Emphyrio

Hello, I was wondering if anyone had any ideas about the role of glutamate in OCD? I think a lot of the literature talks about it relating to low levels of serotonin (hence why SSRIs are used to treat it) but there are still a sizable number of patients for whom SSRIs don't work or are at least not worth the side effects (myself included - I developed post-acute discontinuation syndrome, which included akathisia and visual snow, from stopping citalopram). I have been looking into the role of glutamate in OCD and it seems like there is some initial evidence that the use of glutamate modulating drugs like N-ascetyl-cysteine, pregabalin and lamotrigine can be of benefit in treating OCD. Has anyone here found any kind of benefits from taking glutamate-modulating drugs? Thanks :) Emph

So far mirtazapine appears to be helping somewhat but its still early days. I've only been on 15mg for a week and have noticed a definite lessening of my depression and I feel more driven to do things. Will update with the progress. Still taking my tiny (5mg) dose of citalopram too.

What dose of prozac were you on in the past? While some people need 60mg or more to have relief from their symptoms, others may need just 5-10mg. You could try a lower dose if you think they would benefit you. Some people can get relief from SSRI induced sexual dysfunction by adding mirtazapine or trazodone but both these meds come with their own issues. You could try the herbal medicines ginseng or ginkgo biloba too. Plus there's always viagra... I've not had a great time being completely off meds but in hindsight I came off them too quickly and didn't put into place any non-drug ways of dealing with my issues. So now I've got withdrawal symptoms as well as a return of my intrusive thoughts.

Have you tried the 10% taper method? Basically, you taper your previous dose by 10% each time, waiting 3-6 weeks between drops. It means you need 1-2 years to come off the drug in question, but you minimise withdrawal symptoms and allow the brain to recover. Its a long time, but allows you to put in place non-drug methods of dealing with any anxiety issues.

Hello, I am going to be receiving some therapy through an NHS psychiatrist starting next week for my intrusive (violent) thoughts, but I have also been prescribed mirtazapine which I hope will help. I know that SSRIs and clomipramine are the most commonly prescribed meds for OCD but for some reason I cannot tolerate them - they make my agitation/anxiety worse. I also think that withdrawal from antidepressants in the past has worsened my anxiety and led to a resurfacing of the intrusive thoughts. The current issues I face at the moment are: - Constant feelings of panic/doom/dread/agitation. - Need to move around constantly – tap legs, move arms, nail biting, jaw clenching, constant fidgeting. - Poor concentration. Cannot pay attention to people. - No real hope for the future – can’t enjoy anything. - Feelings that I might ‘lose control’. - Violent intrusive thoughts. - Hypersensitivity to food, alcohol and caffeine. I have some OCD books such as 'Imp of the Mind' but I guess the intrusive thoughts make it difficult to concentrate fully on putting changes into place. I was therefore wondering if anyone here found mirtazapine useful in taking the edge off the anxiety that intrusive thoughts can bring? Thanks

Thanks for the replies I think that my central nervous system has been put into turmoil in the past couple of years - I suspect that a combination of excess alcohol, stress, and changes to my brain caused by SSRIs and SSRI withdrawal are to blame. I guess this explains why fluoxetine sent me into a hyper-anxious state when I took it the second time around. I heard that mirtazapine (Remeron or Zispin) is quite good for anxiety? Anyone had any relief from intrusive thoughts with that? Lamey - I tried escitalopram (Cipralex) for a few days - unfortunately I felt really bad and the visual problems I had developed on citalopram did not go away. I should have given it longer but my doctor advised that if I was having visual and cognitive problems with citalopram, it is likely I would have them on escitalopram. I would ideally like to try to manage my OCD using CBT alone, but feel that my nervous system is so sensitive at the moment - and all the changes/uncertainties in my life need to be addressed first. I guess my goal is to get stable, with the assistance of meds, get some stability in life, challenge my intrusive thoughts using CBT, and them think about coming off the meds at a very slow pace.

Hello, I am have been on 50mg of fluvoxamine for 6 weeks now (a week at 25) and am still dealing with some pretty nasty side effects, some of which have got worse in the past week. They are: - clenched jaw - restlessness and restless legs - a general feeling of agitation, anxiety and akathisia - some heightened intrusive thoughts I know from these symptoms that its a result of the medication rather than any underlying anxiety, so I'm not wanting to increase the dosage as of yet. I'm going to give it a full 12 weeks on 50mg. However, if things do not work out, then what are my options? I've tried several other medications in the past with limited success. Fluoxetine - I was on this for the best part of the last decade, not going over around 20mg/day. However, I came off it due an increase in my anxiety and intrusive thoughts around 2 years ago. The intrusive thoughts went away and I felt great shortly after coming off it - no anxiety. However, I then developed a deep depression, which led me to citalopram. Citalopram - tried 10mg for six weeks in early 2012. Started feeling really restless/agitated around week 5 mark, so stopped taking them. Unlike being on fluoxetine, I didn't go back to a deep depression after discontinuing them, but became really anxious and my 'pure O' went through the roof. Now I realise that I should have let my body get used to them for another 2 weeks and the side effects would have faded. Clomipramine 25mg in spring 2012. I lasted 9 days - severe GI disturbances, impotence, cognitive dysfunction and blurred vision that made it impossible to drive. Back to fluoxetine - 20mg sent my anxiety through the roof - super agitated, restless, loss of libido, and only a slight impact upon my harm OCD thoughts. Tapered down to 5mg by November, but still feel bad. Stopped taking it and felt better for a while, then the depression and intrusive thoughts came back. Spring 2013 - sertraline 25mg - jaw clenching, severe cognitive impairment and severe visual problems. Lasted 5 weeks. I then thought about trying citalopram again at a low dose (5mg). This actually worked. Was on it for around 4 months - the anxiety and intrusive thoughts went away and I could tolerate caffeine again. However, I developed visual snow which has persisted to this day - even though I'm not taking it any more. I also suffered high levels of sedation and cognitive dysfunction, which I was prepared to tolerate for a while as the medication was working well for the anxiety, but in the end it was preventing me reading or studying. Escitalopram 2.5mg for three days – felt suicidal. Back to fluoxetine (5mg) – after around 6 weeks my ‘pure OCD’ thoughts and general anxiety feelings returned with a vengeance. So that led me to fluvoxamine. I feel that part of my problems have been medication-related and medication withdrawal related, so while I would really like to be medication-free, I know that until I get my life sorted out, with a job and some stability, that I will need antidepressants as a crutch. I tried doing CBT after coming off citalopram in early 2012, but the harm OCD was like a stuck record - it was that bad - and I was sure that I was going to follow through with my urges and permanently harm myself. Can anyone relate to my issues, and have any suggestions for me? My issues at present are: - Harm OCD - Fear of social situations or unfamiliar circumstances - depression and apathy - visual snow, like a flickering in my vision/distorted vision - fatigue (need 9 hours of sleep a night to function) - restlessness and a feeling of constantly being on edge - hypersensitive central nervous system - can't tolerate caffeine, alcohol, b-vitamins, anything stimulating - aches, pains, forgetfulness, poor cognition - feelings of hopelessness - low/fluctuating libido. - poor concentration and inattentiveness I am generally suspicious of doctors - I think that they confuse drug-induced akathesia for anxiety and would tell me to up the dose. The psychiatrist I saw suggested augmenting with something with quetiapine which I think would be too sedating given the fatigue I face on a day to day basis - not to mention the cognitive side effects and emotional numbing that antipsychotics bring. Apologies for the long post - thanks for reading.

This is the only SSRI I haven't tried. I know it is the most sedating one though, and quite possibly the hardest one to come off. I'm also sensitive to SSRIs but got good results from just 5mg of citalopram. Unfortunately it led to cognitive problems and visual disturbances so I had to come off them, which is a shame as it worked really good for my intrusive thoughts. You could even start on 5mg and work your way up.

Sorry you're having a bad time at the moment. What I would do if I was in your situation is arrange to talk to a teacher you trust about your concerns - tell them about your fears and the way you're being treated by others in your class. Its not easy talking about OCD to anyone but I'm sure you'll feel a lot better having done so. Mental health issues are taken a lot more seriously these days in schools. You should at the very least keep telling your teachers if people are bullying you though - behaviour like that is never acceptable.

Hi Monica, I experience the same thoughts as you - its all about 'what if' I harm myself/punch someone/spit in someone's face. I know that I don't want to do this and haven't done anything like it before but its the fear that somehow I may do something in future. I also get anxiety thoughts about something that I may have control over. For instance, I worry about having a car crash because of factors that are in my control - e.g. the wiper blades aren't cleaning properly. I switch back and forward between the intrusive thoughts and the anxiety thoughts pretty quickly - it all seems to come down to something within my control. Good to hear you don't have such thoughts often nowadays. Could you please advise what you found helpful? I'm trying to do things like do more exercise, have cut back on caffeine and alcohol etc - I seem to get intrusive thoughts whenever I feel tense. Thanks, Pete

Thanks for the reply Sarah - have went and ordered 'The imp of the mind'. I'm going to see the GP on the Monday to discuss trying out something to take the edge off the anxiety/intrusive thoughts. I've never taken large doses of any medication in the past. When I was on fluoxetine I took 20mg/day and with the citalopram I was on 10mg/day. I did take 40mg fluoxetine a couple of times but had to stop taking it because of its stimulating affect on me. I've come off the fluoxetine twice - the first time was back in 2008 and I pretty much stopped abruptly. Didn't have any adverse effects that I was aware of, though I did start to feel more 'down' after a month or so. The second time was when I came off it to go onto citalopram - that was scary - had only 4 days off the fluoxetine and started citalopram 10mg, working up to 20mg after 10 days. I got tense arms and was pretty much sure I was going to follow through with my thoughts and poke my eyes out. I dropped all medication abruptly after that. The final time I stopped taking citalopram was at the end of February this year - I was cutting up my 10mg tablets into small pieces and therefore properly tapered off. I noticed that the last two times I came off medication, I experienced a 'golden period' lasting about a month where I didn't experience much in the way of intrusive thoughts and where I didn't feel particularly agitated - I was then able to do a lot of things without the OCD trying to 'bring me down' for simply living a normal and comparatively successful life. It's so frustrating - for years I imagined that I'd never do the things I want to do because of low mood, and the second I start putting a healthy lifestyle in place, the pure o thoughts appear in my mind and try to bring me right back down/follow through with my intrusive thoughts.

Hello, I'm Pete - its my first time visiting these forums. I have experienced 'pure o' type OCD (revolving around intrusive thoughts about 'what if' I attack or maim either myself or someone else) and some general anxiety/depression for around 9 years now. For most of those 9 years I've been taking 20mg of fluoxetine a day which has largely helped keep my mood up, but in recent years I began thinking that tit was making me feel physically tense (when I feel tense I often get the intrusive thoughts). More recently I tried citalopram which was a disaster - I was so tense and agitated that I was sure that I was going to follow through with my thoughts. In the last couple of months I have put lots of things in place to try and get better. I have significantly cut down on my alcohol intake, gave up caffeine, ate more healthily, and took up more exercise. I have also had a number of CBT classes. I have also stopped taking medication - I have given up medication on two previous occasions and on both times I experienced a decrease in my 'pure O' type thoughts, but at the expense of an increase in anxiety and depression. I hoped that the healthy eating/living would limit the depression/general anxiety while keeping the intrusive thoughts low, as they had been the previous times I had given up medication. This time being off my medication has been different however. I don't feel depressed and am not worrying about things too much - but the intrusive thoughts are back and are pretty much taking over all aspects of my life. The CBT doesn't seem to be working, even though I've been trying to avoid letting the thoughts control my day to day routine. Its as if the OCD is trying to tell me that I should not experience a good quality of life and that all the positive steps I'm putting in place are pointless. Ideally I would love to stay off the medication (I've been off it for 2 months) but its got to the stage where the thoughts are taking over my whole life. I was just wondering if anyone here knows of an effective medication which is less stimulating than either fluoxetine or citalopram? As well as the intrusive thoughts I have tense muscles, get a pounding heart, can't sit still, have to keep moving my arms and legs, etc. Beta blockers don't really work. I have no reason to feel physically agitated. Does anyone know of any medication which can help with the intrusive thoughts while keeping me calm at the same time? Thanks for listening everyone, Pete