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Hi everyone,

I'm new here, I posted an intro topic which can be found here for anyone who's interested :-)

The escitalopram I was using pooped out after 6 years, so I needed to find something new and I saw a psychiatrist recently.
I was put on sertraline 10 days ago. So far so good. No real side effects. I'm on 50 mg,  that's hardly a therapeutic dose, right? I want to go to 100 or a little more, and see how it goes.

What he also said that I could take quetiapine / Seroquel 'as needed'. Never heard of this but I suppose since he's the doctor he would know.
Are there any people here who take an anti-psychotic 'as needed'?

I won't see this pdoc anytime soon....he only does consultations for my general doctor's office, so I can't ask more questions.
I don't know if I have to wait for the sertraline to kick in?

My issues: I call it 'stuck thought syndrome' because the classic Pure O is more about scary/bizarre/agressive/sexual thoughts and I don't have these.
But it has become a big obsession for me to get rid of a certain unwanted thought. It's really intrusive, it comes back often, I get anxious, I try to find solutions, ruminate about it all the time...It's always the same thought bugging me and after 10 years of therapy I'm still not able to let it go. I have a big aversion to this thought so that is probably why it keeps coming back.
Fluvoxamine pooped out on me in 2010, but helped me a lot, later on escitalopram was helpful....but with sertraline I can't tell yet. I hope it will work, and I really dread the antipsychotics because of side effects. I don't know if I'm going to gain weight on it but I really don't want to. 
But maybe I don't need to worry about this side effect because I just take it whenever this thought comes back and gets stuck again?

The pdoc said it's a really good med for getting thoughts 'loosen up' and 'unstuck'. Could be just what I need! 
 

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27 minutes ago, CeremonyNewOrder said:

When I was on Seroquel, I took small doses as needed for anxiety during the day. I've also taken Seroquel as needed for sleep. It did help for anxiety taking it during the day though I got slightly sedated.

Thanks for your reply!

So it helps with anxiety, but what if I'm not anxious from the intrusive thought directly? 
I'm kind of used to having it and I feel this aversion to it. I'm more anxious that it won't go away...ever! It's a depressing feeling but it's also anxiety of course. I worry and ruminate about the medication, about the future...I try not to...but it's hard! 

 

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Seroquel, at low doses (100mg and below,) primarily acts as an antihistamine. There isn't much antipsychotic benefit in that range. I suppose it does act as an anxiolytic for some people, although I wouldn't expect much help with intrusive thoughts. Personally I've never found antihistamines to be beneficial for anxiety, benzos work far better, and in the right dosage, are less sedating. Seroquel/Remeron/Vistaril/etc just make me hungry and sleepy... sometimes. Mostly just hungry.

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1 minute ago, dtac said:

Seroquel, at low doses (100mg and below,) primarily acts as an antihistamine. There isn't much antipsychotic benefit in that range. I suppose it does act as an anxiolytic for some people, although I wouldn't expect much help with intrusive thoughts. Personally I've never found antihistamines to be beneficial for anxiety, benzos work far better, and in the right dosage, are less sedating. Seroquel/Remeron/Vistaril/etc just make me hungry and sleepy... sometimes. Mostly just hungry.

Thank you for sharing. The pdoc didn't mention the dosage, but when you take it 'as needed' I assume you need to take small dosages...
I don't have any problems sleeping (maybe later on, when I'm upping my dose of sertraline?) and the sedating effect isn't what I need or want (even if it could block intrusive thoughts, I still need to drive my car for work).

I don't think I've ever taken anything that has effect on histamine receptors. I hope I wouldn't even need quetiapine anyway but still, I would like to know if this is a good augment treatment for this specific issue.

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Update:
Talked to general doctor this morning who was not happy that I started with the sertraline. The pdoc working for his office recommended it to me, but my general doctor was the one who said I should withdraw from medication entirely last May (great advice....). He saw the quetiapine recommendation and asked me if I wanted to take it. I said I was very hesitant because of the side effects, especially the weight gain. Because I was hesitant myself and not too enthusiastic he said I should wait for the sertraline to kick in first. 

He wants me to stay on 50 mg of sertraline though. I'm not sure that's enough. Maybe it is for situational depression...?

Edited by Catwoman
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Hi Catwoman - I have a similar issue with persistent ruminations that are a huge feature of my depression/anxiety (without being OCD) I get very very stuck on a negative thought and it takes over. I literally can't distract myself out of it. There were some suggestions you might want to read on my post below about it.

Sounds like you've already taken Prozac? I don't recall Seroquel working for this specific symptom, it was pretty sedating for me i'd take it before bed and sort of zonk out. So I guess in a sense, it slows down/mutes thoughts but made me feel a bit of a space cadet . Different doses might not be as sedating though.

 

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Hey Cloudmonger, no never tried fluoxetine. I was looking for a replacement after escitalopram pooped out on me and sertraline was recommended over fluoxetine because sertraline has more dopamine affinity and that is what I could use. Lexapro made me kinda sluggish and unmotivated. Pdoc says I should go over to clomipramine if sertraline doesn't work out but I might ask for Prozac. It has a better side effect profile and since SSRI's worked for me in the past I don't see why I should switch over to a much less selective med?

To me it seems like there are better options than Seroquel. I'm not super anxious, like you I just can't stop worrying and ruminating, but in my case it is coming from the same obsessive thought. I'm extremely aware and have this big aversion to thinking 'it'. It is a OC-spectrum disorder. Pdoc and psychologist say that I must try to let be and let myself go, and I try, but it keeps coming back, driving me crazy sometimes.


 

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Hey, thanks for replying!

I'm under the impression that the type of intrusive thought I am experiencing isn't exactly the same as Pure O thoughts or intrusive thoughts that come with schizophrenia. 
If I could actually stop caring about having it and stop worrying about it (and don't give it any attention) it would -in theory- go away. I've been having this same thought for years (I was only completely symptom free when I used ssri's succesfully). I think it does have to do with anxiety and obsessing over it (thus making it OCD spectrum) but I really don't understand how anti-psychotics (especially PRN dose or 'as needed') could work for me.

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@Catwoman

If you're having issues with intrusive thoughts, I can't recommend loxapine more. Intrusive thinking is one of my biggest problems. Usually very morbid thoughts that when you're done you look at yourself with a weird look that says "wtf. what was I thinking?" Intrusive enough that you're distracted to the point that you wonder if you have ADD. The only meds that handled that well were Saphris, Zyprexa, and loxapine. However, loxapine is the only one that didn't give me akathisia or make me gain a horrid amount of weight (or increase my blood sugar and cholesterol).

I know I shouldn't force my meds on other people, I just feel like anyone who needs their thoughts to be "settled", a low dose of loxapine is worth a shot. When it originally came out, it dosed from 60-125mg per day. I'm taking 10mg and rarely ever feel like I need to take more of it. I'm a very happy camper.

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On 16-1-2017 at 7:54 PM, browri said:

@Catwoman

If you're having issues with intrusive thoughts, I can't recommend loxapine more. Intrusive thinking is one of my biggest problems. Usually very morbid thoughts that when you're done you look at yourself with a weird look that says "wtf. what was I thinking?" Intrusive enough that you're distracted to the point that you wonder if you have ADD. The only meds that handled that well were Saphris, Zyprexa, and loxapine. However, loxapine is the only one that didn't give me akathisia or make me gain a horrid amount of weight (or increase my blood sugar and cholesterol).

I know I shouldn't force my meds on other people, I just feel like anyone who needs their thoughts to be "settled", a low dose of loxapine is worth a shot. When it originally came out, it dosed from 60-125mg per day. I'm taking 10mg and rarely ever feel like I need to take more of it. I'm a very happy camper.

Thanks for sharing! 

I did a search on loxapine because you're report does sound really promising. Weight gain is really the one thing I absolutely don't want (not because of vanity, but because it is just so unhealthy) and of course no body wants akathisia. Unfortunately loxapine isn't available where I live and not prescribed by doctors...

Another ocd specialist I've talked to suggested Zyprexa, Haloperidol or Seroquel. Of course really low dose and as an SSRI augment. No idea what I can expect....

What I don't get is that pdocs always want to try the nasty stuff first...

What I noticed (a bit from my own experience as well as from others): when you find something interesting online they think you're too smart and you don't know what you're talking about. Then you're having these nice side effects, they pull you off and after two other meds they finally put you on the one think you asked about in the first place.
Why go through all the trouble of trialing and waiting...I don't get it.
 

Edited by Catwoman
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@Catwoman

I can say that Zyprexa definitely can help with intrusive thoughts and the anxiety it causes, but I switched to loxapine from Zyprexa because of weight gain and it started increasing my blood sugar and triglycerides. Haven't tried Seroquel or Haldol. Although I hear that Seroquel's weight gain can have a vengeance too like Zyprexa.

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@browri, yes that's my concern with AP's. It increases appetite, right? I think if you would feel hungry all the time and you know you're on such medication that you just shouldn't eat so much but maybe it isn't that simple either?

I would also think that when you take AP's 'as needed' that it wouldn't be too difficult to maintain a healthy weight.
But I can't find any info on this.

I've read aripiprazole is more weight gain neutral. That sounds interesting, but I'm not sure if it would help with intrusive thoughts or only make them only worse.

I'm on day 18 of sertraline (75 mg). I don't think it has kicked in yet :-(
 

Edited by Catwoman
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  • 2 months later...

@Catwoman thought I'd check in and see how you were doing. Still taking sertraline? Has your pdoc augmented with an antipsychotic? My meds have changed a bit, and I'm absolutely loving them. Went from the immediate release of oxcarbazepine 3x/day to an XR 1/day. I've been stable on oxcarbazepine, loxapine, and fluoxetine for several months. Together they work pretty harmoniously. Oxcarbazepine is good for explosiveness/snappiness/irritability. Fluoxetine is for the depression and energy levels. Loxapine is for the intrusive/obsessive/compulsive thoughts and to make it easier for me to fall asleep. It's a cocktail made in heaven.

I'm reading your signature now actually and it looks like you're still taking only sertraline. If you're still having issues with intrusive thoughts, you'll have a hard time handling those unless you take an antipsychotic. Earlier in the thread you mentioned that you and your doctor were looking at quetiapine (Seroquel). I have no doubt that it will work to a certain degree, but Seroquel will come with weight gain, and I know that's something that you're sensitive to. I am as well. Loxapine doesn't cause weight gain. In fact, I've lost weight since I've started it. That being said, I was coming off olanzapine (Zyprexa), So I'm not sure how much of that was just losing the weight that I gained on olanzapine or how much was actual weight loss.

While the industry insists that Abilify is weight neutral, I've read so many stories of people who've gained 10s of pounds in no time. So I don't think I believe it. Also, Abilify can be stimulating, and that might train your thoughts in the opposite direction. If you are having intrusive thoughts, you need to calm your mind. I don't ever recall Abilify having that effect. Only drugs that truly quieted my mind were olanzapine, loxapine, and asenapine (Saphris).

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  • 3 weeks later...
On 2017-4-20 at 5:53 PM, browri said:

@Catwoman thought I'd check in and see how you were doing. Still taking sertraline? Has your pdoc augmented with an antipsychotic?

 

 

Hi Browri, thanks for asking!
Yes, I'm stil taking sertraline. I've been on 200 mg for about a month now.  I was really noticing improvement on this dose for a few weeks, but issues in my family are causing an enormous amount of stress and anxiety for me. I'm not sure if the sertraline is strong enough to help with anxiety ánd my usual annoying intrusive thought. I can't concentrate, though I don't feel depressed. 

I don't think my general doc will prescribe me anything else than Seroquel or Abilify. He's familiar with these and loxapine isn't available in my country.

He is prepared to switch me to Anafranil (TCA, clomipramine). It's also possible to augment Zoloft with a low dose of Anafranil (I've read that Pamelor, nortryptiline is common to add to Zoloft) since I do respond to Sertraline. 

Glad to read that your own cocktail is working so well for you!!
Life is so much better when your brain isn't working against you, right?

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13 hours ago, Catwoman said:

Hi Browri, thanks for asking!
Yes, I'm stil taking sertraline. I've been on 200 mg for about a month now.  I was really noticing improvement on this dose for a few weeks, but issues in my family are causing an enormous amount of stress and anxiety for me. I'm not sure if the sertraline is strong enough to help with anxiety ánd my usual annoying intrusive thought. I can't concentrate, though I don't feel depressed. 

I don't think my general doc will prescribe me anything else than Seroquel or Abilify. He's familiar with these and loxapine isn't available in my country.

He is prepared to switch me to Anafranil (TCA, clomipramine). It's also possible to augment Zoloft with a low dose of Anafranil (I've read that Pamelor, nortryptiline is common to add to Zoloft) since I do respond to Sertraline. 

Glad to read that your own cocktail is working so well for you!!
Life is so much better when your brain isn't working against you, right?

Starting out with a low dose of Abilify would be worth a shot. Seroquel isn't something you can do well in low doses because at that point it's mostly just an antihistamine, and the higher doses can cause quite a bit of weight gain for some people. Abilify is considered by some to be more weight neutral, but it can definitely still make you gain weight. Seroquel is less likely to cause movement related disorders. Either of these though can be awesome augmentation techniques.

I have taken several SSRIs but I have never personally taken a low dose tricyclic to augment. However, I have heard of it done before. I believe in the last case I remember it was adding low dose amitriptyline and perphenazine. Clomipramine will most likely be sedating so it might be a handy little sleeping pill as well. Seroquel would also be useful this way, but Abilify would be at the other end of the spectrum because it's stimulating and can actually sometimes cause insomnia in its own right.

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  • 3 weeks later...

My old pdoc suggested taking 25-50mg during the day for anxiety (I was taking 600mg then). 

I moved and got a new pdoc (who has done wonders for my stability) and he just shook his head and said no. I never took it during the day though.

Funny how pdoc are so different.

Edited by Savannah
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  • 2 weeks later...
On 2017-5-29 at 10:06 AM, mcjimjam said:

Seroquel didn't help my intrusive thoughts but it didn't make me gain weight, either.

What has helped are high doses of SSRI or SNRIs. I haven't tried clomipramine.

Hey thanks for the feedback :-)

I decided to stay away from the Seroquel. Read a few more articles on it and this one worried me even more:
http://www.psychotropical.com/quetiapine-the-miracle-of-seroquel

The author writes:
"Conclusion

No reliable pharmacological data exists that would even suggest quetiapine is likely to be any use for depression except as an anti-histamine and therefore sedative and anxiolytic. But doxepin would be better and 100 x less expensive.
No reliable clinical data exists indicating useful superiority for schizophrenia.
No reliable clinical data exists indicating usefulness for any form of depression.
Quetiapine is an very expensive drug of minimal usefulness. The world would probably be better off without it. I suggest clinicians who ‘believe’ this works might read the story of Sir Arthur Conan Doyle and the ‘Cottingley Fairies’. "


I understand that anti-psychotics are mainly dopamine antagonists and some studies indicate that Zoloft has an antagonistic effect on dopamine as well (at high dosages).
Since Zoloft at 250 mg doesn't seem to help me with getting rid of my usual / chronic intrusive thought I really doubt that an antipsychotic would help me with that.
It seems like Restless Legs Syndrome (which I have as a side effect from Zoloft) has something to do with dopamine as well, though I had RLS with all three SSRI's I took.

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