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Washed my face and eyes 10 times in 1 hour


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The doubts are intense and my ritual such as face washing and eye washing are intense. Plus I’m taking low dose of paxil(paroxetine) which doesnt help. I’m not able to tolerate other SSRIs too. I start crying after taking 1st dose of any SSRI/SNRIs. Maybe the crying will go away eventually if i hospitalize myself.

I dont think exposure will work cuz my anxiety is intense. My clozapine itself worsens ocd [1]

I’m thinking of hospitalizing myself and change or add any meds(SSRIs).

[1] http://schizophreniabulletin.oxfordjournals.org/content/24/3/381.full.pdf

Edited by clinic
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3 hours ago, clinic said:

The doubts are intense and my ritual such as face washing and eye washing are intense. Plus I’m taking low dose of paxil(paroxetine) which doesnt help. I’m not able to tolerate other SSRIs too. I start crying after taking 1st dose of any SSRI/SNRIs. 

Have you considered asking your pdoc about trying a different class of antidepressant, such as a TCA (tricyclic antidepressant)?

According to Mayo clinic, the TCAs that have better tolerated side effects are nortriptyline and desipramine:  https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983

There's also a class of antidepressants called MAOIs (monoamine oxidase inhibitors), but pdocs tend to use those as a last line drug treatment if nothing else works.....I don't know a lot about them, because I've never tried one.

Here's a link about MAOIs from the Mayo Clinic:  https://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992

Of course, don't hesitate to go into the hospital, if you feel that's what's best for you right now..

Edited by CrazyRedhead
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15 minutes ago, CrazyRedhead said:

Have you considered asking your pdoc about trying a different class of antidepressant, such as a TCA (tricyclic antidepressant)?

According to Mayo clinic, the TCAs least likely to cause side effects are nortriptyline and desipramine:  https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983

I can only tolerate SSRIs, if i take high benzo dose along with it. For example, right now i take 10mg clobazam(benzo), if i increase that to 20mg, i will be able to tolerate any SSRI/SNRIs i want. But increased benzo 20mg gives me severe sleepiness. I'm thinking about adding diazepam but i wet the bed on it. Pdoc said its ok to take 2 benzos.

You can read list of meds which i have tried here -> https://www.crazyboards.org/profile/40990-clinic/?tab=field_core_pfield_13

Well ADs which increase dopamine, worsen my psychosis - in SSRIs, i can't tolerate sertraline. It just worsens my psychosis. in TCA - clomipramine made me psychotic years ago. TCA generally increase dopamine and its not good for me.

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8 minutes ago, clinic said:

I can only tolerate SSRIs, if i take high benzo dose along with it. For example, right now i take 10mg clobazam(benzo), if i increase that to 20mg, i will be able to tolerate any SSRI/SNRIs i want. But increased benzo 20mg gives me severe sleepiness. I'm thinking about adding diazepam but i wet the bed on it. Pdoc said its ok to take 2 benzos.

You can read list of meds which i have tried here -> https://www.crazyboards.org/profile/40990-clinic/?tab=field_core_pfield_13

Well ADs which increase dopamine, worsen my psychosis - in SSRIs, i can't tolerate sertraline. It just worsens my psychosis. in TCA - clomipramine made me psychotic years ago. TCA generally increase dopamine and its not good for me.

You have tried a lot of meds.....I really don't know what else to suggest....I think the best thing to do is consult with your pdoc about this....Getting a second opinion from another pdoc might be a good idea.

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2 hours ago, Iceberg said:

The only immediate thing that jumps out that I didn’t see in your list (I think) is Paxil, which can help ocd 

@Iceberg, you might not have seen it if you're on your phone, but @clinic is already taking a small dose of Paxil CR (37.5mg).

Edited by CrazyRedhead
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On 2/5/2020 at 8:23 AM, CrazyRedhead said:

According to Mayo clinic, the TCAs that have better tolerated side effects are nortriptyline and desipramine:  https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983

Can vouch for nortriptyline and desipramine, but they work primarily on norepinephrine and not much or in the case of desipramine at all on serotonin. I like them in conjunction with an SSRI because it creates a sort of "customizable" SNRI.

I was gonna say you could probably give clomipramine a try, but you tried 25 mg and it worsened psychosis. Imipramine might be a good one to try. Amitriptyline is kinda meh, but may be worth a try.

MAOIs may also be worth a try, probably in low doses in your case. Nardil is really good for anxiety (phenelzine) and other anxiety disorders.

On 2/5/2020 at 7:23 AM, clinic said:

Although i want to be hospitalized but my parents and family are against it. 

I want some family member to stay with me in hospital. Staying in hospital alone makes me anxious.

Why is your family so opposed to it? Do they have some kind of stigma against mental illness? Is it a religious thing? I can definitely understand staying in the hospital alone making you anxious, I was anxious enough with my best friend and my mom at the hospital alternating day and night.

Did you tell me that your pdoc refused to try memantine + lamotrigine? Memantine + low-dose lamotrigine is supposed to be very effective for OCD non-responsive to other treatments. You may not even need the Paxil with that combination. Topiramate, zonisamide, and levetiracetam can also be helpful. I hope that if you try them they don't cause you to have psychosis.

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12 hours ago, mikl_pls said:

Why is your family so opposed to it? Do they have some kind of stigma against mental illness? Is it a religious thing? I can definitely understand staying in the hospital alone making you anxious, I was anxious enough with my best friend and my mom at the hospital alternating day and night.

Did you tell me that your pdoc refused to try memantine + lamotrigine? Memantine + low-dose lamotrigine is supposed to be very effective for OCD non-responsive to other treatments. You may not even need the Paxil with that combination. Topiramate, zonisamide, and levetiracetam can also be helpful. I hope that if you try them they don't cause you to have psychosis.

They say i can admit myself and live alone in hospital but they aint gonna be there 24/7 for me for any support. Plus its a stigma as well, my illness is not known to my relatives. They dont want anybody to know why im hospitalized. I couldnt tolerate lamotrignine well. I have not tried memantine but im pretty sure it will worsen my anxiety attacks.

On a contrary note, I have started CBT and exposure therapy. Plus i have downloaded this book called "The OCD Workbook". I'm making progress in my therapy and im changing my faulty beliefs.  

The book says

Quote

If you assigned a rating of 70 percent or higher to your belief that the feared consequence would occur if you didn’t do your ritual, research predicts that exposure and response prevention may not work well for you (Steketee 1993). In this case, we suggest you start with "Challenging Your Faulty Beliefs" first, then move to exposure therapy.

In other words, i gotta change my beliefs first, then I gotta start exposure. I have to find evidence against my beliefs and convince myself why my beliefs are wrong and then change em.

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4 hours ago, clinic said:

They say i can admit myself and live alone in hospital but they aint gonna be there 24/7 for me for any support. Plus its a stigma as well, my illness is not known to my relatives. They dont want anybody to know why im hospitalized. I couldnt tolerate lamotrignine well. I have not tried memantine but im pretty sure it will worsen my anxiety attacks.

On a contrary note, I have started CBT and exposure therapy. Plus i have downloaded this book called "The OCD Workbook". I'm making progress in my therapy and im changing my faulty beliefs.  

The book says

Quote

If you assigned a rating of 70 percent or higher to your belief that the feared consequence would occur if you didn’t do your ritual, research predicts that exposure and response prevention may not work well for you (Steketee 1993). In this case, we suggest you start with "Challenging Your Faulty Beliefs" first, then move to exposure therapy.

In other words, i gotta change my beliefs first, then I gotta start exposure. I have to find evidence against my beliefs and convince myself why my beliefs are wrong and then change em.

"Live" in the hospital? Like, forever?

That's terrible that your family isn't supportive of you. 😞 I'm sorry to hear that.

I don't tolerate lamotrigine very well at all either. I used to, but something happened and I developed an intolerance to it. Why do you think memantine would worsen your anxiety attacks?

That's great that you've started CBT and exposure therapy! I just started CBT myself, I've only had a handful of sessions, and I'm already learning quite a lot.

That makes sense. I probably need exposure therapy too, and DBT.

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1 hour ago, clinic said:

Been 2 days and no compulsive face washing. Therapy FTW

I just changed my beliefs so far now. Lets see what happens in coming weeks. Will have to continue exposure.

That's great to hear! Best of luck to you! 🙂 

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  • 2 weeks later...
15 minutes ago, dancesintherain said:

exposure therapy (specifically ERP) is the gold standard for treating OCD.  What makes you say it doesn't work?  It's going to take some time.

I have secondary OCD. It is caused by my antipsychotic clozapine. If i reduce its dose or stop it. Then the ocd will go away

Edited by clinic
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Amantadine? (Most likely in high doses, related to memantine but slightly different)

Possibly rimantadine???

Riluzole?

N-acetylcysteine (NAC)? (Over the counter supplement)

Lamotrigine? (I think you said you couldn't tolerate this...)

Topiramate?

High-dose gabapentin or pregabalin?

Levetiracetam (usually high dose or max dose)?

Possibly zonisamide??

D-cycloserine? (may be prescription, may be OTC supplement, may not be available at all, can't remember)

Glycine (super, super high doses)? (OTC supplement)

Possibly ketamine?

Edited by mikl_pls
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