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Increasing Your Dosage...


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Sorry if I'm annoying with my posts, kind of lonely going through this sometimes...

I raised my dosage by a small amount.  For the first week I felt better, like more motivation, able to get up and go a bit more.  But I still don't have much interest in anything.  I have trouble getting out of bed on days I don't work.  

I think I'm going higher one way or another.  I'm dealing with ruminations all day, anxiety, and some depression.  I suppose it's just too low a dosage, but Idk.

 I'm about 10 days in, I feel more depressed now...How long would you guys give a dosage increase before saying...well it's time to go higher?  I meet with my PDoc in a couple weeks.

Edited by BrianOCD
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Thanks for the quick replies guys!  Feels good to have company.

Is it normal to feel a bit down at first?  I was hoping I'd be feeling better than I am.  Worked 50 hours +   Usually I feel good, but off today and feel down.

I don't know what's going on with me lately, my mind and body don't feel synced, and my mind doesn't want to quiet down...

Edited by BrianOCD
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22 hours ago, BrianOCD said:

At Day 10 now.

I've had a bit more of a racing mind...little more anxiety.

 

What antidepressants have you taken? Have you taken Zoloft, Luvox, or the TCA Anafranil?

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1 hour ago, mikl_pls said:

What antidepressants have you taken? Have you taken Zoloft, Luvox, or the TCA Anafranil?

I've taken Paxil, Luvox only for a few weeks.  I took Lexapro for about 7 years, before ending up on Effexor.

Oddly enough Luvox made my OCD much much worse.  Idk if you guys find this to be an issue, but for me, I have to hit the "perfect dosage" otherwise my symptoms actually worsen.

Edited by BrianOCD
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On 7/26/2017 at 6:46 PM, BrianOCD said:

I've taken Paxil, Luvox only for a few weeks.  I took Lexapro for about 7 years, before ending up on Effexor.

Oddly enough Luvox made my OCD much much worse.  Idk if you guys find this to be an issue, but for me, I have to hit the "perfect dosage" otherwise my symptoms actually worsen.

Interesting... especially about the Luvox... The higher doses of the SSRIs tend to work better for anxiety disorders like OCD, sometimes requiring supratherapeutic doses. SNRIs can be beneficial for OCD but aren't necessarily the first line treatment.

There have been positive results with Cymbalta at doses up to 120 mg, at least in this case report.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911164/

Maybe an antiglutamatergic medicine might work as an adjunct for your OCD? Like memantine, riluzole, lamotrigine, topiramate (watch out for cognitive side effects and kidney stones with topiramate! Stay hydrated!), maybe even zonisamide since it modulates glutamate too (couldn't find any studies though), just to name a few...

I know someone on this site (who seems to have not posted in a long time) who is/was on an SSRI + memantine + lamotrigine for his OCD.

Do you primarily grapple with depression or OCD symptoms? If depression, do you think it's primarily depression or secondary to your OCD symptoms?

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23 hours ago, mikl_pls said:

Interesting... especially about the Luvox... The higher doses of the SSRIs tend to work better for anxiety disorders like OCD, sometimes requiring supratherapeutic doses. SNRIs can be beneficial for OCD but aren't necessarily the first line treatment.

There have been positive results with Cymbalta at doses up to 120 mg, at least in this case report.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911164/

Maybe an antiglutamatergic medicine might work as an adjunct for your OCD? Like memantine, riluzole, lamotrigine, topiramate (watch out for cognitive side effects and kidney stones with topiramate! Stay hydrated!), maybe even zonisamide since it modulates glutamate too (couldn't find any studies though), just to name a few...

I know someone on this site (who seems to have not posted in a long time) who is/was on an SSRI + memantine + lamotrigine for his OCD.

Do you primarily grapple with depression or OCD symptoms? If depression, do you think it's primarily depression or secondary to your OCD symptoms?

Anxiety problems are my main problem.

Depression and OCD seems to follow.  

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8 hours ago, BrianOCD said:

Anxiety problems are my main problem.

Depression and OCD seems to follow.  

Generalized anxiety symptoms? Or anxiety from OCD? (Since your name is "BrianOCD" ;))

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15 hours ago, mikl_pls said:

Generalized anxiety symptoms? Or anxiety from OCD? (Since your name is "BrianOCD" ;))

GAD/Panic Disorder was my original dx

I've dealt with every kind of anxiety you can think of...outside of hallucinations and things of that nature.

Right now I'm dealing with the worst kind of ruminations.  Constantly worried about my condition alongside my life...

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5 hours ago, BrianOCD said:

GAD/Panic Disorder was my original dx

I've dealt with every kind of anxiety you can think of...outside of hallucinations and things of that nature.

Right now I'm dealing with the worst kind of ruminations.  Constantly worried about my condition alongside my life...

Zoloft might be beneficial to you, although like @Iceberg said, it might be beneficial for you to check out some of the tricyclics, especially clomipramine (Anafranil).

Also, there have been studies done with the atypical antipsychotics, like Seroquel, Risperdal, and Abilify for OCD/anxiety. Abilify seems kind of odd to me for anxiety because at low doses it can be extremely activating for some people and cause anxiety in some, but usually, as you go higher in dosage, it becomes more calming. I also have to mention it because, well, I'm a Stelazine fanboy—it took me from being unable to leave the house for the simplest things like running errands or visiting friends who I desperately wanted to see but just couldn't leave the house, to not only being able to leave the house, but enjoy myself while I was out, and had a nice antidepressant effect and helped me be more confident in making decisions to boot. Plus, Stelazine is actually one of the few antipsychotics that actually officially has an actual indication for anxiety albeit for up to 6 weeks, but if you're tolerating it well and your pdoc doesn't mind you taking it longer, you can take it longer than that. So there's always Stelazine as an option for anxiety symptoms.

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Just now, mikl_pls said:

Zoloft might be beneficial to you, although like @Iceberg said, it might be beneficial for you to check out some of the tricyclics, especially clomipramine (Anafranil).

Also, there have been studies done with the atypical antipsychotics, like Seroquel, Risperdal, and Abilify for OCD/anxiety. Abilify seems kind of odd to me for anxiety because at low doses it can be extremely activating for some people and cause anxiety in some, but usually, as you go higher in dosage, it becomes more calming. I also have to mention it because, well, I'm a Stelazine fanboy—it took me from being unable to leave the house for the simplest things like running errands or visiting friends who I desperately wanted to see but just couldn't leave the house, to not only being able to leave the house, but enjoy myself while I was out, and had a nice antidepressant effect and helped me be more confident in making decisions to boot. Plus, Stelazine is actually one of the few antipsychotics that actually officially has an actual indication for anxiety albeit for up to 6 weeks, but if you're tolerating it well and your pdoc doesn't mind you taking it longer, you can take it longer than that. So there's always Stelazine as an option for anxiety symptoms.

Zoloft is weaker than Effexor though is it not?

And ya Seroquel has helped me a lot, but lately I'm getting sick of the sedation and my mind being so slow because of it...

Luckily I have a lot of options ahead of me...The ruminations I have about my condition is what's really wearing me down...I have to generally take Seroquel/Ativan to knock myself out.

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1 minute ago, BrianOCD said:

Zoloft is weaker than Effexor though is it not?

Not necessarily. It doesn't hit norepinephrine like Effexor does, but it does hit dopamine a little more, and serotonin quite a bit more than Effexor, so you'll get way more serotonergic action from it which is good for anxiety, rumination, obsessions, etc. Plus it has sigma-1 receptor binding (some sources say antagonism, some say agonism), which has been implicated to be helpful for anxiety as well. It's not as potent at that receptor as Luvox, but it's the second strongest ligand for that receptor if I'm not mistaken. Effexor has negligible to no affinity for that receptor. Even Cymbalta has more affinity for it than Effexor, and it has very little affinity.

3 minutes ago, BrianOCD said:

And ya Seroquel has helped me a lot, but lately I'm getting sick of the sedation and my mind being so slow because of it...

Maybe you might ask about trying Risperdal (though it can cause weight gain, cognitive effects anecdotally, and hyperprolactinemia) or Abilify (maybe starting at 5 mg instead of 2 mg which would probably be less activating), or heck, if your pdoc is open to it, maybe you could do a trial of Stelazine if you're comfortable with taking a typical antipsychotic. I absolutely adore Stelazine, but my pdoc won't prescribe it for me anymore. :( It's literally like brain glue for me.

5 minutes ago, BrianOCD said:

Luckily I have a lot of options ahead of me...The ruminations I have about my condition is what's really wearing me down...I have to generally take Seroquel/Ativan to knock myself out.

Indeed you do have plenty of options available to you. So you have to take the Seroquel/Ativan combo to knock yourself out so you don't ruminate over your condition? Yet you don't like the sedation and cognitive slowing from Seroquel?

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6 minutes ago, mikl_pls said:

Not necessarily. It doesn't hit norepinephrine like Effexor does, but it does hit dopamine a little more, and serotonin quite a bit more than Effexor, so you'll get way more serotonergic action from it which is good for anxiety, rumination, obsessions, etc. Plus it has sigma-1 receptor binding (some sources say antagonism, some say agonism), which has been implicated to be helpful for anxiety as well. It's not as potent at that receptor as Luvox, but it's the second strongest ligand for that receptor if I'm not mistaken. Effexor has negligible to no affinity for that receptor. Even Cymbalta has more affinity for it than Effexor, and it has very little affinity.

Maybe you might ask about trying Risperdal (though it can cause weight gain, cognitive effects anecdotally, and hyperprolactinemia) or Abilify (maybe starting at 5 mg instead of 2 mg which would probably be less activating), or heck, if your pdoc is open to it, maybe you could do a trial of Stelazine if you're comfortable with taking a typical antipsychotic. I absolutely adore Stelazine, but my pdoc won't prescribe it for me anymore. :( It's literally like brain glue for me.

Indeed you do have plenty of options available to you. So you have to take the Seroquel/Ativan combo to knock yourself out so you don't ruminate over your condition? Yet you don't like the sedation and cognitive slowing from Seroquel?

I don't like when it carries into the next day...like if I'm out driving and doing things ya.  Ativan + Seroquel is quite sedating as you can imagine.  But ya in a perfect world, I'd be alert and have no ruiminations, but it just doesnt happen that way.

I have an Aunt that's on Zoloft and she swears by it, says it's helped squash her anxiety.

I'm sure you've had to deal with ruminations?  Sometimes they're very intrusive and you can't away from scary thoughts and worry.  For me, it's nearly impossible to pay attention to things in front of me unless I'm on some sedatives, or wasted. I think what bothers me the most, is I don't have much control over moods and mood swinging.  I worry about dipping into a depression, or anxiety creating panic attacks again.

Edited by BrianOCD
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1 minute ago, BrianOCD said:

I have an Aunt that's on Zoloft and she swears by it, says it's helped squash her anxiety.

Zoloft has done wonders for my friend, @THE_REAL_Bryan. He's a completely new man since he switched from Effexor to it.

1 minute ago, BrianOCD said:

I'm sure you've had to deal with ruminations?  Sometimes they're very intrusive and you can't away from scary thoughts and worry.  For me, it's nearly impossible to pay attention to things in front of me unless I'm on some sedatives, or wasted.

Oh yeah, absolutely, I've dealt with ruminations since my teens/adolescence, but I don't think mine are as intrusive as yours (anymore). That's very unfortunate that you have to sedate yourself or be wasted to deal with your ruminations and anxiety... There's got to be another way to deal with it than that. For a short time, my pdoc prescribed me Klonopin 0.5 mg to take 3x/day for my OCD, but I wound up feeling flat and depressed after a few weeks... I'm not sure that's a good route for dealing with the ruminations and anxiety...

I think I mentioned this to you before, but perhaps an antiglutamatergic medicine would help you. It has been proposed that with OCD and other anxiety disorders that there is a dysfunction of the glutamate system in that there is an excess of glutamatergic neurotransmission. Memantine (Namenda/Namenda XR), lamotrigine (Lamictal), topiramate (Topamax), zonisamide (Zonegran), and riluzole (Rilutek) are examples of some antiglutamatergic meds. Of course, there's always the OTC supplement N-acetylcysteine, but you need to take rather large doses of it to be effective, like 1200-2400 mg.

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Yep that's how it's always been for my anxiety and ruminations.

However, I will admit that 300mg Effexor did the job for anxiety and ruminations.  It's just some of the side effects are so hard to live with...

I've never really gone in and just asked my PDoc for things, but I guess I could mention a few things... 

Ativan seems to help ruminating, or at least it helps calms the anxiety associated with it.  I just hate using a benzo like you said...going too long it becomes numbing and depressing.

Edited by BrianOCD
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Just now, BrianOCD said:

Yep that's how it's always been for my anxiety and ruminations.

However, I will admit that 300mg Effexor did the job for anxiety and ruminations.  It's just some of the side effects are so hard to live with...

Maybe you could tolerate Cymbalta 120 mg better? That's roughly equivalent to Effexor 300 mg. It's more potent of an SNRI than Effexor too.

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On 7/31/2017 at 1:15 AM, mikl_pls said:

Maybe you could tolerate Cymbalta 120 mg better? That's roughly equivalent to Effexor 300 mg. It's more potent of an SNRI than Effexor too.

Cymbalta would be my next stop likely, if I can't get things the way I want under Effexor...

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Pardon the language, but my life was a living hell during my teenage years and up until I turned 30 in 2015. So, that's about 15-20 years of my life that I went either unmedicated or not PROPERLY medicated. I started on Paxil when I was 13 and continued taking it until age 17. At that age, I attempted suicide for the first time. Luckily, I did not succeed. However, I was given the choice of juvy/jail or seek psychiatric help. I chose the latter. I went to this quaint little place that I will not name here. If you want to know what place it was, let me know. I'm not exactly sure on the disclosure rules for medical/psychiatric institutions. Anyway, they switched me to the starting dose of 37.5mg of Effexor, and it seemed to help a good bit... at first. After multiple dosage increases and YEARS of being at the absolute bottom of depression (mostly abusing Xanax while trying to drink myself to death), my friend @mikl_pls suggested that I consult my physician about switching from Effexor to Zoloft. After the first two days, I had already begun to feel like doing backflips and cartwheels. It changed my life COMPLETELY. I'm not exactly sure if I should say this and I definitely don't want to break forum rules, but Zoloft has saved my life! It's almost as if a dark shroud has been lifted. I started to wake up and was happy. For the first time in my life, I don't go to sleep hoping that I don't wake up. I understand that my Zoloft experience is and will not be the same as others', but I know that I'm not the only one out there who felt the way I did. I also hope that someone out there can benefit from my story and that Zoloft or any other medication(s) will have similar results for them. 

Thank you all for being here and taking the time to read all that. I really and truly hope it helps someone out there.

Edited by THE_REAL_Bryan
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20 hours ago, THE_REAL_Bryan said:

At that age, I attempted suicide for the first time. Luckily, I did not succeed.

I'm glad you didn't succeed. Otherwise, who would be my best friend today? (Besides Chad) ?

Edited by mikl_pls
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