Pharmacophobia..(Aripiprazole)

[GrannyG81]

Hi folks...

Just signed up today...Ok a little Background...I'm diagnosed with OCPD (Obsessive compulsive personality Disorder) Although i'm also diagnosed with OCD...Also Mixed Anxiety/Depression..Tbh I kinda Given up on diagnosis as it changes depending on which Pdoc i see..I was also told i'm Treatment resistant which i presume relates to my depression..This was a good few years back...Anyhow I curently take 30mg Mirtazapine which i've been taking for around 7 years..I find it does not do much to help and i think i take more out of habit..Maybe its pooped out??? I'm currently back in mental health services and seeing a nurse practioner...Heres the thing..I'm terrified of Anti Psychotics...I mean Terrified and my treatment plan consists of anti depressent + anti psychotic..I remember one Psychiatrist saying My treatment must consist of the two...Going back 5 years ago when i was last in mental health services Risperidone  was suggested...I refused..Then Abilify...I got the perscription but never took them..Then i saw a different Pdoc..Explained my Fears..(Pharmacophobia) Is whats its called..Olanzapine was suggested..Never took them...And after months of this Refusal on my behalf Depot medication was suggested..I refused...Fast forward to today and Abilify has been offered again...5mg to start with...I have it at home but i'm terrified of the side effects..Anxiety,Akasthesia i even convinced myself i could get NMS a very rare side effect..The Pdoc even perscribed me Diazepam to take incase of any anxiety and guess what..I'm even scared to take them !! So i have a full arsenal at my disposal to help my mental health yet i'm too terrified to take them...(What a trip it is) Its litreally like been stuck between a rock and a hard place..I'll pysche myself up to take them and when the day comes i'm just consumed with so much fear i bottle it..I feel like failure tbh as my mental health is deteriorating i'm getting depressed and i'm to scared to take medication to help it...Sorry if this sounds a bit like rambling on but i'm really desperate to try this abilify as i,m sure it could help.....Any help/Advice or personal stories that can relate to this please help me out...Many Thanks Jamie

I got sober nearly 11 years ago and heres a list of meds i've tried in that time..

Fluoxetine (Prozac) Made me Anxious,Sweat a lot and really bad stomach ache..

Escitalopram..made my thoughts much clearer/Sharper but also made me feel quite clumbsy...Maybe i didnt give it long enough as only tried for a month or so?

Clomipramine...Wonder drug for me..Worked really well..made me feel good..Infact "too good" Remember getting some mild Hyper mania...Had to come off it due to ECG indicating ireggular heart beat

Quietapine..Only tried it a few days...Couldnt handle the hangover period..Maybe should of give a good trial?? (This med has also been suggested again)

Sertaline..Cant remember how this made me feel...Part of me thinks i came off it due to been to activating/Racing thoughts...Was a lot of years back

Imipramine...Didnt take to it..Went on it after coming off Clomipramine..Didnt find any therapeutic effect..Might of been because i compared it to clomipramine and how well that worked..Who knows??

I dont know were this fear of meds has come from as i've tried a few and before been sober i've tried many more

Edited March 17, 2020 by GrannyG81

[CrazyRedhead]

3 hours ago, GrannyG81 said:

I dont know were this fear of meds has come from as i've tried a few and before been sober i've tried many more

When trying a medication for the first time, I get a little nervous, too, so I understand.

It seems from what you posted that you have an extreme fear of trying meds.....Are you currently taking any meds at all?

Do you have a therapist or counselor?.......If so, I think it would really help to talk to them about these fears you're having regarding medication.....If you don't have a therapist, I would highly recommend getting one....A therapist may be able to give you some coping strategies to deal with the fear.

[echolocation]

hi jamie! i'm also diagnosed with OCPD, and the jury's out whether i have OCD or not. the first pdoc i saw took the same approach as yours by prescribing an antidepressant and an antipsychotic. the combination of venlafaxine 225 mg and risperidone 0.75 mg got me through university. i really loved being on that combination, and in particular i loved risperidone. it calmed down my racing thoughts and my intrusive thoughts, and also helped me stop ruminating endlessly on my perceived shortcomings and failures.

i unfortunately had to come off risperidone last year because i began to lactate (raised prolactin levels). i had been on it for a couple of years at that point. my pdoc had initially warned me about this, but said it was unlikely due to the fact that i was taking such a small dose. but, alas. i still take 0.25 mg PRN for racing thoughts and anxiety.

the lactation i experienced cleared up a couple weeks after i stopped taking risperidone. i have no lasting side effects from taking it. i am glad i took risperidone for as long as it helped me. 

after risperidone, i tried 2.5 mg abilify. it was too activating for me and i became anxious. it also made me really air-headed for some reason. my memory and concentration was pretty bad while i was taking it. that cleared up immediately after i quit taking it. abilify is activating at low doses, which is excellent if you're running slow because of depression. i tend more towards the anxious side of things, so it wasn't a good fit for me. i prefer drugs that are sedating.

my pdoc and i decided that venlafaxine on its own wasn't covering my obsessive symptoms well enough, so i tapered off of it and started taking clomipramine. i'm just on clomipramine 80 mg right now, which is working okay. i want to go up a bit when i see my pdoc next, because i'm still getting bothersome intrusive thoughts.

 

what symptoms in particular is your care team trying to control with the antipsychotics? are they targeting OCD or OCPD symptoms, or are they targeting your depression? plenty of folks here have taken abilify for depression and found it quite effective.

i had a fairly poor reaction to abilify. but, it was very easy to come off, and once i stopped taking it, all my side effects went away. i don't regret taking it even though it didn't help me. it gave me more insight into how different meds affect me, which helped me move forward in my treatment.

 

would making a pro/con list about taking versus not  taking abilify help? some pros for taking it might be that it may help you feel better, at a low dose you are unlikely to get serious side effects, you'll learn more about how you react to meds, your treatment will move forward, and you will be treating your phobia with exposure therapy by taking the medicine. the obvious con is that you may develop side effects. pros for not taking it include not risking side effects, and avoiding the anxiety that comes with taking meds. cons for not taking it is that your treatment stalls, your symptoms continue, and your phobia is increasing its grasp on you.

 

CrazyRedhead has a good suggestion in trying therapy. OCD and OCPD both respond really well to therapy. if taking meds is not a feasible option right now due to your phobia, perhaps a therapist would be able to help you get to a point where the phobia has less power over you.

 

i'll stop here as i've already written an essay's worth, but i do hope you find some relief soon. living in fear is a horrible place to be in. 

[GrannyG81]

Thanks for replies folks i'll respond to you both...

Redhead...Yeah am currently taking mirtazapine 30mg..Been on that for around 7 years now..I dont find it has any benefit but i like the sedative side of it which i still get so not looked at changing it..i've had lots of therapy over the years..3 bouts of cbt including group and 1-1..I also had nearly 2 years of psychodynamic therapy...Tbh i dont find therapy helpfull..For some it works wonders,for me i find it quite limited..Plus i normally get resentfull towards the therapists for some reason....I've discussed it with the Pdoc i'm seeing at the moment..All they can really do is offer reasurrance..

Echolocation...I've got all my mental health notes going back years from the docs so i've seen what the psychiatrists have wrote...OCD was a diagnosis...OCPD was a diagnosis...Mixed Anxiety/Depression was there Clinical depression /Hypochondria and then vague things like.."Obsessive ruminations"."paranoid beliefs that are obsessive" Etc i believe OCD is my more prominent problem...I tend to have more intrusive thoughts/Compulsions ..id say i have traits of OCPD..One Psych said OCPD/OCD go hand in hand but other things i've read contradict that and say they are totally seperate thats why i gave up on diagnosis...My anxiety is the main issue they are trying to help with...Although i've lived with depression for years my last real bad episode was about 5-6 years ago when i convinced myself i had HIV from geting blood on my finger at work...I stopped work,Stoppped caring..Couldnt sleep..Didnt wash etc And then the thoughts..Suicidal thoughts etc BUT and heres the BUT...When i get to that state i get really paranoid...My anxiety on the surface looks delusional...For example..With my HIV fears I started Beleiving conspiricary theorys that it was man made etc I also thought things like the terminator was looking for me and thinking wierd things like snipers could be on roof tops etc..I slept with the light on and thought i could feel presences in the room..Plus a whole plethora of other wierd stuff..Now although these thoughts were soooo over whelming there was a tiny part of me that had a grasp of reality hence why i've never been diagnosed with any psychosis...The PDoc i see now i asked him why every psychiatrist i've seen over the years..7 in total now have also perscribed Antipsychotics if OCD is treated best with high Does SSRI..He said that with my obsessions/Anxiety etc it can kind of spill over into almost delusional thought hence why they believe i need antipsychotics.he explained it much better than i'm writing here ..Psychology calls it "Over valued Ideas"..Not quite delusional but much more intense than General anxiety..I also get lots of magical thinking etc.Also OCD now has a Insight factor in the diagnosis from Good insight to poor insight so part of me thinks when mine gets bad my insight can get quite poor...I've much more to write at a later date regarding my symptoms and mood etc but for now i've crammed enough in lol..Any questions fire away and thanks for getting back to me..I really appreciate it...Jamie

[Juniper29]

I share your concerns about the side effects of antipsychotics. Abilify has been a really helpful med for me, though. I guess for me it's worth the risks, to have improved quality of life. But when I was still delusional I thought my pdoc was poisoning me ... That fear cleared up when she increased the dose.

[GrannyG81]

Thanks for the reply Juniper..

I tell myself this over and over about getting better ect...This is in part why i feel like a failure (Even though i know thats depression Talking) because i just cannot bring myself to take the abilify...This is Something i said to the Pdoc in trying to explain this fear.."Imagine your worst fear..Lets say Heights for sake of argument..Now imagine me trying to get you to the top of the effiel tower..Imagine how terrifying that would be trying to get up there" .Thats what this fear is like...Its like a blanket of sheer terror that over comes me when i'm faced with taking them..I just cannot reason with myself (believe me i've tried) I'll psyche myself up the day before and feel good whilst doing it imagining myself getting better and feeling good and i'll be ready to do it..Then the morning comes when i'm faced with taking them and the fear just totally consumes me...At one point a Psychiatrist suggested Depot injection...I'm actually starting to wonder if that might be a viable option as left to my own devices i just cannot see myself taking them..Thats how strong this fear is...Its so over bearing and irrational  words just cannot over come it...Then of course this feeds into my depression etc as i feel like a failure etc...I've even been perscribed Diazepam for any anxiety i get from the abilify and i'm afraid to take them even though i've used them in the past !! Its a real trip it really is..

[GrannyG81]

Good Morning Folks,

Just to add regarding Antipyschotic medication.

My Themes Over the years regards OCD have all had A bizzare content to them...For example I used to have a fear of touching anything electrical as i feared that electricity could somehow seep into my blood stream and cause my brain to imbalance..I feared walking on grass and stepping on magic mushrooms because, same again ,seeping into my bloodstream and imbalancing the chemicals in my brain..I had lots of other scenerios i created that all had a bizzare element to them like the ones mentioned..I said to the Pdoc that although they arnt what you would call "Typical" ocd thoughts as we know it they all share a common underlying theme of "Contamination"..He agreed...Thats what i believe my underlying OCD theme is "Contamination" ..I've often said to different Pdocs that some of my thoughts have what u would call "delusional" content ..(I'e i've had thoughts cameras were in rooms monitoring me etc) They are not delusional in Nature as i still have a grasp of reality and dont 100% Believe them....Maybe this is another reason why PDocs believe i need antipsychotics as my thought process although not delusional it does have a paranoid "flavour" to it...Who knows i'm just getting out what i've come to believe over the years..

[mikl_pls]

On 3/18/2020 at 5:35 AM, GrannyG81 said:

Good Morning Folks,

Just to add regarding Antipyschotic medication.

My Themes Over the years regards OCD have all had A bizzare content to them...For example I used to have a fear of touching anything electrical as i feared that electricity could somehow seep into my blood stream and cause my brain to imbalance..I feared walking on grass and stepping on magic mushrooms because, same again ,seeping into my bloodstream and imbalancing the chemicals in my brain..I had lots of other scenerios i created that all had a bizzare element to them like the ones mentioned..I said to the Pdoc that although they arnt what you would call "Typical" ocd thoughts as we know it they all share a common underlying theme of "Contamination"..He agreed...Thats what i believe my underlying OCD theme is "Contamination" ..I've often said to different Pdocs that some of my thoughts have what u would call "delusional" content ..(I'e i've had thoughts cameras were in rooms monitoring me etc) They are not delusional in Nature as i still have a grasp of reality and dont 100% Believe them....Maybe this is another reason why PDocs believe i need antipsychotics as my thought process although not delusional it does have a paranoid "flavour" to it...Who knows i'm just getting out what i've come to believe over the years..

This is just the abstract (not full text) but highlights that there is a relationship between OCD and delusions.

https://www.healio.com/psychiatry/journals/psycann/1999-9-29-9/{b49c448b-295e-478a-b828-3ee293fa4924}/obsessions-and-delusions-the-relationship-between-obsessive-compulsive-disorder-and-the-psychotic-disorders#

OCD has varying degrees of insight, and it could be that you have low levels of insight such that you have delusional content in your obsessions, but just enough insight to realize that they're not completely rational beliefs, yet you still submit to your obsessions/compulsions surrounding your delusions.

I am very much the same way, but I do exhibit psychotic features when I am profoundly depressed—the more depressed, the more severe the psychosis is.

There is also a connection between schizophrenia and OCD-like symptoms. Whether this is related to schizophrenia itself or the antipsychotics used to treat it isn't clear (the atypical antipsychotic clozapine, used as a drug of last resort in very treatment resistant patients, can often induce anxiety and OCD-like symptoms in psychotic patients, and this has been noted with other atypical antipsychotics too, but to lesser degrees than clozapine). Why this happens doesn't seem to be clear.

Targeting the glutamate system is another way of controlling OCD, but I don't know how well that targets the delusional content of OCD. Personally, in my experience, taking antiglutamatergic drugs for OCD has never resulted in an improvement of symptoms (I've tried lamotrigine, topiramate, zonisamide, gabapentin, memantine, and probably others I'm not remembering).

I do think giving an antipsychotic a try would definitely be worth it. Aripiprazole is usually a pretty harmless drug. Yes, agitation, stimulation, and akathisia are pretty common, and lower doses tend to be pretty stimulating, but as you go up in dose, it tends to even itself out for most people. 10-15 mg is usually a good happy range for most people. Ziprasidone is another that may be good for OCD and is generally well tolerated. Akathisia is also common, but probably not as common as with aripiprazole. It's also weight neutral, and is stimulating in low doses (20-40 mg twice daily) but becomes sedating in high doses (60-80 mg twice daily) where D2 antagonism overcomes 5-HT2A/2C antagonism. Ziprasidone also acts as a "mini-SNRI" and targets several other serotonin receptors as well. Quetiapine is another potentially good AAP for OCD, but would likely need to be dosed on the higher end of the spectrum to have sufficient therapeutic activity. It tends to be sedating, often to a problematic degree, and often causes significant weight gain, but rarely ever causes movement disorders like akathisia. Risperidone is very commonly used in OCD, but it has a very high incidence of EPS, including akathisia (it has been shown to possess the same likelihood of incidence of EPS and hyperprolacinemia as haloperidol).

Typical antipsychotics are used too, but that should be put off for if the atypical antipsychotics don't work.

Personally, I would start with aripiprazole at a low dose of 2 mg or 5 mg first. That's just me.

[GrannyG81]

4 hours ago, mikl_pls said:

I am very much the same way, but I do exhibit psychotic features when I am profoundly depressed—the more depressed, the more severe the psychosis is

When i got servery depressed 5-6 years i got really paranoid...Not the extent of full blown delusions..For example i started thinking The terminator could be looking for me..I'd look out of my spy hole in the door and even though i wasnt 100% delusional and had "Some" degree of insight the over whelming nature of it was terrifying...Also thought i could hear low level voices around me when i laid in bed..Sleeping with the light on..Thought i could feel presences in the  room etc..lots of bizzare weird stuff going on..And my moods were really changing,..Sad to angry to rage to irritable all happening within minutes of each other....Feeling Deeply sad yet happy at the same time..Really chaotic mood shifts...The Pdoc at the Time said Extreme Anxiety/Depression can cause a Mixed state..Thankfully my depression is not at that level..I'm currently on the slope down so to speak..Little things like from going from a obsessively clean house to just hoovering a bit here and there..losing interest in stuff..and life generally losing its colour..I feel reasonable today...Although my mind is very busy my mood state feels resonable..Or what i consider reasonable...I'm very black/white in thinking...If i'm not suicidally depressed i'm not depressed but as we know depression does not work like that..Thats just my thinking style..I think i need something that calms me down..Stabilises my mood and at the same time gives me some degree of motivation to get back into the swing of life..Abilify does sound like it could fit that bill but yet i'm just terrified of it..Thanks for the reply I really appreciate it..

PS on one of the letters from the psychiatrist to the drs ( I've got all my mental health notes) One Psychiatrist had wrote "Evidence of acute psychotic Features).....What does that mean ? Is it tied to any particular disorder or is it just a vague term? I have other terms in my notes like "Obsessive Ruminations" And "paranoid beliefs that are obsessive" but to me they just seem like Vague meaningless terms???

[GrannyG81]

Just to add...Do you think 5mg abilify would work on stabilising mood and clearing up in Irrational thoughts/Bizzare thoughts...I've read mixed results from people saying 5mg and below is simply anti depressant and i've read others who say it had a calming mood stabilising property at 5mg...The Pdoc who perscribed me abilify those 5 years ago wanted me to start at 10mg...The new pdoc i'm seeing is a advance nurse practioner...hes very very cautious about anti psychotics but hes ok with abilify due to its side effect profile..He normally wants ecg before he perscibes AAPs...I did have that done a few weeks ago along with a general medical and it came back ok...Mild Tackicardia? But according to the cardiologist who read the results said that its possible it was picking up anxiety...This new Pdoc suggested Quietapine but wanted a ECG before he would perscribe that..The script for abilify was made before the ECG so the plan was to give it a try and if not successfull then could look at other options like quietiapine..I see him again on the 16th of april..

[Juniper29]

25 minutes ago, GrannyG81 said:

Just to add...Do you think 5mg abilify would work on stabilising mood and clearing up in Irrational thoughts/Bizzare thoughts...I've read mixed results from people saying 5mg and below is simply anti depressant and i've read others who say it had a calming mood stabilising property at 5mg...The Pdoc who perscribed me abilify those 5 years ago wanted me to start at 10mg...

5 mg helped me a little, maybe? But mostly with depressive symptoms. My delusional thoughts didn't really clear up until I went to 10 mg.

I am like you in that I have a fair amount of insight with my delusional thoughts. The content is paranoid and weird and I definitely believe it to some extent but not 100%.