Washed my face and eyes 10 times in 1 hour

[clinic]

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 February 5, 2020 by clinic

[clinic]

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.

[CrazyRedhead]

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 February 5, 2020 by CrazyRedhead

[clinic]

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.

[CrazyRedhead]

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.

[Iceberg]

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

[CrazyRedhead]

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 February 5, 2020 by CrazyRedhead

[Iceberg]

Oh sorry @clinic -I guess I only saw the past med list and not all the current list 

[mikl_pls]

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.

[clinic]

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.

[mikl_pls]

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.

[clinic]

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.

Edited February 8, 2020 by clinic

[mikl_pls]

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! 🙂 

[clinic]

I think i have relapsed. Just washed my face/eyes 6 times in 2 hours. And 9 times hand wash. And 3 times eye drops. Therapy is not long term solution. Medicines are.

Edited February 17, 2020 by clinic

[dancesintherain]

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.

[clinic]

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 February 17, 2020 by clinic

[dancesintherain]

But why do that if there's something that will likely help?

[clinic]

1 hour ago, dancesintherain said:

But why do that if there's something that will likely help?

Yea i have not given CBT and ERP therapy enough time.

[mikl_pls]

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 February 17, 2020 by mikl_pls

[clinic]

Washed my eyes 15 times in 2 hours yesterday. We are thinking about hospitalization

Edited February 19, 2020 by clinic

[Gearhead]

At this point that’s probably a good idea, if for no other reason than to protect your eyes.

[clinic]

Just met my 2nd pdoc. He told me my ocd is worsened by my AP(clozapine) and reduce it to 150mg. And increased my benzo to 20mg. And added lexapro 10mg and risperidone 1mg.

Edited February 21, 2020 by clinic

[mikl_pls]

12 hours ago, clinic said:

Just met my 2nd pdoc. He told me my ocd is worsened by my AP(clozapine) and reduce it to 150mg. And increased my benzo to 20mg. And added lexapro 10mg and risperidone 1mg.

I really hope you tolerate this change in regimen well without any side effects. Is this second pdoc the hospital's pdoc? (Are you already hospitalized?)

Could it be that you may have to get off of clozapine entirely? Risperidone may not be a suitable substitute for clozapine due to hyperprolactinemia at the dose that might be needed to control your symptoms, and for the fact that the risk for extrapyramidal symptoms is equal to that of haloperidol (and is dose-dependent, just like hyperprolactinemia), but there's got to be something out there that can help you. There also has to be something to take for your OCD that doesn't require you to take the higher dose of clobazam. Perhaps just backing off on the clozapine and/or replacing it with another antipsychotic might eliminate your obsessive symptoms?

Is the Lexapro replacing the paroxetine CR or augmenting it?

If you don't mind my asking, where do you live? I'd like to research the medicines available to you in your country. The fact that you have tried amisulpride tells me you're certainly not in the US. (US FDA is so picky about what they approve, yet they also approve things that are very dangerous or completely ineffective.... ugh...) Either that or you could research on your own and make the list yourself if you like. I just thought I'd offer to do it to take some stress off of you since you have enough going on already.

[Iceberg]

It sucks that the clozapine is screwing with you so much. Good luck with the risperdal! Unfortunately, it’s frustrating that there is no easy replacement for clozaril, but hopefully your docs can manage it using the “cocktail” approach they seem to be employing 

[clinic]

5 hours ago, mikl_pls said:

I really hope you tolerate this change in regimen well without any side effects. Is this second pdoc the hospital's pdoc? (Are you already hospitalized?)

Could it be that you may have to get off of clozapine entirely? Risperidone may not be a suitable substitute for clozapine due to hyperprolactinemia at the dose that might be needed to control your symptoms, and for the fact that the risk for extrapyramidal symptoms is equal to that of haloperidol (and is dose-dependent, just like hyperprolactinemia), but there's got to be something out there that can help you. There also has to be something to take for your OCD that doesn't require you to take the higher dose of clobazam. Perhaps just backing off on the clozapine and/or replacing it with another antipsychotic might eliminate your obsessive symptoms?

Is the Lexapro replacing the paroxetine CR or augmenting it?

If you don't mind my asking, where do you live? I'd like to research the medicines available to you in your country. The fact that you have tried amisulpride tells me you're certainly not in the US. (US FDA is so picky about what they approve, yet they also approve things that are very dangerous or completely ineffective.... ugh...) Either that or you could research on your own and make the list yourself if you like. I just thought I'd offer to do it to take some stress off of you since you have enough going on already.

I'm from India.

I can only tolerate any SSRI/SNRIs unless my benzo is bumped from 10mg to 20mg. And the problem with that is increased benzo causes me to sleep all day. This will be the last time I'm going to try 20mg as I have already tried it 2 times. If on 20mg my sleepiness is severe, we will have to go back to 10mg benzo and stop lexapro and risperidone. Lexapro is adjunct to paroxetine. Even to tolerate risperidone i have to take 20mg benzo. I dont know why i have to take high dose benzo to tolerate these meds(SSRI, risperidone). Its very frustrating.  Maybe its something to do with clozapine. Clozapine has worensed my anxiety probably. I'm going to be reducing my clozapine to 175mg tonight from 200mg. Lets see what happens. I hope paranoia doesnt come back. And if i start low dose risperidone, i hope i dont get man boobs(gynecomastia)

Edited February 22, 2020 by clinic

[clinic]

On other note, I'm glad my ocd is secondary. By that I mean its caused by another agent(clozapine). If i reduce clozapine it will surely go away.

Edited February 22, 2020 by clinic

[clinic]

Bad news, I couldnt tolerate my increased benzo clobazam 15mg due to intense sedation. So i cant take lexapro and risperidone due to low clobazam.

I'm back to 175mg clozapine, paroxetine cr 37.5, clobazam 10mg

I'm thinking about adding amisulpride instead but it has prolactin issues.

Edited February 23, 2020 by clinic

[dancesintherain]

are you sure the risperidone might not have the kind of effect that you'd be hoping to get from a benzo?  For me, at least, it was a little sedating but not overwhelmingly so and helped with the anxiety. 

Also, a gentle nudge to talk with your psychiatrist before big changes unless you've been given permission in advance to do it. 

[clinic]

8 minutes ago, dancesintherain said:

are you sure the risperidone might not have the kind of effect that you'd be hoping to get from a benzo?  For me, at least, it was a little sedating but not overwhelmingly so and helped with the anxiety. 

Also, a gentle nudge to talk with your psychiatrist before big changes unless you've been given permission in advance to do it. 

I start crying on risperidone if i take it with clobazam 10mg, but if it take it clobazam 20mg I dont cry at all. So the sedation is very bad on clobazam above 10mg, so i cant take risperidone and lexapro

[dancesintherain]

how many times/days/doses have you tried?

[mikl_pls]

 

2 hours ago, clinic said:

I'm thinking about adding amisulpride instead but it has prolactin issues.

Sometimes pdocs combine aripiprazole with antipsychotics that are known to increase prolactin. Just a thought.

Unfortunately I wasn't able to locate a list of antipsychotics available to you in India.  

[clinic]

15 hours ago, mikl_pls said:

 

Sometimes pdocs combine aripiprazole with antipsychotics that are known to increase prolactin. Just a thought.

Unfortunately I wasn't able to locate a list of antipsychotics available to you in India.  

I cant tolerate abilify. I makes me more paranoid and anxious

[Iceberg]

have you tried any other typical beside the prolixin? maybe some of the medium potency ones could strike the balance in helping psychosis without much sedation  or jacking up the prolactin level