clinic Posted February 17, 2020 Share Posted February 17, 2020 It has been estimated that up to 10 percent of patients treated with clozapine develop obsessive-compulsive symptoms. And I’m in the 10 percent category. I’m constantly washing my hands and face/eyes. There are many studies pointing clozapine with OCD. http://schizophreniabulletin.oxfordjournals.org/content/24/3/381.full.pdf Still, multiple case reports describe this phenomenon. It has been hypothesized that clozapine’s antiserotonergic effects are responsible for the emergence of obsessive-compulsive symptoms (Patil 1992), which have been reported to abate spontaneously after 1 to 3 weeks (Patil 1992) or to respond to a decrease in dosage https://psycnet.apa.org/record/1993-30442-001Emergence of obsessive compulsive symptoms during treatment with clozapine. Explored the relationship between clozapine, a potent antagonist of serotonin receptors, and obsessive-compulsive symptoms, which have been linked to deficient serotonin. The treatment of 49 chronic schizophrenic patients with clozapine was reviewed, and 5 patients (aged 33–41 yrs) were identified who experienced either de novo obsessive-compulsive symptoms or exacerbation of preexistent symptoms. Clinical details are provided for each case. It is concluded that clozapine may produce or unmask obsessive-compulsive symptoms. This may reflect a variation on the normal course of clinical improvement or may more specifically result from clozapine’s atypical pattern of CNS receptor antagonism. (PsycINFO Database Record © 2016 APA, all rights reserved) https://www.ingentaconnect.com/content/ben/cn/2012/00000010/00000001/art00009 Finally, significant correlations of OCS-severity with duration of treatment, dose and serum levels suggest clozapine-induced OCS. https://psycnet.apa.org/record/1994-46263-001 Reports the case of a 46-yr-old man with chronic paranoid schizophrenia who experienced obsessive-compulsive behaviors (OCBs) after initiation of clozapine (350 mg/day) treatment. Treatment with sertraline (75 mg/day) reduced the S’s repetitive counting and checking behaviors. Clozapine’s antiserotonergic properties could be related to the emergence of OCBs https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1819.2005.01362.x The results support earlier findings which suggest that clozapine produces or unmasks OCS. https://journals.lww.com/drug-monitoring/Abstract/2006/06000/Higher_Plasma_Drug_Concentration_in.6.aspx The authors suggest that the emergence of these side effects may be related to higher Cps of clozapine and clinicians should routinely check for and manage these side effects. More clozapine and OCD studies Link to comment Share on other sites More sharing options...
jarn Posted February 17, 2020 Share Posted February 17, 2020 Yes I was just reading that last night. I think I am going to have to change APs and it's either going to be Zyprexa or Clozapine - I think I will ask for Zyprexa first, for a few reasons, not least is that my OCD intrusive thoughts have been worse lately (violent thoughts/images of killing one of the cats). Someone said the murderous thoughts might be psychosis but I don't actually want to kill him, I just like planning stuff, and I've been told my love of planning is an OCD thing, and since taking my meds last night the cat was playing in the sink and I kept having thoughts/images about killing her, but I love her dearly and don't want to - I'm certain it's all OCD. I do get flashes of that kind of thing often with strangers and I know I won't act on it but don't generally talk about it to emergency room pdocs because I think they might misinterpret - but my current pdoc is at the clinic that I used to see the head of and he was always super cool about my intrusive thoughts, said they were OCD and I wouldn't act on them. So I think it's safe to disclose. But it's pretty awful. I feel like there's a storm in my head. My compulsions are fairly steady at least. I'm sorry yours are worse. Link to comment Share on other sites More sharing options...
clinic Posted February 17, 2020 Author Share Posted February 17, 2020 10 minutes ago, jarn said: Yes I was just reading that last night. I think I am going to have to change APs and it's either going to be Zyprexa or Clozapine - I think I will ask for Zyprexa first, for a few reasons, not least is that my OCD intrusive thoughts have been worse lately (violent thoughts/images of killing one of the cats). Someone said the murderous thoughts might be psychosis but I don't actually want to kill him, I just like planning stuff, and I've been told my love of planning is an OCD thing, and since taking my meds last night the cat was playing in the sink and I kept having thoughts/images about killing her, but I love her dearly and don't want to - I'm certain it's all OCD. I do get flashes of that kind of thing often with strangers and I know I won't act on it but don't generally talk about it to emergency room pdocs because I think they might misinterpret - but my current pdoc is at the clinic that I used to see the head of and he was always super cool about my intrusive thoughts, said they were OCD and I wouldn't act on them. So I think it's safe to disclose. But it's pretty awful. I feel like there's a storm in my head. My compulsions are fairly steady at least. I'm sorry yours are worse. I remember when my clozapine was started in 2014, within 2 months i started having intrusive sexual thoughts - like my mind would imagine me having sex with anyone i look at. Pdoc gave me prozac and that ocd went away. But unfortunately I cant tolerate any SSRI right now unless i take high benzo along with them. Link to comment Share on other sites More sharing options...
jarn Posted February 17, 2020 Share Posted February 17, 2020 My concern with ADs is mania...but that's good to know. I think I will ask for Zyprexa. Link to comment Share on other sites More sharing options...
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