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Medication other than anti-depressants?


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For me, the way to deal with OCD and its consequent depression for the sufferer is to make thinking and behavioural changes through CBT. 

The bias needs to be towards this, meds may help by aiding the sufferer's ability to engage with the therapy. I look upon them as "water wings"  to boost our mood and encourage us to make the necessary thinking and behavioural changes. 

So for me the main focus in treating OCD needs to be CBT - preferably mindfulness-based - exercise, meditation and learning how to relax. 

Anxiety is the result of what we think and feel and how we react to that. Since it increases our heartbeat rate and bloodpressure through release of hormones cortisol and adrenalin into the bloodstream, relaxation meditation and exercise ( to burn off those unwanted arousal hormones triggering fight or flight response )  are very helpful, and a betablocker drug may help to bring down the level of cortisol. 

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3 hours ago, seekingERPnorthwest said:

Hi, the anti-depressants I've tried so far are citalopram, dosulepin, paroxetine, venlafaxine and I've been on clomipramine for the past 6 weeks which has been tough.  Has anyone tried anything other than anti-depressants with any success? Thanks

Antidepressants are designed to provide you with breathing space whilst you engage in therapeutic work. They're certainly not a panacea. Personally, I've tried all the ones you've listed (except Dosulepin, with which I'm not familiar) and had little response to any. For OCD (and most other mental health conditions for that matter) therapy (which I appreciate you're seeking) and hard work are the only effective treatments, with or without pharmaceutical intervention.

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  • 3 weeks later...

I've been on medication for years and have found in my case that they become less affective over time. Where once 20mg of citalopram was miracle cure, now I'm struggling to get by on 40mg. Don't make my mistake and get trapped on medication for years, but get cbt as soon as you are able.

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On ‎02‎/‎05‎/‎2017 at 04:47, seekingERPnorthwest said:

Hi, the anti-depressants I've tried so far are citalopram, dosulepin, paroxetine, venlafaxine and I've been on clomipramine for the past 6 weeks which has been tough.  Has anyone tried anything other than anti-depressants with any success? Thanks

What is it you're looking for medication to actually do?  If you're expecting it to make your OCD go away then I am afraid no medication can do that.

But to answer your question, the other used meds for OCD would be anti-psychotics, but the evidence to support their effectiveness is questionable. 

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6 minutes ago, Ashley said:

What is it you're looking for medication to actually do?  If you're expecting it to make your OCD go away then I am afraid no medication can do that.

But to answer your question, the other used meds for OCD would be anti-psychotics, but the evidence to support their effectiveness is questionable. 

Having taken anti-psychotics, I can state categorically that they were of no help with my OCD at all and I certainly wouldn't take them again.

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Ah see this is why you shouldn't ask about medication really as it works differently for everyone! Antipsychotics really helped me, but not Phil, so u really need to decide for yourself wether u want to try them or not without any expectations either way!x

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Yes Meds are so subjective. 

Citalopram really boosts my mood (anti-depressant element of use)  when not in an OCD episode, but only when my anxiety is under control. Maybe when non-anxious it helps me distract from intrusions - jury still out. 

For others here it reduces anxiety and dumbs down triggers, apparently. 

A particular antipsychitic alongside a particular SSRI made a major difference re PolarBear's OCD. 

It's a guessing game unfortunately, trial and error to see what may or may not work for any one individual.

Edited by taurean
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1 hour ago, seekingERPnorthwest said:

The HSS (highly specialised service) criteria say you have to have tried augmentation and that they won't make any exceptions due to lack of organisation.... ...

If there's a medical reason not to take the medication they request, then exceptions are made. Equally, if you don't meet HSS criteria and still want to access one of those clinics you can still go, but would need to get the CCG to refer (in theory no clinical criteria that way).   Access to Prof Salkovski's anxiety clinic in Bath is not part of the HSS programme so there is no medical criteria. 

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Thanks for clarifying that Bath is not part of the HSS programme, Ashley.   Their website says they provide "expert and individualised highly specialist services" - perhaps I've mistakenly been assuming that "HSS" stands for "Highly Specialist Service" when in fact it stands for Highly Specialist Severe specialised service (sometimes).   Or...

Anyway, the Highly Specialised NHSE-funded services say that they are for the most severe cases - at level 6 on the stepped care model, right? - and they are the ones which require you to have tried medications which mightn't have been offered to you...   (unless as you say there's a medical reason for not offering it).

Bath's website says that they aim to "meet a gap in highly specialist evidence-based treatment (CBT), in particular focussing on those service users with the most complex needs", but presumably they can only treat up to "level 5" so how can it not be the highest level but at the same time (?) be for the  "most complex needs".  Eh?  But isn't level 6 reserved for HSS with "most severe cases"?  Almost right but - Springfield says its NHSE-funded service is at level 5!!     And as if anyone can work out which is more severe and / or complex out of severity and complexity...  ...  ...  (I can't).  And if or how the 6 levels do or don't relate to primary, secondary, tertiary etc.  .....  Is it me or is the system bananas?

The reason I was keen to try to meet HSS criteria is because of my experience of how stressful trying to get straightforward and consistent information out of a CCG is.  That is why I was asking about these augmentationy medications which I might need to try to be eligible for central funding instead / in case my CCG won't fund the Bath assessment given that they already funded my assessment at CADAT (not realising that CCG funding is the only option for Bath).  I understood that these include "neuroleptic medication", "first or second generation antipsychotics", "anti-obsessionals", "psychotropics".. etc. etc. so that's why I was wondering what other people had been offered and whether anything improved as a result of taking them! If augmentational agents are on the HSS criteria list then you'd think there'd be a reason for that - just can't seem to fathom why they are on the list if the evidence is weak and experts don't recommend them.

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2 hours ago, seekingERPnorthwest said:

Thanks for clarifying that Bath is not part of the HSS programme, Ashley.   Their website says they provide "expert and individualised highly specialist services" - perhaps I've mistakenly been assuming that "HSS" stands for "Highly Specialist Service" when in fact it stands for Highly Specialist Severe specialised service (sometimes).   Or...

The HSS term (formerly NCG) is just the name of the funding programme. Call me cynical, but some of those services included within the HSS funding programme I am not actually sure they offer an HSS service!    So basically what I mean is there are other HSS services outside of that funding programme, the University of Bath specialist anxiety service being one of those.

2 hours ago, seekingERPnorthwest said:

the Highly Specialised NHSE-funded services say that they are for the most severe cases - at level 6 on the stepped care model, right? - and they are the ones which require you to have tried medications which mightn't have been offered to you...   (unless as you say there's a medical reason for not offering it).

Yes and No. If you access those clinics through the HSS funding programme then yes, there is a medication requirement for eligibility (partly to ensure that due to a limited funding pot, only the most severe patients are seen).   But if your own local NHS clinical commissioning group (CCG) agree to fund the referral to that clinic then in theory there is no specific medical criteria (although the CCG may want you to have exhausted all local services first). 

3 hours ago, seekingERPnorthwest said:

Bath's website says that they aim to "meet a gap in highly specialist evidence-based treatment (CBT), in particular focussing on those service users with the most complex needs", but presumably they can only treat up to "level 5" so how can it not be the highest level but at the same time (?) be for the  "most complex needs". 

Don't assume that just because other clinics are not included in the HSS scheme that they can't offer the same service.   The Bath clinic was only started after the HSS funding programme was formed, so the funding pot as yet to be expanded to include Bath.    Remember, Prof Salkovskis who leads the Bath service helped create and shape the CADAT service in London before he left for Bath.  The service offered by the Bath clinic is just as good, if not better than HSS services.  It can also offer home based therapy where needed, it can offer intensive solutions too.

My advice is forget the stepped care levels, they're perhaps not overly helpful.

3 hours ago, seekingERPnorthwest said:

The reason I was keen to try to meet HSS criteria is because of my experience of how stressful trying to get straightforward and consistent information out of a CCG is.

Yes it is a problem.  But my suggestion is first of all establish which is the best clinic for you, CADAT, Bath, ADRU etc.  Then figure out the referral process later. If you have exhausted all local treatment options, the CCG may say no, but they won't be able to say no forever if you can demonstrate you've tried all local therapeutic options. 

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