- Joined
- Feb 21, 2013
- Messages
- 2
- Reaction score
- 0
Hello to everyone here..i've just started Psych training in the UK and need advise on this strange case.
Well the patient here is Me....Ive suffered from Pure Obsessive OCD since i was in 9th grade..Diagnosed quite a bit later..i was interested in Psychiatry from my Pre med days and had gone over Kaplan and Saddock Synopsis and the Shorter version,Current Psych and Wiley's Psychiatry before i finished Med school.after that ive had a year's experience or working as an SHO in Psychiatry wards.
Hokay,so in all this time ive probably read everything there is to OCD in Psych Books or on the internet..im pretty sure there isnt a single trial that i havent gone through.
Its the practicality of it all that i need help with;Ive now gone through trials with
,
All SSRIs bar Citalopram and fluvoxamine
Clomipramine,
Olanzapine and Aripiprazole as adjuncts to SSRIs
Topiramate,Amantadine(yes i know i probably am the first human subject for its use in OCD),NAC....
Inositol,Codeine
In all of those there have been 3 drugs that have made my symptoms regress by a considerable degree.
those would be Fluoxetine doses upto 100mg/day,Sertraline 300mg/day and Escitalopram 40 Mg/day
Now the problem is none of them have worked for more than 3 months...All three kicked in at the same time,around the 2-3 week .the effect was greater with Sert than the other two ..but all three start to lose efficacy around the 12 week point..an increase in dose seems to bring the effect back...it continues for a week or so and then it starts to drop again ...im back to where i started from..a crippling OCD with makes me practically useless...
Im thinking that use of these serotonergic agents causes the 5HT1a receptor to downregulate itself from the persistent stimulation(confirmed by studies,but no lose of efficacy is observed in any of them) and then i start to lose the anti-obsessional effect. In all OCD patients that ive seen over the years, SSRIs seem to get more and more effective as time goes on but with me its the opposite.
I am very anti-polypharmacy..but was left with nothing but to try SSRI combinations..im currently on Escitalopram 40 mg/day and Sertraline 300 mg/day....i know the danger of serotonin syndrome but there isnt a lot i can do about that now..The effects seemed to be marginally better than either drug alone..but alas that also lasted only 10 weeks
Ive seen two different Consultants over the years for this problem..One of them seems to think i need to add another drug to the regimen,an SNRI he suggests..the other one advises me to give the adjunct antipsychotics another trial.
Both Olanzapine and Aripiprazole made me 'calmer',took the edge off the anxiety,but also made me horribly apathic.Topiramate helped a little but then the dreaded relapse of depression that topiramate causes in a significant no of patients.happened and i weaned it off.
So guys,im pretty much messed up here..there is no chance of the me functioning on a normal level with the current condition.Some of you have years of experience treating these patients as compared to me,someone whos just starting his residency..ever observed anything like this?...
Well the patient here is Me....Ive suffered from Pure Obsessive OCD since i was in 9th grade..Diagnosed quite a bit later..i was interested in Psychiatry from my Pre med days and had gone over Kaplan and Saddock Synopsis and the Shorter version,Current Psych and Wiley's Psychiatry before i finished Med school.after that ive had a year's experience or working as an SHO in Psychiatry wards.
Hokay,so in all this time ive probably read everything there is to OCD in Psych Books or on the internet..im pretty sure there isnt a single trial that i havent gone through.
Its the practicality of it all that i need help with;Ive now gone through trials with
,
All SSRIs bar Citalopram and fluvoxamine
Clomipramine,
Olanzapine and Aripiprazole as adjuncts to SSRIs
Topiramate,Amantadine(yes i know i probably am the first human subject for its use in OCD),NAC....
Inositol,Codeine
In all of those there have been 3 drugs that have made my symptoms regress by a considerable degree.
those would be Fluoxetine doses upto 100mg/day,Sertraline 300mg/day and Escitalopram 40 Mg/day
Now the problem is none of them have worked for more than 3 months...All three kicked in at the same time,around the 2-3 week .the effect was greater with Sert than the other two ..but all three start to lose efficacy around the 12 week point..an increase in dose seems to bring the effect back...it continues for a week or so and then it starts to drop again ...im back to where i started from..a crippling OCD with makes me practically useless...
Im thinking that use of these serotonergic agents causes the 5HT1a receptor to downregulate itself from the persistent stimulation(confirmed by studies,but no lose of efficacy is observed in any of them) and then i start to lose the anti-obsessional effect. In all OCD patients that ive seen over the years, SSRIs seem to get more and more effective as time goes on but with me its the opposite.
I am very anti-polypharmacy..but was left with nothing but to try SSRI combinations..im currently on Escitalopram 40 mg/day and Sertraline 300 mg/day....i know the danger of serotonin syndrome but there isnt a lot i can do about that now..The effects seemed to be marginally better than either drug alone..but alas that also lasted only 10 weeks
Ive seen two different Consultants over the years for this problem..One of them seems to think i need to add another drug to the regimen,an SNRI he suggests..the other one advises me to give the adjunct antipsychotics another trial.
Both Olanzapine and Aripiprazole made me 'calmer',took the edge off the anxiety,but also made me horribly apathic.Topiramate helped a little but then the dreaded relapse of depression that topiramate causes in a significant no of patients.happened and i weaned it off.
So guys,im pretty much messed up here..there is no chance of the me functioning on a normal level with the current condition.Some of you have years of experience treating these patients as compared to me,someone whos just starting his residency..ever observed anything like this?...
Last edited:
