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OCD/Other Anxiety and Medications


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Hi Everyone,

I'm new here, but I'm not new to OCD or anxiety disorders.

I'm a 24 year old female, and I have always been an anxious person, for as long as I can remember. It definitely runs in my family, since my parents are both very anxious people, as are some of my other relatives.

I have had symptoms of OCD (counting, checking, etc) since I was a child. I was also a 'worrier', and I had panic attacks, even back in elementary school. I kind of just dealt with my issues (badly - I missed out on a lot of fun childhood things), but my OCD started getting much worse when I was about 13.

I started having major worries about diseases. I would mostly obsess about HIV and STIs. I would spend hours checking myself for symptoms, and constantly reading up about the diseases online. I went for countless tests that always came back negative, but I always had a new (usually ridiculous) scenario about how I could have possibly caught something.

The extreme anxiety made me depressed. I was also still having major panic attacks almost every day (unrelated to the OCD - I had a fear of throwing up, especially in public). I also just worried about everything in general, and everything (especially the OCD) was way out of control.

I started going to counseling at age 15, and a psychiatrist prescribed Luvox for me. From the beginning, I was really sensitive to the drug. I was started at 25 mg, but I was so sick that I couldn't even sit up without feeling extremely seasick. I would puke and/or pass out if I had to stay sitting up or standing. I remember crawling to the bathroom and barely making it.

My psychiatrist dropped me down to 6.25 mg, but I was still too sick to go to school for a day or two. Eventually, things got better, and I ended up on 50 mg permanently (I know that's not supposed to be a therapeutic dose, but it did work for me). However, some of the debilitating side effect never went away. The most major one was constant sleepiness. I would sleep for 12-16 hours a day, but I still couldn't stay awake in class. My teacher could be looking right at me, but I still couldn't force myself to keep my eyes open.

I actually stayed on the Luvox for eight years, until I was 23. I was always able to kind of work around the sleepiness by taking tons of naps before that. But then I started a job, and I got in trouble for falling asleep at my desk. I knew that I would never be able to stay awake otherwise (I even tried listening to my ipod, and turning my headphones up really loud, but it didn't really help).

Now I've been off the meds for almost a year. My OCD is coming back somewhat , but I also just have major anxiety about everything (driving, finding a new job since I left my last one, my relationship, leaving my dog during the day, etc). My new counselor thinks that I need to be on medication again, and I totally agree with her, but I'm so concerned.

She wants for me to start on Effexor XR 37.5 mg (she called my general practitioner, and he agreed to write the prescription). I'm concerned because that seems like a large dose to start at, given my past history with having a major reaction to small doses of antidepressants. I also heard that a lot of people had really bad experiences with this drug. In addition, I am concerned about sexual side effects a lot. I had some with the Luvox, but it wasn't absolutely horrible - but I have heard that in general, Luvox might not cause them as much as Effexor.

Does anyone have any thoughts or advice? I know that my options are limited, and I hate jumping around between different medicines.

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Effexor doesn't seem that off the mark for treatment resistant OCD. But that's not what you have. You've tried one medication, which didn't work out.

It would make sense to try at least one more SSRI before tossing the class completely. So that would be something to talk over with a doctor.

And then try Effexor? Maybe. It can help for OCD for some people. Some people on the board have found it helps.

You might want to read this short summary:

Venlafaxine in treatment-resistant obsessive-compulsive disorder.

My bigger concern?

That your counselor is dabbling where no counselor should.

It's not their place to be recommending specific medications for you, nor to go so far as to call your GP to see if they will prescribe a med for you.

It's called boundaries. And your counselor has crossed them. It doesn't mean they are bad, I'm sure they want to help. But it does mean they are trying to help with something that they simply don't have the training for.

I know they called your doctor, but your doctor doesn't have the training to manage OCD either.

My recommendation would be to find a psychiatrist.

You will get the most appropriate care that way.

If you are having trouble finding a psychiatrist, maybe we can brain storm about it.

I hope you get this all figured out.

Luna

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What Luna said.

Also, I take Effexor XR for OCD, and it works very well. The starting dose is 37.5 mg. I'm pretty med-sensitive too, so I'm only at 150 mg. Works like a charm, though. Kind of stumbled on it - I didn't realize I had OCD and neither did my psychiatrist as it's more obsessions than compulsions, and I always assumed it was GAD (so did my last therapist). I found it worked, and my psychiatrist and I figured out I have OCD.

Another recommendation that I would like to suggest is finding someone who is trained to treat OCD. I'm going to guess your counselor isn't, otherwise you wouldn't be having the problems you have right now - or it at least wouldn't be so severe. CBT is good.

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I guess response is really an individual thing. Makes me wonder if I should try some other things to see if I can get my remaining depressive symptoms under control.

My doc tried to get me on effexor but I chickened out since Ive had bad brain zaps and discontinuation from other meds already.

What Luna said.

Also, I take Effexor XR for OCD, and it works very well. The starting dose is 37.5 mg. I'm pretty med-sensitive too, so I'm only at 150 mg. Works like a charm, though. Kind of stumbled on it - I didn't realize I had OCD and neither did my psychiatrist as it's more obsessions than compulsions, and I always assumed it was GAD (so did my last therapist). I found it worked, and my psychiatrist and I figured out I have OCD.

Another recommendation that I would like to suggest is finding someone who is trained to treat OCD. I'm going to guess your counselor isn't, otherwise you wouldn't be having the problems you have right now - or it at least wouldn't be so severe. CBT is good.

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  • 2 weeks later...

Ugh - I still really don't know what to do. I called around to some psychiatrists' offices, but the only appointment that I could get last week was with a psychiatric nurse practitioner. They assured me that he has a ton of experience, so I went to him. He decided that Lexapro would be the best medicine to try. I looked it up, and it seems like a better choice than Effexor XR at this point, but I'm still not super impressed with him. He has never prescribed Luvox, and didn't even know that it is usually used for OCD until he looked it up on his Android phone. He looked up a bunch of different meds on it, which wasn't very confidence-inspiring for me.

We also talked about trying the Luvox again with maybe Nuvigil or Provigil so that I wouldn't fall asleep, but I explained that a doctor has prescribed Provigil to me in the past, only to find that it interferes with my birth control pills (luckily, my pharmacist caught that). This nurse practitioner had never heard of such a thing, and he tried to look it up. He pulled up a website menu with different titles such as 'adverse reactions', 'pregnancy', and 'drug interactions', and he NEVER clicked drug interactions - so surprising that he couldn't find anything about the interference with birth control pills! This made me doubt him even more.

He also thinks that I was doing very well, since I apparently wasn't bouncing off the walls, and I didn't look very anxious. I AM anxious, but it's not always that type - I just freak out about a lot of things and feel doomed, but I don't (except when I have a panic attack, which hasn't been lately), usually display a lot of outward symptoms, except maybe shaking my leg or something.

Then, I went to my general practitioner for my yearly female exam, and he felt the need to lecture me. He said that he is disappointed that I am listening to other people and not trying the Effexor XR, and that I should be looking at the true scientific studies only. He didn't seem to understand that so many people have the most negative things to say about Effexor, and I don't hear the same things about the other drugs. He also wouldn't listen when I told him that some people can never get off the Effexor - he was too busy with his own argument, so he thought that I meant that the anxiety came back when they stopped, since he doesn't really seem to acknowledge the withdrawal effects (not just the returning anxiety). Also, tons of drugs have been out there for YEARS, and they are later taken off the market, because it turns out that they cause major problems. If I am seeing a pattern with the Effexor XR causing a lot of issues, why would I try it first? Why risk it? ESPECIALLY since Luvox DID work for me, but just caused horrible side effects.

I'm not sure what to do. I have the Lexapro now, but still haven't taken it. I have been getting along just fine. It may be a struggle from time to time, but it's not horrible.

I don't want to go back to this counselor, either. I agree that she shouldn't be overstepping her boundaries like this. I wasn't even supposed to be seeing her for my anxiety - I originally went in with my fiance for couples counseling. Then, she discovered that I have anxiety and have been diagnosed with OCD, and she decided that she would like to work with me on it, since she also specializes in that. The problem is that it's like she thinks my anxiety is so major, and I feel like she thinks that a lot of my relationship problems are greatly exaggerated by my anxiety. I know that the anxiety is a bit of an issue, and it does play in somewhat, but I almost get the feeling that she think I am being overly anxious about things - when in fact, my fiance has many issues that people without anxiety would run screaming from.

Last time we went as a couple, I was fighting my tears the whole time, because I just felt attacked. It was like, I said that he's so messy that I can't stand it, and he said it was just my anxiety and that I was freaking out about 'one hair in the shower'. That wasn't true at ALL. I freaked out because the shower was full of hair and mildew/mold. The rooms were so messy that there wasn't room to walk in them. For a long time, he couldn't even use his kitchen because he had so much crap piled up on his counters and stove. Seriously. He let his animals destroy the place. They would go to the bathroom all over, and he would miss it (it would dry before he noticed), and the house smelled so bad that I couldn't even walk in without wanting to gag. When they pooped on the floor, he picked it up with a paper towel and that was all - no scrubbing the rug or anything.

He has gotten a lot better, and things have changed a lot, but still not totally. I know that he was going through a hard time (he had just lost his mother, who lived with him, and was usually there to help with the animals), and that cleaning probably wasn't on the forefront of his mind. That's fine, but when he tells her that I freak out about one hair in the shower (and I know that he was being defensive, because he was upset and embarrassed when I told her how messy it was before), she was just like "yeah, that's pretty OCD". I don't feel like any sane person would want to live like that, and it has nothing to do with my anxiety or OCD - but I guess to her, just prescribing a pill for my apparent insane anxiety will make it all better.

It has been a year since I expressed my concern with his house being a mess, and six months since I told him that it HAS to be clean for me to be happy, and for us to move forward with our relationship. He apparently cleans every day, and there is a ton of improvement, but it's just not where it needs to be, and I'm sick of waiting and listening to promises that it will be done in to weeks, or a month, or whatever.

Apparently though, this is mostly just my anxiety and OCD. She basically told me that he is more laid back than me and that I will always need to give him deadlines rather than just asking him to get it done. I felt like she was making excuses for him, and like she really thinks that I just freak out over one hair or whatever.

It was so embarrassing, and I don't want to go back to her. I know my OCD, and it centers around diseases and obsessing about them (like I said, HIV, STDs, etc). I never had any type of pet or mess anxiety, and I have never been the type to keep a super-clean house, or even close. I also grew up with lots of pets, and I never had problems like this.

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Well, what I can say about the nurse practitioner was that at least he was looking things up, not prescribing blindly based on information that he didn't know/wasn't aware of. That's at least a step in the right direction.... And at least he offered you a different option?

As far as the couples counseling goes, I don't really know what to say there. It does sound like maybe there is some bias going on but it's hard to know without being there, you know? I'm sorry you are having bad experiences right now....

Anna

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Any ideas what qualifications your counsellor has?

There are clincial psychologists with expertise in mental health and the prescription of medication. I dont think its unreasonable for someone with those qualifications to work with your GP on an overall treatment plan.

However, recommending a single medication (ie Effexor) and a dose may be taking it a little too far.

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