Jump to content
CrazyBoards.org
CeremonyNewOrder

Med for treatment resistant depression/OCD

Recommended Posts

On 1/12/2020 at 1:58 PM, CeremonyNewOrder said:

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

Yep, that's the "E" in ERP that does the grunt work. 

Share this post


Link to post
Share on other sites
On 1/5/2020 at 4:53 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.

This sounds like a dictionary definition of lack of serotonin according to Stahl.

How was Lexapro for you? I assume you took it at least up to 20 mg. You could try a supratherapeutic dose of it, like 30-40 mg, even 60 mg I believe Stahl mentions.

Emsam, if it's available where you live, is supposed to be a safer MAOI and the low dose, 6 mg/24 hr, doesn't require dietary restrictions, but unfortunately it did nothing for my OCD.

 

The reason (I'm sure you know) the Luvox did what it did to your clozapine is because it is also metabolized by CYP1A2, so they compete with each other for metabolism. You could try Luvox but either try a low, low dose of it, or lower your clozapine dose.

Share this post


Link to post
Share on other sites
11 hours ago, mikl_pls said:

 

 

The reason (I'm sure you know) the Luvox did what it did to your clozapine is because it is also metabolized by CYP1A2, so they compete with each other for metabolism. You could try Luvox but either try a low, low dose of it, or lower your clozapine dose.

Yeah,fluvoxamine (Luvox) is strong inhibitor of CYP1A2 enzyme.

Share this post


Link to post
Share on other sites
11 hours ago, mikl_pls said:

This sounds like a dictionary definition of lack of serotonin according to Stahl.

How was Lexapro for you? I assume you took it at least up to 20 mg. You could try a supratherapeutic dose of it, like 30-40 mg, even 60 mg I believe Stahl mentions.

Emsam, if it's available where you live, is supposed to be a safer MAOI and the low dose, 6 mg/24 hr, doesn't require dietary restrictions, but unfortunately it did nothing for my OCD.

 

The reason (I'm sure you know) the Luvox did what it did to your clozapine is because it is also metabolized by CYP1A2, so they compete with each other for metabolism. You could try Luvox but either try a low, low dose of it, or lower your clozapine dose.

I really like my pdoc and think she is way smart but I'm disturbed now that I know that. She wanted me to titrate to 200mg luvox and stay on 300mg of clozapine. No wonder I was fucked up.

Share this post


Link to post
Share on other sites
7 hours ago, CeremonyNewOrder said:

I really like my pdoc and think she is way smart but I'm disturbed now that I know that. She wanted me to titrate to 200mg luvox and stay on 300mg of clozapine. No wonder I was fucked up.

Oh my... that... that would make you severely bedridden from the increased levels of clozapine. And the drooling... I mean, maybe her goal was to increase the clozapine levels in the end with the Luvox, but I would probably bring this up with her next time you see her and question her about whether she was aware of this interaction (not to doubt her competency as a physician). It's actually a commonly-used combo to effectively increase blood levels of clozapine without having to use higher doses.

Lexapro and Zoloft are the cleanest SSRIs liver-enzyme-usage-wise (especially Lexapro). Lexapro's mechanism of action is also the cleanest, being the most selective of a serotonin reuptake inhibitor over other monoamine transporters. High doses of SSRIs sound like what you potentially need what with the obsessive component and all the other serotonin-less symptoms, but I could be wrong. Zoloft has the sigma-receptor affinity similar to Luvox, though not as potently, and it's an antagonist instead of an agonist. All SSRIs I believe have some affinity for the sigma-1 receptor, but what they do there I don't know. Prozac increases allopregnanolone levels which is a neuromodulator at GABA-A α4 and α6 subunits which aren't touched by benzos (only pregnanolone, allopregnanolone, and related neuromodulators as well as ethanol, and I believe ethylphenidate, a biproduct of concomitant consumption of ethanol and methylphenidate).

I wish I knew of something else to say that would be of some help, but I can't think of anything. I would try high-high dose Lexapro (30-40 mg or more, Stahl mentions 60 mg) or high to high-high dose Zoloft (200 mg or 250-400 mg) and really watch your clozapine levels very, very closely especially as you get up in the upper doses. With Lexapro, even though they say it doesn't, you have to worry about prolonged Qt interval, so getting an EKG periodically while on supratherapeutic doses from time to time might be a good idea. That's just me though.

You've tried the SNRIs I would suggest as an alternative, and I'm assuming you took them at a high dose without results or had intolerable side effects with them. Cymbalta at 120 mg really helped me but my pdoc hates prescribing it. Effexor XR was effective at very high doses for a very short amount of time (like above the max dose of 375 mg). Pristiq and Fetzima were horrible experiences for me.

I see you've tried clomipramine, and that is a heavy hitter. I hated that medicine. The side effects were terrible, especially as the dose got close to the max (I got to 225 mg). I couldn't get out of bed and I couldn't pee... lol. But @Iceberg has a good idea with trying a low dose of clomipramine with an SSRI. That's very commonly done. Only a minute amount of clomipramine is needed to saturate the SERT at 95%, I forget the dose though. I can't seem to find any sources that says anything about it either. But low, low doses (like, less than 25 mg, the lowest dose in the US) are sufficient for adequate SERT saturation, and therefore low-dose augmentation to an SSRI/SNRI should be another viable option.

  • Like 1

Share this post


Link to post
Share on other sites

I saw my pdoc yesterday and we are going to try viibyrd. She said that one of her books says it can be used off label for OCD. Just scared of the possible GI effects but actually it's side effect profile is a little bit better than other SSRIs. Anyone take this med and have advise?

Share this post


Link to post
Share on other sites
On 1/14/2020 at 8:19 PM, Sephiroth999 said:

Venlafaxine and mirtazapine is a common thing to try for severe treatment resistant depression.

Ah, Californian Rocket Fuel :)

Share this post


Link to post
Share on other sites
3 hours ago, CeremonyNewOrder said:

I saw my pdoc yesterday and we are going to try viibyrd. She said that one of her books says it can be used off label for OCD. Just scared of the possible GI effects but actually it's side effect profile is a little bit better than other SSRIs. Anyone take this med and have advise?

 Not viibyrd specifically, but I suggest being very open about any. Potential GI issues right from the get go. No one likes side effect Meds, but there are options to make things more tolerable if you are having issues but really want to stay on the med

I’ve had some med combos that have really screwed my GI up, but current pdoc has helped me manage it without having to make major changes or ditch a med

  • Like 1

Share this post


Link to post
Share on other sites

I personally didn't have GI side effects any of my Viibryd trials (I've been on it like 4 or 5 times lol). But slowing down the titration can help mitigate side effects. Like doing 10 mg for 3 weeks instead of 1 week, etc. That's how my pdoc did it the first time I took it back when samples included 14 days of 40 mg too. Her husband, a retired pdoc, gave me 3 sample packs and told me to titrate slowly with that med, and that titrating every week was in his opinion too quick. Just something to consider if you do have side effects.

  • Like 1

Share this post


Link to post
Share on other sites

Your first stop medication if SSRIs don't work are NARIs such as Reboxetine.

Then multiple reuptake inhibitors such as Duloxetine and novel antidepressants such as Mirtazapine.

Failing this tricycles such as Dosulepin are a good option. They're more open to abuse than SSRIs, which is whys they are used less, but I they're just as effective if not more so.

Penultimately, reversible MAOIs such as Moclobemide take pride of place. They work in a similar way to MAOIs but command far less in the way of dietary restrictions. There's even a patch that delivers Selegeline, brand name Emsam.

Finally, medications for depression alone farthest of down the line are non-reversible MAOIs. The ONLY reason they are not the FIRST line of defenece is the diet and incompatibility with other meds. Otherwise, many psychiatrists find them to be the most effective antidepressants out there. Examples include Tranylcypromine.

Adjunctive therapies also exist. These include mood stabilisers (such as Sodium Valproate), antipsychotics (such as Quetiapine) and stimulants.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...