pregabalin

[Guest sammy71]

Hi anyone tried Pregabalin, I'm about to start this next week?

Hope you are all OK!

Sammy

[Ashley]

Why are you about to try it, who prescribed it? It's not a recommended drug for OCD.

[Snowdog]

I saw my physiatrist today has well and he just given me this to!!

[Ashley]

But did you actually ask why? Don't assume your psychiatrist knows everything, some prescribe a bit OTT without considering the patients individual needs.

Ask them why they are prescribing it when it is not recommended for OCD by NICE. Ask them what are the benefits. Ask them what are potential side effects.

Only take it when you are comfortable with the responses.

[Snowdog]

For anxity he said and he read out the side affects! I'm not taking it! Just read it for people who have fits ?

[Ashley]

It's used for people with GAD. My concern is some of these doctors are failing to understand anxiety many of us face is because of OCD. So they also need to ensure the patients OCD is being addressed, otherwise they are attempting to treat the symptom (anxiety) rather than the cause (OCD).

[Caramoole]

Pregablin can be very effective for anxiety, and is unlike many of the SSRI's which can push intolerably high anxiety even higher. By reducing the anxiety (in a non tranquillising way) it can help sufferers face the therapy they need to. I don't think it's always possible, or sensible, to treat all of these as separate conditions, there's usually a huge overlap of many anxiety problems and GAD can co-exist alongside OCD not only because of it.

One word of caution, it is a drug where tolerance can happen and it then seems less effective.

It's a drug that is used to treat epilepsy but is frequently used for neuropathic pain, fibromyalgia and anxiety.

[Ashley]

I don't think it's always possible, or sensible, to treat all of these as separate conditions, there's usually a huge overlap of many anxiety problems and GAD can co-exist alongside OCD not only because of it.

Of course GAD can run alongside OCD, but sometimes the person with OCD will just be suffering anxiety from their OCD. But that's the point I am making, it's important to ask the question why is it being prescribed (the same with any medication being prescribed, people should ask the question).

[Caramoole]

Agreed. It amazes me how people will just accept medications (of any kind) without asking pertinent questions about it.

[whitebeam]

I do think that at times we are so vulnerable and so desperate that we don't think to ask these questions...we don't know to ask these questions......our psychiatrists are generally people we trust - the people who are offering us a chance to 'escape' from this hell.

My psychiatrist prescribed me an anti-psychotic - which was a disaster. He explained that I wasn't psychotic but that in my OCD I had some psychotic tendencies in my beliefs and that it (Risperdal) had been shown to help some with severe OCD.......What was I to do? desperate, very poorly.....there was no way I would turn this down.

A - it sounded as if it would potentially help

B - I would have tried anything

It was a disaster........

Some time later he prescribed a combination of Clomipramine and Clonazepam. I'm sure some would turn down the offer of a benzo-diazepine - possibly rightly.

He had read an article/been to a symposium (?) I can't now remember - where this had been recommended as a last chance before some sort of surgical intervention..........

Again what was I to do? Again...desperate, still very poorly (just been discharged from a secure psychiatric unit).......why would I not take this chance?

This was, for me, the beginning of my recovery.....

I don't think it is necessarily easy for us - sufferers - to know which questions to ask or to know what the different meds are used for/advised for eg by NICE.

I do believe that not enough is known yet about the treatment of OCD to rule in or rule out any potential support in terms of meds.

I'm not saying that meds are or are not the answer - for some it is, for some it isn't. I was never given CBT - although my psychologist talked of it......but I now know what she 'did' was not CBT..........so, in effect, that was a route closed to me.

I am so glad that i did give a go to the meds I was offered.

I know this may go against what is suggested by OCD-UK but I don't think we all have the choice to choose what we receive - we have to take what we are offered.

[Ashley]

I do think that at times we are so vulnerable and so desperate that we don't think to ask these questions...we don't know to ask these questions......our psychiatrists are generally people we trust - the people who are offering us a chance to 'escape' from this hell.

I know this may go against what is suggested by OCD-UK but I don't think we all have the choice to choose what we receive - we have to take what we are offered.

I think this is part of our role, the make sure people are aware of their treatment options, rights and choices. But also to make them aware it is perfectly acceptable and ok to ask questions of psychiatrists, and maybe even help them with which questions to ask. When people are desperate they may put their trust and faith in their Dr's and most of the time they are right to do that, but it doesn't mean we should not encourage people to ask appropriate questions.

It's also not true that you have to accept what you are offered (although it sometimes feels that way) if you are offered the wrong treatment. The NHS will often make us feel we have to accept what we are offered, but it is simply not true. For example, lets say they offer you counselling for OCD rather than CBT. You can tell them that NICE recommend CBT and request that.

I have heard stories of some NHS services refusing CBT until meds are taken by the patient, but NICE are clear if patients don't respond to an initial course of CBT they should be offered the CHOICE of either more CBT or SSRI meds.

The problem is many people with OCD are not aware of these things, or are too scared to challenge what they are offered. So part of our job is to help people become informed, and offer them help if they need it.

[Caramoole]

but I don't think we all have the choice to choose what we receive - we have to take what we are offered.

We do have the choice.......and we absolutely don't have to take what's offered but I completely understand your point Penny, that it feels that way. That we can feel so ill, so unable to assert ourselves, so desperate that we will try anything at that time. As Ashley says, that's why it's important that the charity helps people to be informed about the treatments, about rights, about choices.

Medication is an option and one that often will work well for many. For some (more than perhaps is reported by the profession prescribing it) it won't, worse than that, it can be catostrophic. People should be properly advised about medication, not only about the positive aspects but the potential negative ones.....and if one is unfortunate to find yourself in that category, those problems should be given due consideration and taken seriously. I have been on this treadmill for 40 years and have not had any effective support. Doctors tend to prescribe because it's the only immediate tool they have at their disposal. The decision to take a history, diagnose and prescribe is given in a 10 minute window and is done because there isn't the option of giving someone the immediate psychological support they need and deserve.

As I said in my earlier post, everyone is different......and despite being an OCD forum, treating the OCD issues won't necessarily resolve all the anxiety issues, it can be more complex and intertwined than that.

I have heard stories of some NHS services refusing CBT until meds are taken by the patient, but NICE are clear if patients don't respond to an initial course of CBT they should be offered the CHOICE of either more CBT or SSRI meds.

I'd need to re-read the guidelines but doesn't it say somewhere that to be eligible for "specialist referral" sufferers should have tried at least 2 SSRI medications?

But back to the question raised by Sammy (and Heidi's concerns) give it a try. The effect on anxiety should (hopefully) be apparent (or not) quite quickly. Weigh that up with any side-effects and make a decision based on that. My personal advice would be to be cautious about escalating the dose too quickly and staying on the lowest dose that provides benefit, due to the possible tolerance issue,

[snowbear]

I have heard stories of some NHS services refusing CBT until meds are taken by the patient, but NICE are clear if patients don't respond to an initial course of CBT they should be offered the CHOICE of either more CBT or SSRI meds.

I think a lot of pressure is put on people to take medication for their OCD, especially where local waiting lists for CBT are long, or if the person has had OCD for a long time. Whether the health professionals mean to or not, sometimes it's implied that if only you would take the meds you could be better by the time your turn comes and not need CBT after all. (And wouldn't that be convenient if it was true...)

Sometimes it's implied that if you don't try the meds on offer it's the same as 'refusing treatment', but people should be clear this isn't so.

Meds are a choice, and it should be a choice you willingly opt into, or a choice you can confidently say 'no thanks' to if it's not what you want. You shouldn't be made to feel you're opting out of a viable alternative to CBT just because it's easier for the doctors to prescribe than to arrange therapy.

I may be biased, but I think this pressure towards medication is a newish trend and a ploy to hide the fact there aren't enough CBT qualified therapists available to meet demand.

While I've nothing against meds in themselves, I think it's very important that people know taking meds is a CHOICE and not compulsory. Don't allow anyone to make you feel bad if your informed choice is not to take them. Don't be guilt-tripped into taking something you're not happy about.

I'd need to re-read the guidelines but doesn't it say somewhere that to be eligible for "specialist referral" sufferers should have tried at least 2 SSRI medications?

I vaguely recall reading that somewhere too, Caramoole, that to get referred to one of the specialist treatment centres you've either got to have been tried on 2 courses of SSRI (or the equivalent) or have been under secondary care (a hospital psychiatrist). Secondary care (whether as an inpatient or an outpatient) almost always involves trying medication, so in my opinion that's using medication as a gateway to filter numbers of patients referred rather than a recommendation for medication.

I could be wrong about the referral criteria, but it stuck in my mind because it seemed strange to say 'our specialist CBT is the best treatment available for OCD...' while implying... [but you can only access it if you've tried the less effective methods first and failed with them at least twice.] :dry:

Edited April 29, 2016 by snowbear

[Caramoole]

I may be biased, but I think this pressure towards medication is a newish trend and a ploy to hide the fact there aren't enough CBT qualified therapists available to meet demand

.

Agree whole-heartedly. For GP's faced with a desperate sufferer, it's often the only tool available on offer in their 10 minute slot.

[Ashley]

Will respond about the specialised services and Meds in morning. Hate typing long posts on phone so will post then. In brief you're right sort of, but not fully depending on referral route.

[Hal]

I could be wrong about the referral criteria,.......

I don't think you are. I was told by my CBT therapist who was with the NHS (but I saw them privately) I needed more intensive treatment through the NHS and in order to access it, I'd have to have had two courses of SSRI's before I could take that step...as I'd only had one that wasn't an option, the side effects were too great and neither he or anyone I consulted could explain why (they'd affected my immune system).

In retrospect I guess I could have been somewhat economical with the truth and played the system by getting the prescription for the second course but not taken them....ironically from what I've heard since though, I'm glad I didn't do that and access treatment at the place that had originally been recommended to me.

(Edit: Posted simultaneously with Ashley)

[taurean]

Gosh we've all been on some journeys.

As I know only too well the SSRIs are drugs with side effects,tolerance to and duration of which is very individual.

I couldn't tolerate Fluoxetine (prozac) at all,turned me into a zombie with permanent diarrhoea - but I found a way to get through initial side effects of tremors diarrhoea and insomnia and on to doing fairly well on Citalopram.

I am on a modest dose because of my age (20 mg a day) but it is beneficial currently - my plan is towards trying to see if I can ease back off it again next year, but still hold onto (through psychological methods) the better mental strength it seems to give me.

Edited April 29, 2016 by taurean

[Guest sammy71]

This drug was prescribed by a private Consultant Psychiatrist that I pay to see as the mental health support where I live is dreadful.

She basically said try it for a week, if no good then stop!

[Guest sammy71]

Sorry just to add I get terrible anxiety and it was given for that, not for my OCD for which I sertraline. I also take mirtazapine and quetiapine

[Caramoole]

This drug was prescribed by a private Consultant Psychiatrist that I pay to see as the mental health support where I live is dreadful.

She basically said try it for a week, if no good then stop!

I think that's fair advise. Have you taken it yet?

[Ashley]

Will respond about the specialised services and Meds in morning. Hate typing long posts on phone so will post then. In brief you're right sort of, but not fully depending on referral route.

It took a bit longer to type than planned, but I have posted on a new thread - http://www.ocdforums.org/index.php?showtopic=73702

[whitebeam]

Pregablin can be very effective for anxiety, and is unlike many of the SSRI's which can push intolerably high anxiety even higher. By reducing the anxiety (in a non tranquillising way) it can help sufferers face the therapy they need to. I don't think it's always possible, or sensible, to treat all of these as separate conditions, there's usually a huge overlap of many anxiety problems and GAD can co-exist alongside OCD not only because of it.

One word of caution, it is a drug where tolerance can happen and it then seems less effective.

It's a drug that is used to treat epilepsy but is frequently used for neuropathic pain, fibromyalgia and anxiety.

I think this sounds like a valuable weapon in the armoury.

By reducing the anxiety (in a non tranquillising way) it can help sufferers face the therapy they need to - I think this is a really good point, Caramoole. I believe this was how my meds helped me. Previously, I had been unable/unwilling (through fear) to access the treatment - but once my anxiety was reduced, I could try the ERP and was willing to take 'risks'. I did not 'have' to seek safety by carrying out my compulsions immediately.

One word of caution, it is a drug where tolerance can happen and it then seems less effective. That is a shame but, hopefully, the sufferer will have been able to work with CBT / ERP and made improvements in the time it is effective......forward steps could be taken in this time.

[whitebeam]

I think this is part of our role, the make sure people are aware of their treatment options, rights and choices. But also to make them aware it is perfectly acceptable and ok to ask questions of psychiatrists, and maybe even help them with which questions to ask. When people are desperate they may put their trust and faith in their Dr's and most of the time they are right to do that, but it doesn't mean we should not encourage people to ask appropriate questions.

It's also not true that you have to accept what you are offered (although it sometimes feels that way) if you are offered the wrong treatment. The NHS will often make us feel we have to accept what we are offered, but it is simply not true. For example, lets say they offer you counselling for OCD rather than CBT. You can tell them that NICE recommend CBT and request that.

I have heard stories of some NHS services refusing CBT until meds are taken by the patient, but NICE are clear if patients don't respond to an initial course of CBT they should be offered the CHOICE of either more CBT or SSRI meds.

The problem is many people with OCD are not aware of these things, or are too scared to challenge what they are offered. So part of our job is to help people become informed, and offer them help if they need it.

I think this is part of our role, the make sure people are aware of their treatment options, rights and choices. But also to make them aware it is perfectly acceptable and ok to ask questions of psychiatrists, and maybe even help them with which questions to ask. Definitely, Ashley. It is fantastic that this sort of help is available for people. I'm not sure when I found the OCD forum which initially offered support (where I 'met' Ashley before the days of OCD-UK) but I don't think it was when I was at my worst and having to make choices and so on about treatment.

.......it doesn't mean we should not encourage people to ask appropriate questions. Totally agree.

For example, lets say they offer you counselling for OCD rather than CBT. You can tell them that NICE recommend CBT and request that. Again - it's fantastic to have this knowledge...this knowledge and the support of eg OCD-UK does give a sufferer more ammunition, more confidence in what to ask for. But only if you know about it. When I was referred to a psychologist (having been to a counsellor while I was waiting and having refused to see her after a couple of sessions - because she talked about flooding techniques - not calling it such - and that scared me so much I wouldn't carry on seeing her as I knew I would not do any of those things).

When I did see my psychologist who was a fantastic lady - truly supportive and kind - not very knowledgeable about OCD - I hadn't heard of ERP, CBT, NICE guidelines - it was all totally new to me and, although I did look up what I could about OCD, my knowledge was very basic.

The problem is many people with OCD are not aware of these things - unfortunately true

or are too scared to challenge what they are offered - again, unfortunately true

So part of our job is to help people become informed, and offer them help if they need it. Definitely - and that is one of the reasons we are so grateful to you, to OCD-UK and to all the support on this forum.

[whitebeam]

We do have the choice.......and we absolutely don't have to take what's offered but I completely understand your point Penny, that it feels that way. That we can feel so ill, so unable to assert ourselves, so desperate that we will try anything at that time. As Ashley says, that's why it's important that the charity helps people to be informed about the treatments, about rights, about choices.

Medication is an option and one that often will work well for many. For some (more than perhaps is reported by the profession prescribing it) it won't, worse than that, it can be catostrophic. People should be properly advised about medication, not only about the positive aspects but the potential negative ones.....and if one is unfortunate to find yourself in that category, those problems should be given due consideration and taken seriously. I have been on this treadmill for 40 years and have not had any effective support. Doctors tend to prescribe because it's the only immediate tool they have at their disposal. The decision to take a history, diagnose and prescribe is given in a 10 minute window and is done because there isn't the option of giving someone the immediate psychological support they need and deserve.

As I said in my earlier post, everyone is different......and despite being an OCD forum, treating the OCD issues won't necessarily resolve all the anxiety issues, it can be more complex and intertwined than that.

I'd need to re-read the guidelines but doesn't it say somewhere that to be eligible for "specialist referral" sufferers should have tried at least 2 SSRI medications?

But back to the question raised by Sammy (and Heidi's concerns) give it a try. The effect on anxiety should (hopefully) be apparent (or not) quite quickly. Weigh that up with any side-effects and make a decision based on that. My personal advice would be to be cautious about escalating the dose too quickly and staying on the lowest dose that provides benefit, due to the possible tolerance issue,

"We do have the choice.......and we absolutely don't have to take what's offered but I completely understand your point Penny, that it feels that way". I think probably in this aspect I haven't been clear; I was happy to try the meds I was offered - the positives were put to me - as you say maybe the potential negative effects were not exlained. However, at that point I would have taken anything offered. I don't think I would have risked surgery (it wasn't mentioned) ......but meds, I thought, certainly offered me a way out and, as it turned out, this was the actuality.

"As Ashley says, that's why it's important that the charity helps people to be informed about the treatments, about rights, about choices". This is absolutely right - in another post (with ref to one of Ashley's) I have explained that when I was at my poorliest - I didn't have much information but that amazing organisations like OCD-UK do give such support and knowledge really have changed the game - for those that have found them.

"I have been on this treadmill for 40 years and have not had any effective support. Doctors tend to prescribe because it's the only immediate tool they have at their disposal. The decision to take a history, diagnose and prescribe is given in a 10 minute window and is done because there isn't the option of giving someone the immediate psychological support they need and deserve." I'm sorry to hear this, Caramoole that you have not had effective support in all that time. and yet, look how amazing you are at giving effective support :original: I know I was lucky in so many respects - I had fantastic support. My GP never limited me to 10 minutes.....I virtually lived in his surgery at one stage!! and I was seen by a psychiatrist very early in the piece. He was also amazing - when I wasn't getting any better, he did ERP with me - he saw me every week for treatment (my psychologist was not happy and said she would no longer see me - but that's another story) but, as I said, I accepted any help offered.

"But back to the question raised by Sammy (and Heidi's concerns) give it a try. The effect on anxiety should (hopefully) be apparent (or not) quite quickly. Weigh that up with any side-effects and make a decision based on that. My personal advice would be to be cautious about escalating the dose too quickly and staying on the lowest dose that provides benefit, due to the possible tolerance issue" I totally agree with this, Caramoole - it's certainly worth trying meds which are prescribed - but be aware of how you are and if/how it is affecting you - particularly adversely and if so contact your GP/psychiatrist.

[Snowdog]

Thanks guys for your information etc I only just seen this has I haven't been online! Till now! I've decided not to take it I rather not take a medication that is not meant really for ocd and my anxiety is from my Ocd so I need to address my ocd to get rid of the anxiety!

Thanks everyone hope you are all well ? X