I apparently have very treatment-resistant OCD. My pdoc hasn't said it, but I have gathered this from my profound lack of insight into my obsessions, psychotic preoccupations, and the fact that OCD is not only interfering with life, but treatment as well.
I have tried novel strategies like memantine (30 mg), lamotrigine (400 mg), zonisamide (400 mg), topiramate (400 mg), etc. I've tried somewhat high doses of SSRIs (my pdoc hates prescribing anything at max dose) (fluoxetine 80 mg, fluvoxamine 100 mg (nightmare), escitalopram 10 mg (nightmare), sertraline 200 mg), SNRIs (venlafaxine XR 825 mg!!, duloxetine 120 mg, desvenlafaxine 150 mg, Fetzima (joke...)), Viibryd 40 mg, Trintellix 20 mg, etc., clomipramine 225 mg. I've tried various antipsychotics (typical and atypical) alongside SSRIs: fluphenazine 1 mg tid, perphenazine 4 mg tid, trifluoperazine 5 mg bid, haloperidol 1 mg tid to 5 mg x1, pimozide 2 mg bid, etc. Nothing seems to really help. Basically, if there's a way to treat it, I've probably tried and failed it or tried it partially due to conservative prescribing habits of my pdoc.
I have not tried low-dose clomipramine + SSRI, supratherapeutic doses of SSRIs (pdoc won't hear of it...), higher doses of typical antipsychotics (for acute psychotic preoccupations), certain antipsychotics (thioridazine, clozapine, etc.). I'm thinking about seeking a second opinion from another pdoc soon because my current pdoc is no longer helping me. She just keeps me on the same useless regimen and never wants to change anything, pats me on the back saying "you're better than you think you are," and sends me on my way. The office staff are severely understaffed, and one of them in particular always bitches me out after my sessions because it's so late, but it doesn't matter if I take 5 minutes or 55 minutes... she's going to bitch me out no matter what about it. She never says anything to the people who go back there and take two hours though. Just me, because I'm at the end of the day. It royally pisses me off and I'm about to snap at her, and I really don't want to (the office staff person). I'm also about to snap at my pdoc and ask if she'd rather the meds kill me or me kill me due to inadequate medication. I know meds aren't all there is in treatment, but she seriously has to budge for something to change.
I am seeing a therapist, but he's new and still getting to know me, so nothing has been done yet. He's taking notes and asking thorough questions though. I like him so far. He actually has a white dry-erase board in his office that he uses to illustrate things he's trying to convey to patients, and he's the only therapist with one in that whole office. I wish I could see my original therapist though. She's known me since I was 9 years old... She knows me like no other mental health practitioner knows me, and has the most extensive history on me. Last I saw her, she was in "partial retirement," which meant she blocked off half her office to this new guy (ex-pastor gone family counselor), disposed of all her notes on all her patients, sent half of her patients to this new guy, and kept the other half of her patients (mostly younger patients she said). I saw her twice or 3 times during that time, and she dismissed me after that. I wasn't really seeing her for my own purpose, but because of a problem I had I didn't know how to deal with. I tried calling her semi-recently when I was looking for a counselor several times, texting her, everything, and never got an answer, so I assumed she fully retired.
Anyway, I didn't mean to digress so much in this post.
I hate being on adderall. I can't seem to work when i'm not on it. I'm on 15 mg now. It's working, but I feel speedy & have a hard time sleeping. I'm wondering If i go down to 5 mg, if I can still get some work done.
Does anyone just take 5mg of adderall?
So about 5pm every day of late, my mood just turns black. I can't buy a neutral (forget positive) cognition or emotion, I start to feel and think very negatively no matter what I do. Of course, I'm feeling and thinking badly beforehand, but it just sinks to another level, or depth if you will.
So I'm wondering if it's a med (or meds) that I'm taking that's losing effect around 5pm. I take the following meds - yes, it's a crazy-looking brew I know, but it allows me to function somewhat - at 6am (in milligrams):
200 Provigil, 2.5 Abilify, 40 Fetzima, 30 Lexapro, 15 BuSpar, 150 Lyrica, 10 Percocet and these at 2pm:
150 Lyrica, 15 BuSpar and these 4 times a day, where the last dose is typically 2pm:
15 Adderall 10 Percocet (for chronic pain) and these at 7pm for sleep:
150 Trazodone, 50 Benedryl It's impossible to confidently predict a "culprit" but if anyone has any hunches, I'd love to hear them.
For example, today I'm splitting (some of) the 6am batch into two and taking the second half at 2pm as an experiment. I feel that empirical experimentation might be the way to go because the theory is too complex with this many psychotropic medications in play.
Cheers , Pete