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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Greywolf on April 18, 2005, at 12:42:56
I posted here quite often last year while I was struggling to find a pharmo solution for severe depression. I'm bipolar, complicated by a rather intractable OCD problem of many years.
I've got a great doc who's very open-minded and willing to try anything reasonable. Over the last decade and longer, I've tried every SSRI/SNRI/NDRI, etc., etc., etc., out there. They generally have not been very effective even at higher doses, and most of you can appreciate the various SEs.
Last year, I started on Nardil. It was great in terms of low SEs, the dietary restrictions were no big deal, and the efficacy at 60mg/day was decent. I still have all the BP symptomology--severe episodes of depression, occasional euphoric states lasting hours to days--but the intensity is toned down appreciably.
So, things are livable with the BP, though not a life that'll knock your socks off. Unfortunately, the OCD has come to the fore very strongly over the months I have been taking Nardil, and it's become a real daily hindrance. Obsessional thoughts abound, repeated compulsive acts (often related to making myself re-do things because the completed (and perfectly fine) act was accompanied by some type of negative thought) occur throughout the day. Frankly, it's exhausting.
I recently consulted with my doctor about the OCD in particular. He has suggested dropping the Nardil (can't take both together) and starting up with Anafranil (clomipramine). It will likely have the some of the SEs I've experienced with anti-depressants (and probably a diminished effectiveness re: depression), but it will focus on the OCD aspect that is seriously interfering with my life.
Which brings me to my questions:
1. Does anyone know of an OCD med that can be safely used in conjunction with Nardil?
2. What has been your experience on Anafranil? (I had one course of it years ago, but in combination with lithium and an AD I can't remember--which didn't work out too well).
Thanks for your thoughts.
Greywolf
Posted by ixus on April 18, 2005, at 15:49:23
In reply to Switching from Nardil to Anafranil, posted by Greywolf on April 18, 2005, at 12:42:56
> I posted here quite often last year while I was struggling to find a pharmo solution for severe depression. I'm bipolar, complicated by a rather intractable OCD problem of many years.
>
> I've got a great doc who's very open-minded and willing to try anything reasonable. Over the last decade and longer, I've tried every SSRI/SNRI/NDRI, etc., etc., etc., out there. They generally have not been very effective even at higher doses, and most of you can appreciate the various SEs.
>
> Last year, I started on Nardil. It was great in terms of low SEs, the dietary restrictions were no big deal, and the efficacy at 60mg/day was decent. I still have all the BP symptomology--severe episodes of depression, occasional euphoric states lasting hours to days--but the intensity is toned down appreciably.
>
> So, things are livable with the BP, though not a life that'll knock your socks off. Unfortunately, the OCD has come to the fore very strongly over the months I have been taking Nardil, and it's become a real daily hindrance. Obsessional thoughts abound, repeated compulsive acts (often related to making myself re-do things because the completed (and perfectly fine) act was accompanied by some type of negative thought) occur throughout the day. Frankly, it's exhausting.
>
> I recently consulted with my doctor about the OCD in particular. He has suggested dropping the Nardil (can't take both together) and starting up with Anafranil (clomipramine). It will likely have the some of the SEs I've experienced with anti-depressants (and probably a diminished effectiveness re: depression), but it will focus on the OCD aspect that is seriously interfering with my life.
>
> Which brings me to my questions:
>
> 1. Does anyone know of an OCD med that can be safely used in conjunction with Nardil?
>
> 2. What has been your experience on Anafranil? (I had one course of it years ago, but in combination with lithium and an AD I can't remember--which didn't work out too well).
>
> Thanks for your thoughts.
>
> GreywolfHi Greywolf,
I have read somewhere that AD + low dose of AP +/-benzo works nice for BPD. Maybe you should consider higher Nardil dose ( >= 1mg/kg ). Low dose of olanzapine or risperidone may be helpful as AP.
I have positive outcome of clomipramine usage in MD, however it did nothing for OCD, I had terrible GAD on it.
/ixus
Posted by Phillipa on April 18, 2005, at 18:22:48
In reply to Re: Switching from Nardil to Anafranil » Greywolf, posted by ixus on April 18, 2005, at 15:49:23
The only other med I know of for OCD is luvox.Fondly, Phillipa
Posted by Greywolf on April 18, 2005, at 20:23:41
In reply to Re: Switching from Nardil to Anafranil, posted by Phillipa on April 18, 2005, at 18:22:48
> The only other med I know of for OCD is luvox.Fondly, Phillipa
Thanks, ixus and Phillipa.I probably won't go with a higher dose of Nardil since it won't really work on the OCD, which has gotten progressively worse. It's disappointing because I really took the Nardil up slowly over a long period of time. But I'm spending too much of my day on the OCD quirks, so that aspect's become the main issue.
I've had Luvox before and it wasn't helpful. So, I'll try Anafranil. It kind of stinks, because taking the Nardil up a few notches would probably have really helped with the depression, but I'd also like to get out of the house in the morning in under 2 hours for a change.
Thanks for the advice though.
Posted by ace on April 18, 2005, at 21:42:56
In reply to Switching from Nardil to Anafranil, posted by Greywolf on April 18, 2005, at 12:42:56
Obsessional thoughts abound, repeated compulsive acts (often related to making myself re-do things because the completed (and perfectly fine) act was accompanied by some type of negative thought) occur throughout the day. Frankly, it's exhausting.
I can relate totally to those obsessive thoughts!!!! When the "Bad" thought comes in to play while doing something, you must start the process over again, until no "Bad" thoughts interrupt...i have this a lot! It is a pain big time!
>
> I recently consulted with my doctor about the OCD in particular. He has suggested dropping the Nardil (can't take both together) and starting up with Anafranil (clomipramine). It will likely have the some of the SEs I've experienced with anti-depressants (and probably a diminished effectiveness re: depression), but it will focus on the OCD aspect that is seriously interfering with my life.After all the meds you tried, I wouldn't even bother with Anafranil....I would absolutely got to a low dose of an atypical antipsychotic. Don't be scared of them -- I have had them for years and there is no prob. Just have a low dose. See, the drugs you have tried, essentially a lot of them act in many ways similar to Anafranil. The may be less potent on a particular neurotransmitter, but withAnafranil, you are getting SERIOUS serotonin blockage of re-uptake and Noradrenaline. Now, all the SSRIs have covered serotonin, and the SNRI's have covered Noradrenalin. Even Nardil affects both Serotonin and Noradrenalin, not to the same extent as Anafranil but.
I'd give it a go, but don't expect a miracle. I'd hope you would, but it seems unlikely. I think your better off pushing Nardil to 90mg and adding a small dose of Zyprexa, seroquel or risperidone -- to be taken daily.
>
> Which brings me to my questions:
>
> 1. Does anyone know of an OCD med that can be safely used in conjunction with Nardil?Sure. I have tried many that are supposedly not safe either. Remeron (no effect on OCD), Lithium (no effect on OCD), Reboxetine (no effect on OCD), Lamictal (no effect on OCD), Tramadol (no effect on OCD), Amitryptiline (no effect on OCD), Amisulpride low dose (does not act as an atypical antipsychotic at low doses (no effect on OCD)
I have tried more but forgot. Only antipsychotics low dose help my OCD. And all those drugs above have had studies stating they have helped OCD. Some of them, when combined with Nardil, would have acted very similar to Anafranil too -- ie. Reboxetine (boosting Noradrenalin levels), also Lithium (bossting Seotonin levels)
Only other drug i can think of is clonazepam.
>
> 2. What has been your experience on Anafranil? (I had one course of it years ago, but in combination with lithium and an AD I can't remember--which didn't work out too well).Tried it 3 times. Coyuldn't get past the first 3 days.
1. Exremem sedation
2. Made my anxiety and derealization worse
3. Made depression EXTREMELY bad.> Thanks for your thoughts.
>
> Greywolf
>
>
Good luck dude!
ace
Posted by Maxime on April 18, 2005, at 21:55:51
In reply to Switching from Nardil to Anafranil, posted by Greywolf on April 18, 2005, at 12:42:56
Maybe Nardil and CBT?
maxime
> I posted here quite often last year while I was struggling to find a pharmo solution for severe depression. I'm bipolar, complicated by a rather intractable OCD problem of many years.
>
> I've got a great doc who's very open-minded and willing to try anything reasonable. Over the last decade and longer, I've tried every SSRI/SNRI/NDRI, etc., etc., etc., out there. They generally have not been very effective even at higher doses, and most of you can appreciate the various SEs.
>
> Last year, I started on Nardil. It was great in terms of low SEs, the dietary restrictions were no big deal, and the efficacy at 60mg/day was decent. I still have all the BP symptomology--severe episodes of depression, occasional euphoric states lasting hours to days--but the intensity is toned down appreciably.
>
> So, things are livable with the BP, though not a life that'll knock your socks off. Unfortunately, the OCD has come to the fore very strongly over the months I have been taking Nardil, and it's become a real daily hindrance. Obsessional thoughts abound, repeated compulsive acts (often related to making myself re-do things because the completed (and perfectly fine) act was accompanied by some type of negative thought) occur throughout the day. Frankly, it's exhausting.
>
> I recently consulted with my doctor about the OCD in particular. He has suggested dropping the Nardil (can't take both together) and starting up with Anafranil (clomipramine). It will likely have the some of the SEs I've experienced with anti-depressants (and probably a diminished effectiveness re: depression), but it will focus on the OCD aspect that is seriously interfering with my life.
>
> Which brings me to my questions:
>
> 1. Does anyone know of an OCD med that can be safely used in conjunction with Nardil?
>
> 2. What has been your experience on Anafranil? (I had one course of it years ago, but in combination with lithium and an AD I can't remember--which didn't work out too well).
>
> Thanks for your thoughts.
>
> Greywolf
>
>
Posted by temoigneur on April 18, 2005, at 22:26:22
In reply to Re: Switching from Nardil to Anafranil » Greywolf, posted by ace on April 18, 2005, at 21:42:56
>
>
> >
> > 2. What has been your experience on Anafranil? (I had one course of it years ago, but in combination with lithium and an AD I can't remember--which didn't work out too well).
>
> Tried it 3 times. Coyuldn't get past the first 3 days.
>
> 1. Exremem sedation
> 2. Made my anxiety and derealization worse
> 3. Made depression EXTREMELY bad.
>
>
>
> > Thanks for your thoughts.
> >
> > Greywolf
> >
> >
>
>
> Good luck dude!
> ace
>
"After all the meds you tried, I wouldn't even bother with Anafranil....I would absolutely got to a low dose of an atypical antipsychotic."I've lost track of who's saying what to whom, but I had to interject here - Almost like Ace and others I had tried nearly everything, common and obscure for OCD and anxiety, except for Anafranil. I had been put on it while in university, and I desperately wanted something that would clear the anxiety/OCD quickly. I don't remember exactly, but I think I started on too high a dose, and had heavy anticholinergic side effects - felt like my head was going to spin off. I went off it, and had no interest in trying it after a long trial of imipramine. TCA's make me dull, numb, groggy, and completely kill my creativity.
However, a few years later, after tramadol + Effexor, landed me in the hospital with anxiety, I was slowly titrated up on clomipramine. It, like other TCA's killed my creativity and emotions, etc, but I have experienced a steady improvement in OCD symptoms over the past 6 months, to the point where I'm now virtually asymptomatic. I'm still, however, very vegetative and dull, so Prozac, will likely be added, and other strategies tried, but if I can retain the anti obsessional effects of clomipramine, and rid myself of the anhedonia I will be extremely happy. I'll keep you posted, (just prod me; bentley79@hotmail.com) but I'm optimistic about my prospects with clomipramine + an activating agent - I was a horrific mess before going on clomipramine.
For me, A-typicals, did little to nothing, to diminish OCD - never tried geodon, or abilify. I was at the U.S. national anxiety disorder conference and a clinician from a prominent OCD treatment center said from the thousands of cases he's seen, at a 'good average response to an SSRI's, (not including clomipramine) would be a 45% decrease in OCD symptoms, whereas clomipramine can effect a 65% improvement - when it can be tolerated - slow titration is often imperative.
Ben
Posted by ace on April 18, 2005, at 22:36:48
In reply to Re: Switching from Nardil to Anafranil » ace, posted by temoigneur on April 18, 2005, at 22:26:22
>
> >
> >
> > >
> > > 2. What has been your experience on Anafranil? (I had one course of it years ago, but in combination with lithium and an AD I can't remember--which didn't work out too well).
> >
> > Tried it 3 times. Coyuldn't get past the first 3 days.
> >
> > 1. Exremem sedation
> > 2. Made my anxiety and derealization worse
> > 3. Made depression EXTREMELY bad.
> >
> >
> >
> > > Thanks for your thoughts.
> > >
> > > Greywolf
> > >
> > >
> >
> >
> > Good luck dude!
> > ace
> >
> "After all the meds you tried, I wouldn't even bother with Anafranil....I would absolutely got to a low dose of an atypical antipsychotic."
>
> I've lost track of who's saying what to whom, but I had to interject here - Almost like Ace and others I had tried nearly everything, common and obscure for OCD and anxiety, except for Anafranil. I had been put on it while in university, and I desperately wanted something that would clear the anxiety/OCD quickly. I don't remember exactly, but I think I started on too high a dose, and had heavy anticholinergic side effects - felt like my head was going to spin off. I went off it, and had no interest in trying it after a long trial of imipramine. TCA's make me dull, numb, groggy, and completely kill my creativity.
>
> However, a few years later, after tramadol + Effexor, landed me in the hospital with anxiety, I was slowly titrated up on clomipramine. It, like other TCA's killed my creativity and emotions, etc, but I have experienced a steady improvement in OCD symptoms over the past 6 months, to the point where I'm now virtually asymptomatic. I'm still, however, very vegetative and dull, so Prozac, will likely be added, and other strategies tried, but if I can retain the anti obsessional effects of clomipramine, and rid myself of the anhedonia I will be extremely happy. I'll keep you posted, (just prod me; bentley79@hotmail.com) but I'm optimistic about my prospects with clomipramine + an activating agent - I was a horrific mess before going on clomipramine.
>
> For me, A-typicals, did little to nothing, to diminish OCD - never tried geodon, or abilify. I was at the U.S. national anxiety disorder conference and a clinician from a prominent OCD treatment center said from the thousands of cases he's seen, at a 'good average response to an SSRI's, (not including clomipramine) would be a 45% decrease in OCD symptoms, whereas clomipramine can effect a 65% improvement - when it can be tolerated - slow titration is often imperative.
>
>
> Ben
Ben -- thanks heaps for this reponse...maybe i should give Anafranil a go -- but then again, the atypicals stop my OCD preety much around 80%, depression is my main prob now,,,take care mate!
ace
>
Posted by ixus on April 19, 2005, at 1:07:57
In reply to Re: Switching from Nardil to Anafranil, posted by Greywolf on April 18, 2005, at 20:23:41
> > The only other med I know of for OCD is luvox.Fondly, Phillipa
>
>
> Thanks, ixus and Phillipa.
>
> I probably won't go with a higher dose of Nardil since it won't really work on the OCD, which has gotten progressively worse. It's disappointing because I really took the Nardil up slowly over a long period of time. But I'm spending too much of my day on the OCD quirks, so that aspect's become the main issue.
>
> I've had Luvox before and it wasn't helpful. So, I'll try Anafranil. It kind of stinks, because taking the Nardil up a few notches would probably have really helped with the depression, but I'd also like to get out of the house in the morning in under 2 hours for a change.
>
> Thanks for the advice though.
>
>
Hi,
I forgot to mention that AP augmentation can help you with your OCD.
/ixus
Posted by Greywolf on April 19, 2005, at 6:21:41
In reply to Re: Switching from Nardil to Anafranil » ace, posted by temoigneur on April 18, 2005, at 22:26:22
Thanks, Ben. Good to see some success with Anafranil, but the SEs are, unfortunately, what I expected. But, as long as the fatigue/fuzziness factor isn't too bad, it would be nice to be free of the OCD issues that are so frustrating.
Thanks again for the advice everyone.
Greywolf
This is the end of the thread.
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