Hi Pierre, I think you and medievil have gotten some good points in. Excuse me for interrupting the flow of conversation, but I need to clarify something I wrote earlier.
jadamgo, on 24 August 2012 - 04:37 AM, said:
Judging by the quality of your writing, you're not "formerly gifted" at all.
I didn't pay very close attention to those quotation marks! What I meant to say is that you're not "formerly" gifted -- i.e. you're still gifted today. Even in the midst of all the cognitive impairment and preoccupation you may be experiencing now, it's still clear from your posts that you're effectively comprehending the complex things medievil and I have been saying, and you've been responding thoughtfully. So you haven't lost your intelligence -- depressed people do experience difficulty with attention, decision making, and sometimes comprehending things, but due to the negativity bias in depression, those impairments often feel
a lot worse than they objectively are.
lucky.pierre, on 25 August 2012 - 08:06 AM, said:
Thank you for your reply. Parnate withdrawal has had some weird dysregulating effect on my noradrenergic system (feel constantly anxious, hyper-alert, etc.), so I suppose my post doesn't really reflect my baseline cognition when depressed.
Yes, I had a similar problem with selegiline withdrawal. Even with gradual tapering over a month, I felt sort of frantic, out of control, tired-but-wired, and emotionally hypersensitive. Several times a day, it seemed like I might panic, though I never actually did panic or do anything "out of control." Fortunately, the symptoms faded over the next several weeks until I returned to baseline.
I've tried Tianeptine (exacerbated "atypical" symptoms), and have been undergoing psychodynamic therapy for the past 1.5 years (which has been helpful, to an extent, but obviously done nothing to relieve the depression or OCD).
I'm sorry to hear that Tianeptine wasn't the magic bullet for you, the way it can be for some people.
As for psychodynamic therapy, the evidence base suggests trying it for depression, relationship problems, some personality disorders, and certain other conditions that you don't have. But for OCD, the only evidence-based psychotherapy I know of is ERP, or Exposure with Response Prevention. It's designed to desensitize you to the obsessive thoughts and feelings, and to the urges to act on the compulsions. The goal is that you no longer feel bothered by those thoughts and feelings anymore, nor do you feel uncomfortable if you disobey the compulsions.
To clarify, I'm not suggesting that you abandon the psychodynamic therapy if you've found it helpful in some ways. It can be a great therapy, and there are certain benefits to receiving both talk therapy and medication management from the same doctor. Still, given that you've gone through most of the chemical treatments for OCD and the psychodynamic therapy isn't helping it, I think you'd really benefit a lot from tracking down a clinical psychologist or a psychiatrist who specializes in OCD. It's a tough, tough condition to treat if
the doctor isn't extensively trained in helping with OCD, but those experts who are
trained can work magic that would surprise any general psychiatrist/psychologist.
You are right about personal environment -- when I am not in my parents' house, my suicidal urges usually weaken. But I can't leave here when my OCD is basically severe, neverending, and completely incapacitating (I'm essentially agoraphobic)
Interestingly, exposure and response prevention are also the preferred tools for treating agoraphobia. From a behavior modification standpoint, removing the compulsion to escape from an unfamiliar situation in agoraphobia works via the same deconditioning processes as removing the compulsion to act on an obsessive thought in OCD.
I can't wait for the day when we have drugs which selectively and effectively target these abnormal processes in the brain. Until that day comes, the most effective remedies for such problems operate by modifying the contingencies that permit them to continue.
Your reference to drug addicts and depressants struck a chord -- maybe not because I see things as hopeless (which I do; I've been stuck in this state for 4+ years, and have battled OCD for 9 years), but because I guess I don't really like the idea of compromise. For example, one med-happy professor had me on high-dose Lexapro and Zyprexa; my symptoms were more 'under control' but I felt lobotomized, which isn't really a way to live. I'm trying not to compromise my recovery with my perfectionism, and am basically just aiming to leave my parents' house at this point, but without the ability to read, pay attention etc., I don't really feel 'recovered'.
You are right to insist on eventual full recovery of a fulfilling and productive life instead of permanently settling for partial treatment response. There are reams of bad advice out there to "accept that these problems will never go away" or, as one "therapy" for bipolar disorder horrifyingly phrases it, "Mourn the lost healthy self." (Unsurprisingly, that therapy keeps failing in its clinical trials.)
I don't believe in following that advice. It was understandable decades ago, before we learned about the vast possibilities of adult neuroplasticity. Nowadays, it's inexcusable.
The counterbalance to this point is, as you pointed out, that perfectionism (and I'd add impatience) don't speed up the process. I don't really see perfectionism compromising your recovery, seeing as how you've set a reasonable intermediate goal of recovering your functioning enough to get out of your parents' house. Harmful perfectionism would be something like "I want a pill to make me completely normal in six months."
I think the comorbid ADD (I have lifelong symptoms, which were only detected recently; OCD started at 18) complicates things because stuff that quells my anxiety typically worsens my attention/cognition.
That's par for the course for mainstream anxiety/OCD drugs today. There's some new stuff coming out in the next decade or so that works on metabotropic glutamate receptors or neuropeptide systems, but until then, the options to treat anxiety while preserving executive function are limited.
Limited, but not nonexistent. Among the possibilities I know about:
Eleuthero (very cheaply and effectively available in Celestial Seasonings' Tension Tamer herbal tea, present in grocery stores throughout the US.)
CBD-high, THC-low marijuana, especially if vaporized instead of smoked. (Many people find that vaporized cannabis does not cause the cognitive impairment of smoked cannabis.)
I'd be remiss if I didn't mention meditation! Meditation, aniracetam, and frequent physical exercise are the only things I know of that both strengthen cognitive function and calm anxiety.
... good lord, what a tome I've written here. Whoever is still reading should receive a medal for attention span of the year. I tried to make all of it useful and relevant, but maybe it's too much of a good thing...