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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.

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can you give us a little more information about your symptoms? in what ways is your OCD interfering with treatment/life? i don't ask that because i doubt what you say, it would just be helpful to know what kind of behaviours/thoughts you're trying to get a handle on.

correct me if i'm wrong, but i didn't see risperidone on your past meds list. have you ever tried that? it was very good for intrusive thoughts/general brain calming for me. i was on 0.75 mg.

i know your pdoc is not being helpful right now, but would it be worth talking to her about this? you said she hasn't talked about it, but you've had an OCD dx for a while, no? has it just been on the backburner while trying to get the depressive episodes controlled?

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No medication has also not worked for my OCD as well. What has partially worked for me is exposure therapy. Can you ask your tdoc about trying this? It is standard OCD treatment so he should know it. My old pdoc and current therapist say that therapy is the gold standard for OCD and not medication. I'm still looking for a med to help me though.

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1 hour ago, echolocation said:

can you give us a little more information about your symptoms? in what ways is your OCD interfering with treatment/life? i don't ask that because i doubt what you say, it would just be helpful to know what kind of behaviours/thoughts you're trying to get a handle on.

correct me if i'm wrong, but i didn't see risperidone on your past meds list. have you ever tried that? it was very good for intrusive thoughts/general brain calming for me. i was on 0.75 mg.

i know your pdoc is not being helpful right now, but would it be worth talking to her about this? you said she hasn't talked about it, but you've had an OCD dx for a while, no? has it just been on the backburner while trying to get the depressive episodes controlled?

Absolutely, I'll do my best, but I can't assure you it will be an accurate picture as I lack insight into my obsessions.

I do know that one thing I do is obsess over my meds, how they aren't working, and I will either schedule an appointment with my pdoc to change them (and she doesn't because she catches onto what's going on), or I change them myself (I keep all my past meds just in case of an unforeseen emergency). That's just one example.

Another example is when I was in school, while studying for a test, I would fixate on all the things I am not remembering and in my eyes it outweighs the things I have a good grasp on, and I allow that to throw me off and I just don't show up for the test, for example. Or I do very poorly on the test because I tried to study for too much the night before. 

Evidently, my suicidality plays into my OCD and vice versa. How, though, I'm not sure. My pdoc brought this up but wouldn't go into depth about it, probably because she didn't want me to obsess over it. She has to withhold information about my diagnoses and whatnot because she knows I'll obsess over it. I can tell her all day that I won't, and that I would appreciate not being left in the dark, but she still doesn't tell me anything. Whether she's right or not I don't know.

I obsess over the negative things in my life so much that I don't see the positive. I obsess over my current situation with myself (32, no job, living with parents), and at home (family is basically disintegrating...), to the point where I become suicidal. I don't see all the positive things I have going for me (a wonderful, expansive network of close friends who are willing to do whatever it takes to help me, in addition to an extended network of friends I have yet to even come to for help, but who I know would do something for me, for example).

I turn everything into a catastrophe. Small scale issues in plans turn into giant meltdowns. Not sure if this is OCD or depression symptom, but it's a big one for me.

I hope that explains my symptoms at least a little. I know for a fact that it's not a wholesome picture though. It's way more complicated than I can possibly explain.

 

You're right, I haven't tried risperidone. I have asked my pdoc about it, knowing it can cause hyperprolactinemia, and she is vehemently opposed to prescribing both it and Invega for me. I'd be willing to try a low, low dose of it, though, if it meant having my life back together (as much as it can be at this point now).

 

Yes, I have been diagnosed with OCD since I was about 9 or 10 years old. My mom took me to a pediatric neuropsychiatrist when I was about that age. He diagnosed me with Tourette's disorder, OCD, and ADHD, which was basically just a confirmation diagnosis of what all my pediatrician had diagnosed me with. He didn't offer anything much in the way of treatments as the meds for Tourette's often have very harsh side effects (typical antipsychotics were probably the only meds available at the time, possibly even Zyprexa as it was brand new back then). I was medicated for OCD with Prozac, which made my behavior worse. I was tried on Adderall when it was all the rage to prescribe to kids, but it made my stomach hurt and kept me from eating, so my mom took me off of it after a week and didn't bother to pursue other ADHD treatment options. I think at this time, pemoline was still on the market or had just been taken off the market. Ritalin had a huge stigma to it at the time, which is why I guess my mom didn't bother letting me try that. So I just stayed on 10 mg Prozac for a few years until summer before 6th grade, when I took myself off of it after having a massive panic attack in Walmart because there were people nearby me talking loudly to each other (misophonia?).

I believe it is being treated directly alongside my depression. In fact, I think my OCD is responsible for a majority of my depressive and self-destructive symptoms.

1 hour ago, CeremonyNewOrder said:

No medication has also not worked for my OCD as well. What has partially worked for me is exposure therapy. Can you ask your tdoc about trying this? It is standard OCD treatment so he should know it. My old pdoc and current therapist say that therapy is the gold standard for OCD and not medication. I'm still looking for a med to help me though.

I have never had exposure therapy before. I have thought about trying it though. I just wouldn't know what to work on because, like I've said, I lack insight into my obsessions so much.

I have gone psychotic as a result of obsessive psychotic preoccupations before—it's that bad.

I'll ask my tdoc about it next time I see him.

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2 hours ago, mikl_pls said:

 Anyway, I didn't mean to digress so much in this post.

That's okay....I hear you.....I have severe TR OCD which no med has helped....I agree with @CeremonyNewOrder, that ERP (exposure) therapy might be  the way to go, if you can find a therapist trained in it in your area.

Unfortunately, I am unable to find anyone trained in ERP in my area, that takes my insurance, so I'm sort of stuck.

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50 minutes ago, CrazyRedhead said:

Unfortunately, I am unable to find anyone trained in ERP in my area, that takes my insurance, so I'm sort of stuck.

I'm sorry to hear that. I hope that changes for you really soon.

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18 hours ago, mikl_pls said:

I'm sorry to hear that. I hope that changes for you really soon.

Thanks.....I'm always searching therapists, so hopefully I'll have that option eventually....I have a therapist now that I really like, but she's not trained for ERP.

17 hours ago, CeremonyNewOrder said:

Thanks so much for link..!!.......I can definitely try some exercises in the book.

Edited by CrazyRedhead

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