial.
Noorbala AA, Hosseini SH, Mohammadi MR, Akhondzadeh S.Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Iran.
OBJECTIVE: There is growing interest in investigating noradrenergic functions in obsessive-compulsive disorder (OCD) because some antidepressants with strong effects on serotonin reuptake blockade fail to relieve obsessive-compulsive symptoms. We undertook a trial to investigate whether the combination of clomipramine with nortriptyline was more effective than clomipramine alone. METHOD: Thirty patients who met the DSM-IV criteria for OCD completed the study. Patients were allocated in a random fashion, 15 each to clomipramine 150 mg/ day plus nortriptyline 50 mg/day and clomipramine 150 mg/day plus placebo. RESULTS: Although both protocols significantly decreased the scores of the Yale-Brown obsessive-compulsive scale over the trial period, the combination of clomipramine and nortriptyline showed a significant superiority over clomipramine alone in the treatment of OCD. CONCLUSION: As this study indicates, a rapid onset of action is one of the advantages of this combination. This study supports further investigation of the noradrenergic-serotonergic hypothesis in OCD.
Not exactly your situation, but similar->
J Affect Disord. 2002 Feb;68(1):59-65.Click here to read Links
Does SSRI augmentation with antidepressants that influence noradrenergic function resolve depression in obsessive-compulsive disorder?
Mancini C, Van Ameringen M, Farvolden P.Anxiety Disorders Clinic, McMaster University Medical Centre, Hamilton Health Sciences Corporation, McMaster Site, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5. mancini@fhs.mcmaster.ca
BACKGROUND: Obsessive compulsive disorder (OCD) often coexists with major depressive disorder (MDD). Serotonergic antidepressant medications have emerged as the treatment of choice for both OCD and MDD. In the usual course of events, both the patient's OCD and depressive symptoms improve in parallel following initiation of serotonin reuptake inhibitor (SRI) treatment for OCD. However, such is not always the case. We report here on a series of ten patients whose OCD but not depression improved following a trial of SRI therapy. METHOD: Ten patients with OCD and comorbid MDD who experienced a worsening or exacerbation of depressive symptoms while being maintained on an adequate dose of SRI therapy were treated using a combination of SRIs and agents with effects on noradrenergic reuptake. Response to treatment was based on clinician-ratings of severity and improvement of OCD and MDD (CGI-S and CGI-I). RESULTS: Following augmentation, nine of the ten patients had a significant improvement/resolution of their MDD, with little further change in the severity of their OCD. LIMITATIONS: Inferences from the results of this study are limited by the lack of a control group, the small sample size, and the use of nonstandardized ratings as measures of symptom severity. CONCLUSIONS: These results are of practical significance to clinicians insofar as they suggest a possible guideline to clinicians treating depression in OCD with SSRIs without success.
PMID: 11869783 [PubMed - indexed for MEDLINE]
uh, so another study from Iran->
http://journals.tums.ac.ir/upload_files/pdf/3511.pdf
Combination of Citalopram and Nortriptyline in the Treatment
of Obsessive-Compulsive Disorder: A Double Blind,
Placebo-Controlled Trial
Abbas Ali Nasehi, MD
1
Marzieh Tavakoli, MD
2
Firoozeh Raisi, MD
2,3
1 Iran Helal Institute of Applied Science &
Technology
2 Psychiatry and Psychology Research Center,
Roozbeh Hospital, Tehran University of Medical
Sciences, Tehran, Iran
3 Department of Psychiatry, Roozbeh Hospital,
Tehran University of Medical Sciences, Tehran,
Iran
Corresponding author:
Firoozeh Raisi,
Assistant Professor of Psychiatry,
Psychiatry and Psychology Research Center,
Roozbeh Hospital, Tehran University of Medical
Sciences, South Kargar Avenue,
13337,Tehran, Iran
Email:raisi_f@yahoo.com
Tel: +98-21-55412222
Fax: +98-21-55419113
Objective: The fact that some antidepressants with strong effects on
serotonin reuptake blockade fail to relieve obsessive-compulsive
symptoms has caused growing interest in investigating noradrenergic
function in obsessive-compulsive disorder (OCD) . In light of the
above, we undertook a trial to investigate whether the combination of
citalopram with nortriptyline is more effective in treating obsessive-
compulsive symptoms than citalopram alone.
Method: 40 patients who met the DSM-IV criteria for OCD were
included in the study. Patients were allocated in a random fashion: 20
patients to citalopram 40mg /day plus nortriptyline 50mg /day, and 20
patients to citalopram 40mg /day plus placebo.
Results: Both protocols significantly decreased the scores of the
Yale-Brown Obsessive Compulsive Scale (Y-BOCS) over the trial
period, but the combination of citalopram and nortriptyline showed a
significant superiority over citalopram alone in the treatment of OCD.
Conclusion: As this study indicates, nortriptyline improves the
efficacy of citalopram. In addition, a rapid onset of action is one of the
advantages of this combination. This study supports further
investigation of the noradrenergic serotonergic hypothesis in OCD.
Iran J Psychiatry 2006; 1: 54- 58Another NRI which improves sri response->
World J Biol Psychiatry. 2005;6(1):57-9.Links
Citalopram plus reboxetine in treatment-resistant obsessive-compulsive disorder.
Fontenelle LF, Mendlowicz MV, Miguel EC, Versiani M.Anxiety and Depression Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. leofontenelle@hotmail.com
While serotonin reuptake inhibitors (SRIs) are the first-line treatment of obsessive compulsive disorder (OCD), as many as 40-60% of patients fail to respond to adequate trials with these drugs. In this study, we describe the case of a patient with an SRI-resistant OCD who was successfully treated with a combination of citalopram (a selective SRI) and reboxetine (a selective noradrenaline reuptake inhibitor (SNRI)). This report suggests that future studies accessing the efficacy of the SRI SNRI combination in treatment resistant OCD are needed.
here is a negative result showing desipramine didn't help->
Addition of desipramine to serotonin reuptake inhibitors in treatment- resistant obsessive-compulsive disorderLC Barr, WK Goodman, A Anand, CJ McDougle and LH Price
Clinical Neuroscience Research Unit, Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, USA.OBJECTIVE: The purpose of this study was to determine whether combined treatment with a selective serotonin reuptake inhibitor (SSRI) and a norepinephrine reuptake inhibitor, desipramine, effectively reduces obsessive-compulsive symptoms in patients who do not respond to SSRIs. METHOD: In a double-blind study, desipramine or placebo was added for 6 or 10 weeks to the treatment of 30 patients with obsessive-compulsive disorder whose symptoms were refractory to SSRI treatment (fluvoxamine, fluoxetine, or sertraline) alone. RESULTS: There were no significant differences between the adjunctive desipramine and placebo groups in obsessive-compulsive or depressive symptoms. CONCLUSIONS: These data suggest that clomipramine's possibly superior efficacy in the treatment of obsessive-compulsive symptoms may not stem from its capacity to inhibit reuptake of norepinephrine
Also i think it might be relevant that clomipramine has a metabolite with NRi properites so while not quite the same it does have some NRI affect, and it is considered the gold standard (although high side effecty). There seems to be a disjunct in that people either respond to desipramine or to nortryptaline, i wonder if that is why desip didn't help in that last study.
i was going to babblemail you but it seems you've got it turned off
-d/r
poster:desolationrower
thread:868434
URL: http://www.dr-bob.org/babble/20081214/msgs/869455.html