Med for treatment resistant depression/OCD

[CeremonyNewOrder]

I just tried Luvox and it was a total failure. It increased the clozapine in my system to the point where I became bed ridden because I was too sedated to move. I was so hoping it would work. I have an appointment with my pdoc on the 25th and for once I'm out of ideas for what to replace the Luvox with. Any ideas? Tried meds are in signature.

Edited January 5 by CeremonyNewOrder

[Simba Cub]

For depression meds wise, MAOIs such as Tranylcypromine can't be beat.

[CrazyRedhead]

9 hours ago, CeremonyNewOrder said:

I just tried Luvox and it was a total failure. It increased the clozapine in my system to the point where I became bed ridden because I was too sedated to move. I was so hoping it would work. I have an appointment with my pdoc on the 25th and for once I'm out of ideas for what to replace the Luvox with. Any ideas? Tried meds are in signature.

Maybe ask your doc about Viibryd?...I've seen some folks on here who have had good results with it.

Also, I noticed you haven't tried Paxil, Celexa, or Lexapro........Paxil might increase sedation, though.

Edited January 5 by CrazyRedhead

[Gearhead]

4 hours ago, CrazyRedhead said:

Also, I noticed you haven't tried Paxil, Celexa, or Lexapro........Paxil might increase sedation, though.

I’d try any of those, or Viibryd, before I tried an MAOI. In fact I’ve taken all of them except Paxil at one point or another. Exactly what symptoms are you trying to relieve?

[CeremonyNewOrder]

3 hours ago, Gearhead said:

I’d try any of those, or Viibryd, before I tried an MAOI. In fact I’ve taken all of them except Paxil at one point or another. Exactly what symptoms are you trying to relieve?

OCD intrusive thoughts, suicide ideation, lack of energy, extreme self criticism, isolation etc...

 

Note: I had forgot to list it but I have tried Lexapro. I don't want to do paxil because I'm already having trouble with sedation. I seriously doubt I could do an MAOI because of the food restrictions. Food is one of the few joys in my life.

[Gearhead]

1 hour ago, CeremonyNewOrder said:

Note: I had forgot to list it but I have tried Lexapro. I don't want to do paxil because I'm already having trouble with sedation. I seriously doubt I could do an MAOI because of the food restrictions. Food is one of the few joys in my life.

In your shoes, I would try Viibryd. I didn’t find it sedating. It was also pretty easy in terms of sexual side effects. My one complaint was that it gave me increasingly bad GI issues, but I have those regardless of what I’m on, so take that with a grain of salt.

[CeremonyNewOrder]

2 hours ago, Gearhead said:

In your shoes, I would try Viibryd. I didn’t find it sedating. It was also pretty easy in terms of sexual side effects. My one complaint was that it gave me increasingly bad GI issues, but I have those regardless of what I’m on, so take that with a grain of salt.

Yeah I've read it can cause really bad GI problems. I think I'll suggest it to my pdoc next because its an SSRI and am wary about trying a TCA or MAOI.

[sming]

On 1/5/2020 at 2:31 AM, Simba Cub said:

For depression meds wise, MAOIs such as Tranylcypromine can't be beat.

For me they can. I tried Parnate twice and Nardil 3 times and only got a positive response once I added a stimulant.

On 1/5/2020 at 5:53 PM, CeremonyNewOrder said:

OCD intrusive thoughts, suicide ideation, lack of energy, extreme self criticism, isolation etc...

 

Note: I had forgot to list it but I have tried Lexapro. I don't want to do paxil because I'm already having trouble with sedation. I seriously doubt I could do an MAOI because of the food restrictions. Food is one of the few joys in my life.

I have very similar symptoms. I've had extremely TRD, SI and pure OCD for 25 years   I've only responded to:

- Abilify. I can't seem to work out which dose is best. Oscillating between 2.5 and 5mg seems to be the best, it seems to keep my brain from acclimating/downregulating and defeating Abilify's effect.
- But far more importantly, stimulants help me by far the most. Methylphenidate-based, Amphetamine-based or even Provigil all work for short periods of time. 

FTR my current regimen is (and yes, I know it's insane) : 200 Provigil, 5 Abilify, 40 Fetzima, 30 Lexapro, 30 Ritalin, 60 Adderall, 45 Buspar (good for OCD), 300 Lyrica (for pain), 300 Trazodone (for sleep), 40 Percocet (for chronic pain), 50 diphenhydramine (for sleep).

Cheers, Pete 

[Blahblah]

Same depressive symptoms OP,  except for compulsions, though I have horrible looping negative thoughts...Seems you've tried the gamut of different meds (like me) Did the other meds in your sig, previously cause sedation or mainly have no benefit/effect?

I would probably go for Vibryyd next (Sadly not available where I live, and not generic). Could also be worth doing a 2nd trial of something? Sometimes meds work differently years later, or in combos.

To echo what @sming said: Stimulants (short term) have helped me the most noticeably with no side effects. Particularly with energy, motivation and isolation symptoms. The issue is that they poop out.. Unfortunately I'm riding out a 2 month break, with hopes they work better when I re-instate.

Edited January 10 by Blahblah

[Iceberg]

@CeremonyNewOrder did you ever try clomipramine and an SSRI at the same time? I know that’s maybe not ideal given your other comorbid symptoms which require clozaril, but I just wondered cuz I read an article about it

[Chandleresque]

Escitalopram and Aripiprazole combination have a particularly strong synergy for MDD and OCD in the research literature and in my exp. 

I take 40 mg escitalopram and 7.5 mg Aripiprazole and 54mg Concerta ( also for MDD).

this combo brought me back to life from being TRD and unable to work. Now I’m flourishing. 
 

the book ‘ when antidepressants are not enough’ has also really helped - using mindfulness to alleviate depression

[CeremonyNewOrder]

Has anyone had success with depakote for depression and/or OCD? I now it's primarily used for mania. I was thinking about trying it again but scared of more weight gain and sedation.

[sming]

14 hours ago, Chandleresque said:

Escitalopram and Aripiprazole combination have a particularly strong synergy for MDD and OCD in the research literature and in my exp. 

I take 40 mg escitalopram and 7.5 mg Aripiprazole and 54mg Concerta ( also for MDD).

this combo brought me back to life from being TRD and unable to work. Now I’m flourishing. 
 

Wow, that's almost the exact regimen that's helped me so much against my TRD and TR pure OCD. Our brains sound similar. I'm far, far away from flourishing, mind, I'm barely making it through the day. I'm on 2.5 Abilify and whenever I try going higher, I get crazy irritability and anxiety and have to go back down. And for stimulants (the most important part by far) I take Adderall and Ritalin. 

14 hours ago, Chandleresque said:

the book ‘ when antidepressants are not enough’ has also really helped - using mindfulness to alleviate depression

I find that mindfulness helps when I'm anhedonic and moderately depressed but it's useless when my depression is severe. I just can't bring myself to do it in that situation. 

Cheers, Pete

[morpheus]

8 hours ago, CeremonyNewOrder said:

Has anyone had success with depakote for depression and/or OCD? I now it's primarily used for mania. I was thinking about trying it again but scared of more weight gain and sedation.

No. I've tried over 50 meds, and no one are really helping with OCD. But  cognitive behavioral therapy (CBT) really works, 

 

[sming]

2 hours ago, morpheus said:

No. I've tried over 50 meds, and no one are really helping with OCD. But  cognitive behavioral therapy (CBT) really works, 

 

Just for the rounded-out picture, I have severe TR OCD and CBT made it much, much worse - all the thoughts about thoughts just exacerbated it. For me, ERP (Exposure Response Prevention) was the key and reduce my OCD tremendously. HTH. YMMV.

[CrazyRedhead]

1 hour ago, sming said:

Just for the rounded-out picture, I have severe TR OCD and CBT made it much, much worse - all the thoughts about thoughts just exacerbated it. For me, ERP (Exposure Response Prevention) was the key and reduce my OCD tremendously. HTH. YMMV.

I have severe TR OCD as well....CBT therapy didn't help me, either.....I'm glad ERP helped you......

I would like to try ERP, but in my area, at least so far, I have been unable to find a therapist trained in ERP, that also takes my insurance.....I do see a therapist regularly, and I like her, but she's not trained in ERP.

[sming]

32 minutes ago, CrazyRedhead said:

I have severe TR OCD as well....CBT therapy didn't help me, either.....I'm glad ERP helped you......

I would like to try ERP, but in my area, at least so far, I have been unable to find a therapist trained in ERP, that also takes my insurance.....I do see a therapist regularly, and I like her, but she's not trained in ERP.

oh man that's a shame. It is rather specialised, there aren't that many in NYC in fact. I wonder if there's a good book from which you can get the gist of it?

[morpheus]

2 hours ago, sming said:

Just for the rounded-out picture, I have severe TR OCD and CBT made it much, much worse - all the thoughts about thoughts just exacerbated it. For me, ERP (Exposure Response Prevention) was the key and reduce my OCD tremendously. HTH. YMMV.

Ok,didn't know that.

Edited January 12 by morpheus

[CeremonyNewOrder]

I attend an OCD group and see a therapist that specializes in OCD. We use a combination of CBT, exposure therapy, and mindfulness. These have been helpful but OCD as I understand is also a chemical thing going on in your brain so it seems like you'd need a medication as well. 

 

I find exposure to be the most helpful. It's scary and hard work but worh it.

Edited January 12 by CeremonyNewOrder

[Simba Cub]

Also bear in mind that there are various different types of spoken therapy. I found CBT to be effective for depression, EMDR for PTSD and straight-forward counselling for just getting things off my chest!