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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by greywolf on May 28, 2009, at 5:12:37
As many of you know, I have bipolar depression and serious OCD problems, mostly of an obsessional quality. I am currently taking Parnate 60mg/day, Cytomel 50mcg/day, Xanax 4.5mg/day, and Lunesta 3mg/day. This is for the depression and has no effect on the OCD.
I've tried all of the traditional meds for OCD, all of which were either ineffective or produced side effects that outweighed whatever limited benefit the med produced.
I recently read that UCLA studied 17 people for use of Namenda for the obessional aspect of OCD. The study was completed last year, but the report has not been issued. My doctor took the time yesterday to go over the description of the study with me and agreed to give it a try since Namenda is a relatively safe med.
So, now we've added 20mg/day Namenda to the med regime. I've read several posts here where people were taking Namenda for depression, but nothing regarding OCD treatment. I was wondering if anyone has taken Namenda for obsessional side issues and whether it helped.
Thanks.
Greywolf
Posted by SLS on May 28, 2009, at 8:15:01
In reply to Starting Namenda for OCD, posted by greywolf on May 28, 2009, at 5:12:37
I wish you luck on the memantine. The majority of studies appearing the medical literature indicates that memantine can be very effective for OCD.
Isn't Nardil considered to be a better drug than Parnate for treating OCD?
- Scott
Posted by greywolf on May 28, 2009, at 9:09:05
In reply to Re: Starting Namenda for OCD » greywolf, posted by SLS on May 28, 2009, at 8:15:01
Yes, but Nardil really didn't do anything for me. Never noticed an effect, either positive or negative.
Parnate's been somewhat effective on the depression, but hasn't done anything for the OCD. Anafranil, Luvox, Paxil, etc. did nothing for the OCD.
Frankly, I was surprised that he put me on Namenda given that it's only officially been studied in a few people with OCD. But it's supposedly a safe med, so he figured why not.
Greywolf
Posted by Phillipa on May 28, 2009, at 10:39:37
In reply to Re: Starting Namenda for OCD, posted by greywolf on May 28, 2009, at 9:09:05
Luvox didn't work? Namenda is the Alzheimers drug right? Strange that it would help OCD. Sure hope it works well for you. Good luck. Phillipa
Posted by SLS on May 28, 2009, at 11:04:46
In reply to Re: Starting Namenda for OCD, posted by greywolf on May 28, 2009, at 9:09:05
> Frankly, I was surprised that he put me on Namenda given that it's only officially been studied in a few people with OCD. But it's supposedly a safe med, so he figured why not.
This might be a long shot, but if antiglutamatergic drugs are helpful in treating OCD, then taking lamotrigine (Lamictal) might be worth a try further on down the road.
Basically, this study shows that:
1. Marble-burying behavior is an animal model for OCD. The more marbles, the higher the ocd quotient.
2. NMDA glutamate receptor antagonists (blockers) like memantine and amantadine inhibit marble-burying, demonstrating an anti-OCD effect.
Other studies have pointed to hyperactive looping glutamatergic circuits as being a component of the etiology of OCD.
One thing that is important to take into consideration is that OCD often takes longer to resolve upon treatment when compared to depression. This is certainly true of the SSRIs. It might take 10 weeks before an improvement emerges.
I think using memantine is worth a try, especially when used as an augmenter of other OCD drugs.
- Scott
Posted by greywolf on May 28, 2009, at 11:36:34
In reply to Re: Starting Namenda for OCD » greywolf, posted by SLS on May 28, 2009, at 11:04:46
Thanks, Scott. Already tried Lamictal twice without success.
My limited understanding is that the mechanics of the obsessional aspects of OCD mimic some aspect of Alzheimer's, so UCLA ran a small, 17-peson trial ending last year to see if Numenda helped. The study has not been reported out yet.
Greywolf
Posted by SLS on May 28, 2009, at 12:18:34
In reply to Re: Starting Namenda for OCD, posted by greywolf on May 28, 2009, at 11:36:34
> Thanks, Scott. Already tried Lamictal twice without success.
I forgot about Topamax (topiramate). It also inhibits glutamatergic hyperactivity, albeit in a different way than the others. Topamax is a AMPA/kainite glutamate receptor antagonist. It does not work at the NMDA receptor. If I remember correctly, there is a complex relationship between the functioning of NMDA receptors and AMPA/kainite receptors. It might make sense to attack both receptors at once. I am hoping the same thing for my bipolar depression.
- Scott
Posted by g_g_g_unit on May 28, 2009, at 16:58:48
In reply to Re: Starting Namenda for OCD » greywolf, posted by SLS on May 28, 2009, at 11:04:46
i'm busy trying Namenda out for OCD; i've been on 15mg for 2 days (out of a total of 16 days on the drug).
so far the results have been pretty erratic - early dosing resulted in a light amphetamine-effect which was great for motivation (though bad for OCD), but now that seems to have faded.
on 15mg there are times where i feel unusually calm & peaceful, but that occasionally seems to shade over into some more depressive. i wonder if might be better used in augmentation with something serotonergic
Posted by greywolf on May 28, 2009, at 23:24:09
In reply to Re: Starting Namenda for OCD, posted by g_g_g_unit on May 28, 2009, at 16:58:48
I'll be interested in whether you think Namenda helped with the OCD. If I could get the obsessional side of the OCD issues even somewhat under control, it would really help with my depression and self-injury issues.
Best of luck.
Greywolf
Posted by desolationrower on May 29, 2009, at 0:56:15
In reply to Re: Starting Namenda for OCD, posted by greywolf on May 28, 2009, at 23:24:09
have iether of you tried before NAC??
-d'/r
Posted by Kimbersaur on May 29, 2009, at 1:15:42
In reply to Re: Starting Namenda for OCD, posted by desolationrower on May 29, 2009, at 0:56:15
I started Namenda for OCD about 2 weeks ago. I've had no really noticeable side effects. I think it is too early to say how helpful it will be with my OCD. I'm kind of living in a limbo with my OCD right now due to the "contamination" of a classroom I have to visit twice a week, so it is hard to judge how well I am doing given the especially stressful circumstances. However, I have started to notice that I am able to let some things slide that may have previously bothered me more and that some things feel cleaner faster when I do cleaning rituals. I've got my fingers crossed.
Posted by greywolf on May 29, 2009, at 1:49:43
In reply to Re: Starting Namenda for OCD, posted by desolationrower on May 29, 2009, at 0:56:15
Forgive my ignorance, but what's NAC?
Greywolf
Posted by greywolf on May 29, 2009, at 1:53:11
In reply to Re: Starting Namenda for OCD, posted by Kimbersaur on May 29, 2009, at 1:15:42
From what I read in a letter to a major psychiatry journal, 2 psychiatrists decided to try Namenda on a patient with treatment resistant obsessions. While Namenda did not "cure" her of the obsessions, the impact of the obsessions on her life and the amount of time devoted to them decreased significantly within a few weeks.
Hopefully, improvements will continue for you.
Greywolf
Posted by Sigismund on May 29, 2009, at 21:36:00
In reply to Re: Starting Namenda for OCD, posted by greywolf on May 29, 2009, at 1:49:43
N Acetyl Cysteine.
There's a thread about it on Alterntive, the most relevant section of which might be....
http://www.dr-bob.org/babble/alter/20090204/msgs/887652.html
Posted by Sigismund on May 29, 2009, at 21:43:39
In reply to Re: Starting Namenda for OCD, posted by greywolf on May 29, 2009, at 1:53:11
If you are worried about making a mistake, is that OCD?
As in you can't work out what you want or which milk to buy because you have no criteria against which to measure a decision....is that OCD?
Interestingly the only thing that *abolished* that with me was hallucinogens (5ht2a agonism?).....the whole box and dice was opened and the question of which milk to buy became subsumed so that I felt 'wtf, milk, buy, shop, wtf do I care?'
Although this might be something different for all I know.
I'm a little curious because I have a heap of memantine which I only tried once. I was just worried about insomnia resulting.
Posted by Phillipa on May 29, 2009, at 22:18:11
In reply to Re: Starting Namenda for OCD » greywolf, posted by Sigismund on May 29, 2009, at 21:43:39
Sigi sounds more like performance anxiety or plain fear about making the wrong decision. Love PJ
Posted by greywolf on May 29, 2009, at 22:38:56
In reply to Re: Starting Namenda for OCD » greywolf, posted by Sigismund on May 29, 2009, at 21:43:39
> If you are worried about making a mistake, is that OCD?
>
> As in you can't work out what you want or which milk to buy because you have no criteria against which to measure a decision....is that OCD?
>
> Interestingly the only thing that *abolished* that with me was hallucinogens (5ht2a agonism?).....the whole box and dice was opened and the question of which milk to buy became subsumed so that I felt 'wtf, milk, buy, shop, wtf do I care?'
>
> Although this might be something different for all I know.
>
> I'm a little curious because I have a heap of memantine which I only tried once. I was just worried about insomnia resulting.No, OCD is a lot different than what you describe. The obsessive component is characterized by repetitive, unwanted, intrusive thoughts, often of a horrible nature. The compulsive aspect is characterized by repetitive acts--counting, hand washing, repeatedly checking things like whether the door's locked or the iron's off or the stove's shut off, etc. It comes in an infinite variety of forms.
I suffer from both obsessive thoughts--particularly blasphemous thoughts--and physical rituals. Most of the rituals are performed because I fear someone close to me dying. For instance, if I flip a light switch when I'm having a negative thought, one of my children may die. I close a door with my left hand instead of my right, someone close to me will get hurt.
When my therapist asked me to write out what I experience, I think she was a little shocked to get a 10-page, single-spaced letter in return. I've been in CBT for several years, and I figure we'll be spending even more years of Saturday mornings together.
Greywolf
Posted by Sigismund on May 30, 2009, at 0:18:48
In reply to Re: Starting Namenda for OCD, posted by greywolf on May 29, 2009, at 22:38:56
I read of a man who felt that if he did not remove every leaf from his lawn his deceased parents would be demoted from heaven to hell. He had every treatment, including the obvious pastoral one of a priest saying that God would never do such a thing for such a reason. None of the pharmaceutical treatments were effective. He eventually tried psychosurgery, but the journal article was unable to follow the results beyond a certain point because of funding cuts. It seemed like a very black comedy.
Posted by g_g_g_unit on May 30, 2009, at 0:49:20
In reply to Re: Starting Namenda for OCD » greywolf, posted by Sigismund on May 29, 2009, at 21:43:39
> If you are worried about making a mistake, is that OCD?
>
> As in you can't work out what you want or which >milk to buy because you have no criteria against >which to measure a decision....is that OCD?No, though I did experience that while on Nardil (simple, day-to-day conversation became a tortorous experience because i'd agonize over the minutae of what i was saying; it's like i was incapable of making a spontaneous decision).
the stimulating phase of Memantine eradicated that (i felt completely prepared for any social moment), while simultaneously pushing my perfectionist/OCD tendencies into code-red. now on 15mg that's calmed down, though given the grand boost in idea formulation + conversation making i felt before, i'm thinking it might be a good idea to play around with a low dose of something dopaminergic if i can stabilize on memantine.
prior to ssri's i would often get those surges of ideas, etc. at the same time as i experienced crippling OCD. when i wrote i would compose most of the sentence in my head, and then once it was committed to paper (or 'perfected'), refuse to change a letter. it's like i was forced to obey that compulsive 'spark' for better or worse; i would rush through the ideas that appeared to me without really thinking them through, etc.. whenever i tried an SSRI, i would mistake the loss of that spark with thinking that i was being completely dumbed down, where as in reality i guess i was being forced to fend for myself finally, rather than rely on that inner prompting.
so i guess once i had been stuck cycling through SSRI's for too long, it was like i was experiencing the extreme opposite of that impulsive behaviour, i.e. what you describe Sigismund, where minute decisions become impossible to execute.
sorry, just thinking out loud .. but being through all of this has been a good object lesson for me. i guess balance is the key to everything huh.
on a final note: does anyone see any benefit/downside to taking NAC *with* Memantine?
also, i am meant to meet with my pdoc in a week or so, and am busy thinking of potential augmentation ideas to bring up.
i was thinking of maybe SAM-e, moclobemide, or a small dose of liquid deprenyl (a bottle of which i have on hand, but have never used).
Posted by desolationrower on May 30, 2009, at 8:53:52
In reply to Re: Starting Namenda for OCD, posted by g_g_g_unit on May 30, 2009, at 0:49:20
they work in quite different ways so its possible they would complement each other.
-d/r
also not meaning to minimize the difficulty of it but it is interesting to hear about the rituals people contruct
Posted by Elanor Roosevelt on May 31, 2009, at 22:16:30
In reply to Re: Starting Namenda for OCD » greywolf, posted by Sigismund on May 29, 2009, at 21:43:39
> If you are worried about making a mistake, is that ?
>
> As in you can't work out what you want or which milk to buy because you have no criteria against which to measure a decision....
why do these symptoms occur?
i melt down in super markets making decisions sometimes
i hate the fear of making the wrong decision
Posted by Sigismund on June 1, 2009, at 3:27:49
In reply to Re: Starting Namenda for OCD, posted by Elanor Roosevelt on May 31, 2009, at 22:16:30
>i hate the fear of making the wrong decision
We have so much choice in everything that doesn't matter (and none...or much less.... when it does).
Posted by g_g_g_unit on June 2, 2009, at 1:55:28
In reply to Re: Starting Namenda for OCD » greywolf, posted by SLS on May 28, 2009, at 12:18:34
just wondering if Namenda is beginning to exert any positive influence on your OCD?
for me, pushing up to 15mg made a world of difference; i've been at my present dose for 5 days and am beginning to experience a definite reduction of 'mental noise'. i'm still prone to a slightly drunken-ish feeling, but it's becoming a lot easier to pull myself out of negative thought loops, and direct my attention as i please. i plan on moving up to 20mg in 2 days, and then holding tight there to see if i can finally reap some of the positive cognitive effects that seem to come about through stable dosing.
Posted by Sigismund on June 2, 2009, at 17:50:21
In reply to hey greywolf, posted by g_g_g_unit on June 2, 2009, at 1:55:28
Doesn't cause or aggravate insomnia?
Posted by greywolf on June 2, 2009, at 18:28:36
In reply to Re: hey greywolf » g_g_g_unit, posted by Sigismund on June 2, 2009, at 17:50:21
> Doesn't cause or aggravate insomnia?
It's only been a few days, but I haven't noticed any side effects from Namenda. Of course, I take it first thing in the morning, so any insomnia effect would probably blend into the day.
Greywolf
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