5 replies to this topic

[t0rp3d0]

Thanks beforehand: I appreciate any help!
I've suffered from OCD for a long time now. I don't like the drug I was on (fluoxetine, ie prozac) so I've stopped. I've been off it for about 2 and a half weeks, at some points since then anxiety has returned with my OCD (in particular the obsessions, I can *mostly* refrain from any compulsions). In this time I've taken Ashwagandha, EFAs, and Multi-vits, while maintaining a healthy diet. I don't know whether the ashwagandha has been of any benefit, because I haven't got a control to compare it to (started taking ash as soon as I dropped fluox).
But point is I feel still pretty shit in terms of OCD (going back on SSRIs isn't something I want though), and I am still slightly depressive and unmotivated/lethargic.

This thread details some of my symptoms:
http://www.longecity...nergy-and-mood/

I would love for someone to suggest a substance to take daily that's safe and has few or no side effects.
So far I've been looking at: Kava root extract.

Again, thanks a ton to any helpers.

P.S, I don't want to be too sleepy or cognitively impaired... I love things that require the analytical side of me, unfortunately that coincides with my OCD quite often. Also, rather than just being safe for temp use, long term would be preferable... until I try some self CBT to work through it.

[addx]

Try memantine low dose, one pill a day(10mg) take it in the morning as it is a little activating(it is a D2 agonist amongst other things). You'll see if it works soon enough, you dont have to wait weeks. There is some cognitive decline with memantine initially(few days) so it is tapered in initially in steps of 10mg usually, but aiming for a low dose of 10mg means no titrating at all. There is no withdrawal and the main effects being as soon as the pill is digested as far as I have noticed. I used it 3 times to stop obsessions but I've learnt I shouldnt be on it all the time for some reason, maybe I was using too much. I think the key is low dose, it's half life is long, 60-80 hours because it doesn't metabolise, it is just extected as is(which is good for sideeffects and toxicity - there is none). So the doses add up over days.

Anyway it's effortless to try it when comparing to other meds. Sideeffect panel is extemely benign and there is no addiction or withdrawal with it and you see if it works immediately.

Memantine is for alzheimers, so this is off-label use, but trust me, and if you don't trust me, there's pubmed studies about memantine that prove it's efficacy for a wide array of disorders, it is often better than 1st line treatment. In one study it stopped acute mania in all participants even without causing depression. It also seems quite effective for OCD -> http://www.huffingto..._n_1552012.html

Memantine achieves its effect by antagonizing NDMA receptors but only during pathological Ca+ influx - meaning it cuts extra strong currents but doesnt touch the normal ones. This normalizes many disorders as emotionality goes through NDMA networks(NDMA networks facilitate modulation of these and facilitate memory storage of these in a way). NDMA networks are able to amplify or reduce signals that go though them, they're more of an internetwork.

You can compare it to lithium. Lithium blunts Ca+ currents although it does do this by attaching to the NDMA receptor but nevertheless. The main difference is lithium blunts proportionaly and memantine blunts only strong currents. Thus lithium causes a slight cognitive/depressive decline while memantine does not(at least not in this way).

If you're feeling frisky, visit the jdtic group buy thread and maybe get some insight into how this stuff really works.

Edited by addx, 13 August 2013 - 12:34 PM.

[celebes]

Buspirone. It's not effective for everyone but when it does work it does wonders.

You need to take at least 10mg 2-3 times a day and it might make you feel worse for the first month. It is as or more benign than memantine though, with no dependence or withdrawal, and generic hence cheap. The only side effect I have ever had taking it is feeling so relaxed that I am compelled to nap - and then only occasionally.

Paracetamol increases natural cannabinoids in your brain. It shouldn't take more than a few days of taking one 3 times daily for you to figure out if it works for you. More for the OCD than depression.

Regarding supplements, personally I've had nothing but bad experiences with ashwagandha.

Curcumin (BCM-95) and uridine (UMP) really do work wonders. Curcumin will crush your testosterone though, and even more so when combined with fish oil. No downside to uridine apart from the price. Glutathione is implicated in OCD and D3 can increase levels >25%. Softgels not powder. K2 is also anxiolytic (majorly, for me). Make sure to get the MK4 from Carlson or AOR. And if you do nothing else, take zinc (monomethionine is best). It will do you reams of good.

I have a feeling the supplements might be enough to pull you together a fair bit. But definitely give buspirone a month of your time if you can.

[nupi]

Inositol has some decent research behind it for pure OCD. Did not do a thing for depression in my case.

[nowayout]

Is there a possibility of doing CBT with a professional rather than thinking in terms of of getting on more pills long term? It may be cheaper and if it works it is obviously a superior choice. I am not sure self-CBT is going to be all that effective, especially given that you seem to be a procrastinator from the tone of your post.

[Tom_]

The reason people use SSRIs (and other psych drugs is because they work - or at least have been shown to). The low down is, they are your best pharmacological choice. A two year course is likely to see you right. In combination with CBT or another evidence based therapy as well as some behavioral work for moderate OCD they are the best option you have.

I know what the side effects of SSRI's are like, let alone the MAOI's I'm on. So I'm going to make this a three part answer: advice on approved/reasonable off license drugs with a focus on minimizing side effects, nootropic supplementation and psycho-social interventions.

Mirtazapine, Moclobemide, Paroxatine & Sertraline are your best options. The first two aren't approved for OCD and Moclobemide doesn't have much of an evidence base but its very much tolerable with no sexual side effects and not likely to cause weight gain. Mirtazapine has a large evidence base although tends not to be approved in most countries for OCD. Its most severe side effects are weight gain (mostly mediated though increase in appetite) and somnolence - taken at night its likely to irradiate insomnia. It doesn't effect sexual function negatively and like Moclobemide may actually improve it.

Paroxatine and Sertraline I won't bother telling you about as I assume you know plenty enough about SSRI's.

Mirtazapine can be combined with an SSRI to produce a very potent antidepressant/antiobessional effect. Something like Sertraline and Mirtazapine will to an extent cancel out each others side effects in most cases. Low doses used together for a year + will likely irradiate the syndrome.

I would strongly urge you to try another non SSRI psychotropic. Moclobemide is an excellent candidate.


Nootropic supplementation options include alone or together:

NAC in doses of 1600mg/day
L-Tryptophan 2-6 grams/day
Phenibut 500-1000mg USED ONLY FOR PRN
L-Theanine 200-400mg
SAMe
Omega 3 can't hurt

Psychotherapy:

First line treatment is CBT. Book or online has been shown in one or two fairly large studies to be as effective as face to face for mild to moderate depression and anxiety. The trick is plugging away at it for a few weeks until you start to see effects. None the less if possible I would recommend face to face CBT if possible in a group setting.
Working out a behavioral desensitization & activation program can really improve your situation and results can be seen almost as fast as antidepressants.

CBT is very effective and my go to recommendation. It does like all treatments have its draw backs however. It doesn't do much for emotional and social processing and is highly structured - playing to the strengths of the average OCD sufferer...which is useful but it also doesn't help improve on your weaknesses. Being in a group setting will amolilate some of those negatives. IPT for depressive disorders is equally effective, although unlikely to help overly much with OCD unless the obessions are very much socially based. An integrative therapy with some of the structure of CBT and some of the more interpersonal qualities of IPT could be ideal, again in a group setting being the better option.