45 replies to this topic

[Catwoman]

I took Luvox (fluvoxamine, an SSRI) for obsession/intrusions for about a year. It worked very good and the intrusion faded (I had therapy as well). Then I tapered (because I thought I didn't need the drug anymore, this was in 2009) and was in remission for about 1,5 years.  When I relapsed suddenly and started having the same obsession again I went back on Luvox. After 9 weeks on 200 mg nothing changed. It didn't work like the first time.
My general doctor switched me to Lexapro (escitalopram). After 3 weeks I felt it kick in. The intrusion disappeared once again and I felt really liberated.
I was on Lexapro for 6 years. Slowly tapered to 5mg but wasn't planning to withdraw. I was feeling happy with minimal side effects!

Three months ago it seemed like I reached poop-out; The obsessive thought came back with double force. I wasn't able to turn things around. My psychologist thought the dose was too low, so I increased to 15 mg. After four weeks I didn't feel any better.  He said the serotonin-receptors might be depleted or desensitized from the long term use. Never knew this could happen but OK.... 
I was given the option to switch to another SSRI or an SNRI but I figured this class of drugs won't work for me on the long term so I decided to taper to 0 mg and then see what happens. I consulted a psychiatrist and he advised Haldol or Risperdal...but the side effects scare me!

I rather switch to a supplement or a stack of supplements and maybe cycle these.

My first thought was L-tryptophan. I also looked for info on 5HTP,  Inositol and Rhodiola. They all sound promising. I also read up on NAC and SAMe. Also promising.

Increasing serotonin levels seemed to have worked for me in the past. But now I'm really insecure about it. 
I do notice that being among good friends or going on a holiday with lots of sunshine and long walks in nature actually makes me feel a lot better. I am able to let the intrusion pass by much more easily; the result is that it even doesn't pop up as often! 

My question: will these kind of supplements work after pooping-out from an SSRI? If my brain isn't responding to a serotonergic drug I figure it might not respond to a serotonergic supplement either. Or am I thinking too simple?
Of course I won't use these in combination with the Lexapro (I'm on 2,5 mg now)

Thanks for your feedback!

 

Edited by Catwoman, 09 August 2016 - 08:40 PM.

[Galaxyshock]

Fucking psychiatrist, seriously suggested Haldol or Risperdal? Neurotoxic antipsychotics only suitable for acute psychosis.

[Catwoman]

Fucking psychiatrist, seriously suggested Haldol or Risperdal? Neurotoxic antipsychotics only suitable for acute psychosis.

Was having my doubts as well.Thanks for the cool reply :-) I hear more people with OCD take anti-psychotics as an augment drug. I guess I would not need this if an SSRI already does the trick but he said a low dose of an anti-psychotic drug can be taken as a mono-therapy. I thought it might be something when all else fails....

Oh BTW, this psychiatrist has OCD himself and is really open about this. I am sure he knows what he's talking about when it comes to regular medication to treat mental health disorders but it seems treating the symptoms is more important than the underlying cause and you just have to put up with nasty side effects.

Edited by Catwoman, 10 August 2016 - 06:24 AM.

[Ames]

You'd likely be a good candidate for rTMS, at least as far as qualifying for it would be concerned.

 

Expensive, but probably worth it  - considering.

Edited by golgi1, 10 August 2016 - 02:53 PM.

[Catwoman]

Read good stuff about rTMS. I researched Dutch information extensively, but I wouldn't know how to pay for it, since you need like 30 or 40 sessions. 
I'll check the threads here as well.

I'm not saving money just yet...I do think it needs more research.
The psychiatrist I mentioned earlier had rTMS treatments here in the Netherlands. He said it had positive effect on his OCD but it wasn't lasting. There was also a Dutch lady on our local OCD forum who did the treatments, but she didn't notice any significant effects on her OCD. The clinic said it was probably necessary to reach deeper parts of the brain and they (or the rTMS equipment?) could not do that.

Furthermore, I'm still wondering about the downregulation of the serotonin receptors. If this is the case then why did I feel so much better on my holiday?

Is there any use in trying with inositol or a serotonin raising supplement like rhodiola?


 

[Ames]

I apologize. I read "SSRI" and my brain proceeded to assume and miss the part of your post where you detailed that the antidepressants were for OCD. Yeah,  the anecdotes I read for rTMS were for depression.

 

Anecdotally, i conquered OCD in my late teens after having it for ten years in varying modes of intensity.

 

What I did was binge drink, which got rid of it by, I assume, flooding my brain with serotonin and GABA. I also smoked a lot of marijuana. I'm not suggesting that you do that, Though, I can't say that it didn't work. It'll relax you.

 

Anyway, I bring that up to point to serotonin enhancing agents like the Rhodiola that you mentioned that may, in fact, help. Rhodiola personally put me into a sleepy fog for three days the one time that I took it. That is, it was strong for me in its serotonin effect. It may work for OCD, but I've heard that it also poops out. It was too overwhelming for me, but I know that others realize different effects. In sum, you probably have nothing to lose for its strength alone that may be beyond what you will get with other supplements.

 

I wish I could be of more help.

[Catwoman]

Hi Golgi, no problem. I think rMTS needs more research for OCD but it could be something in the future...

I'm so unsure about the supplements because the SSRI pooped out on me. When I increased following the relapse nothing happened.
Although I have been tapering Lexapro and I'm now on 2,5 mg....I'm just scared stuff like rhodiola or inositol won't work for me because of the previous poop-out (in the case of tolerance of depleted receptors).

I won't go binge drink I promise ;-)
But I can see that flooding the brain with serotonin and GABA would work since when I'm really relaxed during a vacation I notice that my OCD thought is still there but I'm a lot less worried and I much more able to let it go and not pay too much attention to it.

The less worrying the better is goes.




 

[Ames]

I would only had that inositol had an accute memory inhibiting effect for me. Personally, I avoid it.

[Catwoman]

I would only had that inositol had an accute memory inhibiting effect for me. Personally, I avoid it.

Guess we're all different! Why did you take it?

I would love to find something natural which works for OCD.
I only took SJW for a week, years ago. I was on birth control at the time, so I had to stop taking it.

Maybe I can try a BDNF booster together with a serotonin boosting supplement. 

At the moment the only thing that is really good is my appetite and my sleep. My mood goes up and down and I can clear my mind during meditation, except for the intrusive thought...that's bugging me, but I can't help that.
And physically I'm OK, I run 2/3 times a week and my muscles are becoming much more supple from yoga.

So...what's up with me? No idea...

[Starvinsky]

For the love of God, DO NOT take Risperdal, Haldol or any neurolepitc for OCD!! Those are potentially life destroying drugs with permanent effects, and should only be used in life threatining situations.

 

I beg you to trust me on this one, a lot of professionals wildly understimate the long term sequels (and I'm not talking about tardive diskinesia, diabeetus, or weight gain; I'm talking about permanent cognitive loss, apathy and general graying of life).

 

I took 0,5mg risperdal daily as a teenager and it's the worst mistake I've ever made (and I made quite a few). I wouldn't wish it on my worst enemy, it was worse than dying, it was dying an still being there.

Sorry for the drama, it's still a bit raw =).

 

 

I'm afraid SSRI poopout (why don't we just say tolerance?) is perfectly normal as our bodies adapt to the new serotonin influx. Maybe cycling with different targets will help.

 

 

Also have you tried behavioural cognitive therapy or meditation? I know it sounds a bit new agey, but it's free and it might help (I think we overstimate the strenght of chemical agents and understimate our brain's own supply and plasticity).

 

Anyways I wish you do best! Keep us posted!

 

 

 

 

 

 

[Catwoman]

For the love of God, DO NOT take Risperdal, Haldol or any neurolepitc for OCD!! Those are potentially life destroying drugs with permanent effects, and should only be used in life threatining situations.

 

I beg you to trust me on this one, a lot of professionals wildly understimate the long term sequels (and I'm not talking about tardive diskinesia, diabeetus, or weight gain; I'm talking about permanent cognitive loss, apathy and general graying of life).

 

I took 0,5mg risperdal daily as a teenager and it's the worst mistake I've ever made (and I made quite a few). I wouldn't wish it on my worst enemy, it was worse than dying, it was dying an still being there.

Sorry for the drama, it's still a bit raw =).

 

 

I'm afraid SSRI poopout (why don't we just say tolerance?) is perfectly normal as our bodies adapt to the new serotonin influx. Maybe cycling with different targets will help.

 

 

Also have you tried behavioural cognitive therapy or meditation? I know it sounds a bit new agey, but it's free and it might help (I think we overstimate the strenght of chemical agents and understimate our brain's own supply and plasticity).

 

Anyways I wish you do best! Keep us posted!

Thanks for your reply Starvinsky!

Yes, I've been seeing a psychiatrist for a few months (combination of talk therapy and CBT). I wasn't making much progress so he prescribed me Luvox. That worked so good (the issue literally vanished) that I had a few more sessions and then he advised me to continue on my own with Acceptance & Commitment Therapy (ACT).

This was 6 years ago, so I thought I could handle it without a high dose of medication.

Now that I've reach the tolerance stadium I've been seeing a new therapist and I've started taking mindfulness classes. I've always been interested in meditation, but since I couldn't concentrate on it for more than 10 minutes it just sort of lost my interest. 

I've picked up meditation again and it does calm me down. The frequency of the thought popping up will increase during meditation. It's not funny and not motivating to keep it up.

I figured I need something, a supplement perhaps, to calm down the over activity and work on meditation techniques from there on.

Edited by Catwoman, 14 August 2016 - 12:12 PM.

[Flex]

what about Clomipramine ? I guess its anyway not suitable for long-term because of the anti-cholinergic effects that causes dementia through oxidative stress IIRC.

i.e. anything that blocks the D2 receptor but doesnt alter the synapses like real anti-psychotics i.e. kiss and run effect, fast dissociation(afaik) or anything that doesnt cause dyskinesias

 

could be  that a D3 antagonist might held but thats just a wild guess from me b/c D3 acts like a reputake inhibitor in the striatum (IIRC!), so it "should" lower the Dopa content.

the only that I know are Clomipramine and maybe Cyproheptadine but this is a non-selective 5-ht antagonist (and anti-cholinergic), so it could be contra productive.

 

just an idea, (not that I´m certain about this): what about glutamergic decreasing stuff like Tumeric or any off-label medication like Topiramate ?

though topiramate has annyoing side-effects at the required dose

Double-blind, placebo-controlled trial of topiramate augmentation in treatment-resistant obsessive-compulsive disorder.

http://www.ncbi.nlm....pubmed/20816027

Edited by Flex, 16 August 2016 - 01:57 AM.

[Catwoman]

 

just an idea, (not that I´m certain about this): what about glutamergic decreasing stuff like Tumeric or any off-label medication like Topiramate ?

though topiramate has annyoing side-effects at the required dose

Double-blind, placebo-controlled trial of topiramate augmentation in treatment-resistant obsessive-compulsive disorder.

http://www.ncbi.nlm....pubmed/20816027

 I thought about turmeric and did some reading on it. But I'm still not sure what I should get. Is it the 'curcumin' I should take in supplement form? That's also the BDNF booster, right?

About topiramate: I've knew some one taking this for OCD years ago. As the brand name Topamax and not as an augment to an ssri but as a mono-therapy. But I'm not sure how she's been reacting to it.

To conclude for now: I would like to stay as far away from any sedative and/or toxic psych-drugs as possible.
No classic/a-typical anti-psychothics and no benzodiazepines.

I'm open to clomipramine (aka anafranil) or another SSRI if nothing else works. I've looked at fluoxetine ('good old' Prozac??) but maybe I would go back to fluvoxamine because it's been like 7 years. I am 
worried about the tolerance effect of another SSRI though.
I know for sure that serotonin has a good effect on the intrusion, but since you can't cycle on and off with these meds it seems like I should go for something like a serotonin-supplement?

I think I will get L-Theanine today. Last week I;ve been drinking quite strong Chinese green tea and it seemed to make me a less worried and more focussed.


 

[Flex]

Buy some legit Tumeric from the shelf and if this isnt strong enough, buy some pepper to enhance the absorbtion. I would consider the curcumin brands just when it isnt strong enough but the effect is interresting & etc.

I personally just sip the powders as a whole with water but Tumeric can also be cooked with milk.

 

another herb could be be Gou teng aka uncaria rhynchophylla. You can find some other on: https://examine.com/...-rhynchophylla/

or coptis chinensis aka huang lian

Antidepressant-like effect of ethanol extract from Zuojin Pill, containing two herbal drugs of Rhizoma Coptidis and Fructus Evodiae, is explained by modulating the monoaminergic neurotransmitter system in mice.

http://www.ncbi.nlm....pubmed/23702040

 

or ashwagandha, (though it has also some dopamine actions)

Effect of Withinia Somnifera and Shilajit on Alcohol Addiction in Mice.

..Chronic administration of ashwagandha was found to significantly increase GABA and serotonin levels whereas shilajit altered cortico-hippocampal dopamine in mice...

http://www.ncbi.nlm....pubmed/27279696

https://examine.com/...ts/ashwagandha/

 

or scutellaria baicalensis aka huang qin.

 

other than this I cant say much about other supplements like Inositol. You have to ask others about this.

 

Although those suggestions might augment the SSRI´s, it may or may not elevate the risk of PSSD. I dont know, just saying so You can consult Your Doc and ask some academics here or in reddit about any interactions.

http://rxisk.org/pos...sfunction-pssd/

 

maybe Theanine and/or Tumeric is enough. just see for Your self.

Edited by Flex, 16 August 2016 - 09:08 PM.

[Catwoman]

Well I did not succeed in buying L-theanine. I've been asking at 3 different health stores with high quality supplements but they dont sell it anymore.
Might order it online...

Flex, you seem to know much about the (chinese) herbs.
I've been on powder form combinations of different chinese herbs, the effect was monitored by my acupuncturist(this was pre-SSRI, about 8,9 years ago). I have no memory of the names of the mixtures but most of tasted really bad! Also they had no effect on the intrusive thought.
The ones you mention might by totally different herbs though. I will do some reading on them!

I already considered ashgawanda. But there's much which -could- work for my Pure O...I got a little lost in all the choices! And because I dont have the funds to try more than two of maybe three...I must know which has the highest succes rate for me. Thats gonna be difficult beforehand :-(

Edited by Catwoman, 17 August 2016 - 04:40 AM.

[the_apollo]

Okay so I got to ask; who said that one goes into "remission" with obsessive compulsions (OCD)?

Having OCD problems myself, i've done some researching into what causes OCD, and to my knowledge, it's unlikely to go into remission from OCD,

since it's a mental disorder that is (said to, not definitive) be caused by genetic malfunctions causing abnormally low serotonin levels in the basal ganglia,

additionally: by low serotonin in a circuit in the basal ganglia that inhibits signalling from the thalamus to the orbitofrontal cortex, causing too much signalling to the parts causing obessions and/or compulsions.

Personally, I'm putting my hope into future pharmaceuticals or medical advancements, mainly with gene-editing, CRISPR editing is one medical advancement I'm keeping an eye on.

 

Anyway, in regards of increasing serotonin levels, if you feel an SSRI doesn't do everything it needs to, even if you feel like tolerance has occurred,

it should usually not present any problems trying a supplement that increases serotonin, just be cautious with L-tryptophan, and herbs that blocks MAO-A,

to avoid pesky thinks like 'serotonin-syndrome'. Start low and move up.

And oh, while I'm on the subject, MAOIs is another way to go when treating OCD, as they work by blocking the enzymes responsible for breaking down monoamines,

but is usually not talked very much about if already on an SSRI as SSRIs and MAOIs don't mix very well).

Another alternative to SSRIs is the pharmacological predecessor to SSRIs - tricyclic antidepressants, though I don't know much about this, I do know that they have sometimes been used in replacement for SSRIs when they don't do the trick.

 

Lastly, to actually answer a question of yours, if your SSRI-medication "poops out", supplements that increases serotonin should still work, Yes.

Take for example L-tryptophan, it is the precursor for serotonin, it simply metabolizes to serotonin, while SSRIs works by sneaking into the synapses and blocking presynaptic re-uptake of serotonin, totally different ways of achieving effect.

 

[Catwoman]

Thank you so much Apollo. This has been very helpful!

I'll have a talk with my psychiatrist next month. I hope he will be open to alternative methods like the serotonergic supplements. I have no idea if they will have any effect. 

I've been responding well to SSRI's, so that would fit the genetic malfunctioning you described. It doesn't run in the family, but addictions like gambling and smoking do. And I'm almost sure that my grandmother was an obsessive cleaner.

But now I am confused about the glutamate. This got my interest: https://iocdf.org/ex...nion-glutamate/
I'm not sure how I can know if glutamate modulation will be effective for me. I have no compulsions but my research for remedies has become quite obsessive. It calms me a bit.

 

[NinefingerJoe]

I remember in the psychiatric hospital the psychiatrist suggested I take Risperdal, I told him to go fuck himself.

Has there been any research on aripiprazole having any effect (alone or in combination) on OCD?

[Mind_Paralysis]

I remember in the psychiatric hospital the psychiatrist suggested I take Risperdal, I told him to go fuck himself.

Has there been any research on aripiprazole having any effect (alone or in combination) on OCD?

 

Yes, there is some evidence. Check out this recent overview:

 

http://www.medscape....rticle/778119_4

 

The reason why Dr.'s keep suggesting Risperidone is because it's the only atypical which has actually gone through thorough testing and review, and shown efficacy.

It works, but it has side-effects.

 

Whether you want to use it or not, of course depends on how severe your OCD is - if you pretty much cannot function anyway, which is the case in treatment-resistant OCD, then there is absolutely nothing to lose - a flattening of affect would seem preferable in such a case, now wouldn't it?

 

If I was to vaguer a guess though, Aripiprazole could well turn out to be just as effective, and the even newer Brexpiprazole as well - with far fewer side-effects. There aren't any big studies though, so it's all guesswork.

 

Two reasons why Atypicals might be effective are the following two new findings via fMRI-scanning of OCD-brains:

 

1. Anxiety-disorders show ENHANCED serotonergic neurotransmission. If OCD is a anxiety-disorder, then the 5ht-blocking effects of antipsychotics will have a profound effect. SSRI's are nearly useless, IMNSHO!

 

2. OCD-brains showed increased DOPAMINERGIC neurotransmission! 0_o Not to the extent of schizo's, but in a certain region, more than neurotypicals.

 

 

If you think about it... it's not so weird, now is it? OCD-ers show manic behaviour when doing their compulsive tasks, they can even hear voices!

(I know this, because I suffer from S-OCD - Suicidal Ideation-like Obsessive Compulsive Behaviour -  an inner voice telling me that I don't deserve to live, since I cannot perform at, frankly, SUPERhuman levels. This could be a source of my burnout even.)

 

The difference of course being that it's always their own voice, and they know it's their own voice - the delusions of OCD are never more than a slight, slight pinch, something fussy and uncertain, that something bad will happen if the rituals are not performed. In schizo, the delusions are clear, and have obvious, to the sufferer, reasons.

 

It's also a known fact that stimulants, Methylphenidate and amphetamine in particular, which are highly dopaminergic, can INCREASE OCD-symptoms in non-hyperactives which take the compounds - high dopamine makes you fidgety as F*CK.

 

I actually have genes which show enhanced dopamine-synthesis, which makes me a high-achiever, a go-getter - problem is, I also have impairments which makes such behaviour impossible - hence, DISEASE.

 

 

Anyways, here's the references, draw your own conclusions. (YES! I'm in a terrible mood this evening! >: [  )

 

Neurobiological model of obsessive-compulsive disorder: evidence from recent neuropsychological and neuroimaging findings.

http://www.ncbi.nlm....pubmed/24762196

 

Role of dopamine in the pathophysiology and treatment of obsessive-compulsive disorder.

http://www.ncbi.nlm....pubmed/20136383

 

Preclinical, neuroimaging and neurochemical studies have provided evidence demonstrating that the dopaminergic system is involved in inducing or aggravating the symptoms that are indicative of OCD.

 

 

There are also studies showing the opposite.

 

Either there is simply the problem of some of the patients in certain studies being undiagnosed with ADHD, which would explain why dopamine-agonism HELPS their OCD, or there are simply two or more different classes of OC-Disorders.

 

That, or the relationship is not stable, and it is in fact MODULATION which is the key - if that is the case, then the SDAM's, wherein Rexulti is the the first (or second, depends on if you'd count Abilify) could be a break-out effective medication.

 

Again, draw your own conclusions.

[Catwoman]

Hi Stinkorninjor, thanks again for all the information. You seem to have more patience than I when it comes to searching and reading up on those articles.

I'm almost sure that -in my case- it has much to do with serotonin, but there must be other stuff at work too. It's just too simple to throw it all on serotonin. The SSRI's did a good job.
Fact is, I don't have the typical compulsions.

There is a 'addictive' component though: I can't let the searching online go. I just NEED to have my issue fixed. And if I find something promising with Google, I can get this calming feeling, a feeling of reassurance.

Fortunately, I can do without my phone or the internet and I -can- feel OK when I'm not in the position to look on Google or forums. At first I will feel a little uncomfortable, but then I'll just go do something else.
I'm also learned to stop the ruminating to a big degree.

I can imagine that my sort of OCD can be linked to addictive behaviors and brain patterns. here are similar processes going on in OCD brains and in addicted brains. 
There's addiction running in my family (alcohol, gambling) so I wouldn't be surprised.

I don't think I would go the 'Atypical route'. I am able to function and I would like to keep it that way :-)

Oh...Did your mood improve over the weekend? I hope so!




 

[Catwoman]

I was reading an article on Crazy meds on tolerance/poop-out. What he writes makes sense when you want to stay on the psych meds train.
https://www.crazymed...ass/SSRIPoopOut

And he suggests trying 5HTP or trypthophan, so I might just try that first before talking to a new psychiatrist.

My mood is going up and down the last few days, and the Pure O does too.
Friday was an awfull day (depression thanks to withdrawal) and yesterday I went out, had some cocktails and I did have fun, despite the intrusive thought popping up now and then. When I'm feeling relaxed and don't pay too much attention (thanks alcohol) I can manage a little bit better.
Serotonin and gaba and at work?

 

[Flex]

sry for the late response, I wasnt able to answer You.

 

I just wanted to give You some suggestions to start with and yeah, Coptis chinensis is the Naplam of bitters. the bitterness stays in You mouth for half of a hour^^

TCM and Ayurveda (the one with "medicinal" heavy metals....) is a different story. some swear it works as other people claim about homeopathy.

 

The things is that they have a traditional theory and assign (iirc) a property to a herb like cold, sweet and so on and they say that Your disease is because of too much yang or blood-stasis(which doenst exists) &etc.

However this isnt scientifically proven, so theres a chance that You get the wrong herb/combination.

 

It must be said that studies could be also flawed for any reason and should afaik therefore only taken as a hint. Its the consensus of several studies that brings an evidence(if I´m not mistaken).

 

reddit is a great place to ask about further informations because of the academics btw.

[Catwoman]

sry for the late response, I wasnt able to answer You.

 

I just wanted to give You some suggestions to start with and yeah, Coptis chinensis is the Naplam of bitters. the bitterness stays in You mouth for half of a hour^^

TCM and Ayurveda (the one with "medicinal" heavy metals....) is a different story. some swear it works as other people claim about homeopathy.

 

The things is that they have a traditional theory and assign (iirc) a property to a herb like cold, sweet and so on and they say that Your disease is because of too much yang or blood-stasis(which doenst exists) &etc.

However this isnt scientifically proven, so theres a chance that You get the wrong herb/combination.

 

It must be said that studies could be also flawed for any reason and should afaik therefore only taken as a hint. Its the consensus of several studies that brings an evidence(if I´m not mistaken).

 

reddit is a great place to ask about further informations because of the academics btw.

Hi Flex, thanks for the reply!

I took Chinese herbs (powder form, mixed with hot water and most of the combinations tasted bitter) for about a year and combined this with TCM. I had acupuncture and later on auricular acupuncture. She studied my tongue and felt my pulse on different parts of my wrist every time I saw her. The treatments never really lessened the Pure O, but I think it helped me deal with it. I felt a little calmer and my moods weren't as low as before.

After a year or two I realised it wasn't really going anywhere. I still wanted to get rid of the Pure O thought ( still wasn't having any other intrusive thoughts than the one I'm having now, it's always been the same), so I stopped with the treatments and tried CBT.


About Reddit, I don't really get it. I read somewhere at the ask-section that you're not supposed to ask advice on personal matters, medical advice, etc?
But how am I to explain anything or get advice on supplements or meds when I can't say anything personal?
Or do I need to be in another section of the site?

[Finn]

Antidepressant tachyphylaxis describes a condition in which a depressed patient loses a previously effective antidepressant treatment response despite staying on the same drug and dosage for maintenance treatment.

 

 

tachyphylaxis (also known as antidepressant tolerance, antidepressant “poop-out,” or “breakthrough” depression)

 

 

http://www.ncbi.nlm....les/PMC4008298/

 

So that might not count as poop-out, since it is layman term for tachyphylaxis. Now whether the mechanism for antidepressant stopping working during the treatment and antidepressant not working after stopping the treatment and restarting it months or years later is the same, I don't know.

 

For most adult disorders, you are usually supposed to stay on the drug as long as it works, so if you manage to find something that works for OCD next time, don't quit taking it until it becomes medically necessary to quit it. 

 

Agomelatine has had some case reports of positive results for OCD.

 

 

https://www.reddit.c...ad_at_least_25/

Agomelatine cured my OCD that I've had at least 25 years.

I'm not here to promote any pharmaceuticals and generally I'm against medicalization. I have been suffering from dermatophagia (biting flesh from around fingers) since I've had 'Legos' in my mouth. I'm 30 years old, so you can do the math. I'm also diagnosed as being bipolar type 2 + Generalized anxiety disorder. I have taken SSRIs, and every other pills that didn't do much to help me cope with bipolar nor anxiety and I always thought that I'm going to eat my fingers for the rest of my life. It was not big deal, that habit was part of me. Everything changed when I started to take Agomelatine. I kind of forgot the whole routine of finger biting. It was really bad before, I mean bleeding fingers didn't stop me from doing it. Now my fingers are almost like new.

 

 

Edited by Finn, 29 August 2016 - 09:12 AM.

[Catwoman]

 

Antidepressant tachyphylaxis describes a condition in which a depressed patient loses a previously effective antidepressant treatment response despite staying on the same drug and dosage for maintenance treatment.

 

 

tachyphylaxis (also known as antidepressant tolerance, antidepressant “poop-out,” or “breakthrough” depression)

 

 

http://www.ncbi.nlm....les/PMC4008298/

 

So that might not count as poop-out, since it is layman term for tachyphylaxis. Now whether the mechanism for antidepressant stopping working during the treatment and antidepressant not working after stopping the treatment and restarting it months or years later is the same, I don't know.

 

For most adult disorders, you are supposed to stay on the drug as long as it works, so if you manage to find something that works for OCD next time, don't quit taking it until it becomes medically necessary to quit it. 

 

I guess I will find something which works, eventually.... and keep combining this with all the good stuff like diet, exercise, meditation and maybe some therapy as well (though I'm not sure there is much learning left).

I wasn't planning on stopping escitalopram either, three months ago. 5 mg seemed like a good maintenance dosage. For me it kept the Pure O at bay (or at least I thought it did). Maybe the dose was too low, I don't know. Fact is, is seemed like it suddenly stopped working...and I'm very worried that another SSRI won't do the trick OR that it will work but poop out a few years later....

 

Edited by Catwoman, 29 August 2016 - 09:15 AM.

[Finn]

To add on my previous comment on agomelatine, if it doesn't cause liver problems at the beginning for you, it is relatively mild and nice substance to stay on indefinitely. Agomelatine is a naphthalene analog of melatonin so it might cause liver problems for some people, but apparently it can also be liver friendly for some people, which could be due to it's 5-HT2B antagonism

 

https://www.ncbi.nlm...les/PMC3428919/

 

It is also by it's mechanism totally different from SSRIs, so if SSRIs don't work anymore consistently, it might.

 

 

[Quaker32]

Has anyone seen this before regarding poop out? http://www.dr-bob.or...e-response.html

 

http://content.karge.../Abstract/72662 Maybe it reverses tolerance for the antidepressant effect as well?

 

"Date: Fri, 16 May 1997 09:20:19 -0700 (PDT)

From: ferrell@cmgm.stanford.edu (James Ferrell)
Subject: Naltrexone for SSRI poop out

Lee Dante wrote, in part:

 

This phenomena of the SSRI "poop out" can usually be reversed by adding 25 mg of naltrexone (marketed in the US as Revia), usually on top of supper to avoid transient nausea. In anywhere from two weeks to five of once daily dosing the SSRI regains the full effect and often is perceived as working better than it did at first. I have done this in over forty cases where this has been most gratifying. At this dose of naltrexone the incidence of side effects is very low, and the improvement is sustained over a period of years. It has been the end of poop out in my practice.

 

Date: Sun, 18 May 1997 11:53:46 +0500
From: "Dr. Niraj Ahuja" <niraj@giasdl01.vsnl.net.in>
Subject: Naltrexone for SSRI poop out

That reminds me of a patient with opiate dependence in the post-detox phase. He was receiving 20 mg of fluoxetine for a comorbid major depression and was improving when naltrexone 50 mg/day was added. Within 4 days, he was hypomanic. On discontinuation of fluoxetine (on the presumption of a SSRI-induced hypomania), he returned to his previous baseline over a period of one week. At that time, I did not think much of a possible interaction between fluoxetine & naltrexone. Now, I begin to wonder!

 

Edited by Quaker32, 29 August 2016 - 12:57 PM.

[jaiho]

Some psychiatrists i converse with believe that SSRIs require either an anti psychotic, or a TCA to keep it effective in the long term.

Anti psychotics are used nowadays instead of TCAs, because they are generally safer in overdose.

The biggest liability to doctors is patient self half when prescribing drugs, and if theres an adverse reaction, or the patient gets worse, they will try to kill themselves with the pills prescribed.

Do this with a tricyclic and there's a chance of death.

SSRIs & anti psychotics are safer in that regard.

 

Adding something like Nortriptyline boosts an SSRI immensely in my experience, if people are against anti psychotic use.

[Catwoman]

Some psychiatrists i converse with believe that SSRIs require either an anti psychotic, or a TCA to keep it effective in the long term.

Anti psychotics are used nowadays instead of TCAs, because they are generally safer in overdose.

The biggest liability to doctors is patient self half when prescribing drugs, and if theres an adverse reaction, or the patient gets worse, they will try to kill themselves with the pills prescribed.

Do this with a tricyclic and there's a chance of death.

SSRIs & anti psychotics are safer in that regard.

 

Adding something like Nortriptyline boosts an SSRI immensely in my experience, if people are against anti psychotic use.

Thanks for your feedback!
I am not willing to go the anti-psychotic route. I know a low dose is being used as an augment treatment for OCD and that this seems effective for some people, but I just feel that there are better options with less side effects. All psych drugs are toxic, some to a higher degree than others. It would rather have the single Pure O thought than poisoning my brain with haloperidol or risperidone.

The problem with the SSRI's for me is that they work great for the first few years. I was on Luvox and it felt it kicking in 4/5 weeks later. When the Pure O came back, I tried Luvox again and it didn't work anymore. The same with Lexapro (although I wasn't off Lexapro technically, but the increase of dosage just didn't help me with the Pure O).

So in theory SSRI's could work again.
The problem is...looks like they don't work for the long term and it seems that I may need them for the long term....or till a point where I can resolve things with therapy, diet en meditation alone.

What I gather from the topics I started and the advice everyone gave me I can talk to my psychiatrist about alternative / experimental drugs like memantine, SSRI's or a TCA.
Don't prefer the TCA because of side effects, but when chances on tolerance are smaller I am willing to try it.

Or I can go see naturopath / choose vitamins and supplements and go the trial & error route to see what will work. Either NAC, inositol or SAM-e.


There's much to choose from...I guess I need some patience and new courage as well.

Edited by Catwoman, 30 August 2016 - 10:19 AM.

[jaiho]

Nortriptyline actually has very little side effects compared to other TCAs, being predominately an NRI. 

TCAs get a bad rap due the likes of clomipramine which are potent SNRIs, and along with that have strong anticholinergic side effects.

 

The benefits of Nortriptyline come from its 5ht2a antagonist properties, which is why anti psychotics boost SSRIs so well. Then you have the added benefit of the NRI also boosting anti depressant response in conjunction with SSRIs.