Raffles

I had to take a year out between second and third year of Uni because I had a crisis -- just in case it helps to hear that this can happen. Is she receiving Disabled Students Allowance? I was allocated an hour a week from a mental health support person. Not a therapist, but someone who could help me keep on track with studies, touch base with. One time, when I was becoming quite unwell, they came with me to the GP to advocate for me. They were also great at helping me navigate the extenuating circumstances process.

I hadn't appreciated the Oxford clinic is tertiary. Thank you for explaining things, Ashley.

It really shouldn't have to be so convoluted to receive appropriate treatment. I've seen your posts about your experience - the system needs radical improvement so these things don't happen. Hope your current CBT+ERP is helping.

Do you know how feasible it is to get referred through patient choice? It's not as simple as just asking when you see your GP - your local CCG still have to sign off/fund it?

I was more wondering whether you'd heard what the waiting times were like/how referrals are going for the new clinic, since it could be helpful for members! It is interesting to hear how these documentaries are created though. Paul's principles are solid and admirable, and Nadiya is just downright amazing.

I think that last part is crucial in recognising how Nadiya could have got treatment so promptly. The NHS and the BBC/show producers may have valued its awareness-raising potential, demonstrating good CBT. The specialist centre in Oxford has only recently opened its doors for referrals, and it says on their website there's no waiting times at the moment apart from administrative ones. So theoretically, at this point, anyone could be referred and seen relatively promptly. I don't know if you could request it through patient choice from your GP, and I imagine getting your Clinical Commissioning Group to agree to fund the referral (if you haven't exhausted local resources first) could be tricky... Any ideas, @Ashley? I only know about the above because I've been through the mill of local CBT (through my GP, then CMHT, then private, then IAPT) and so have had grounds to request a referral to another specialist centre, CADAT, through the NHS Highly Specialised Service. I've had to research it to convince my CMHT to make the referral. The charities (OCD-UK and OCD Action) have really good resources explaining the NICE guidelines and referral routes, but I can imagine if it's people's first time using services it can be bewildering to know what to do for the best. People shouldn't have to go so far afield to access appropriate treatment, or wait as long as they are.

It's your first session, right? Maybe ask the therapist if you can speak to your mother together if you're going to have another home visit, if it would be beneficial for her not to be there. I hope it goes well for you.

Knowing a bit about the structure of NHS services, and who Paul is, did make me feel keenly aware that the show has been produced with a narrative hook/storytelling element. It does seem rare for someone who, in the course of the narrative, hasn't been involved with services before, should be referred to a specialist centre rather than local IAPT -- although if you're savvy, do your research, and exercise patient choice it's possible. I imagine the team making the show with Nadiya would have helped research the best options. Perhaps the BBC Action Line explains more details about how to access treatment. It would have been better for me if they'd said who Paul was, and he was consulting for the show to explain how CBT and the diagnostic process works. It felt... intrusive seeing Nadiya in therapy, although I'm also glad they communicated the rawness and how it can be hard work. I'm glad the clips were brief, and I really hope she's continued with therapy and reduced her suffering.

I'm glad to hear it!

No worries! I really feel for you. I also have a healthy appetite, when well, and the times I've lost it have felt pretty scary. When you're anxious and go into the fight-or-flight response, the body temporarily shuts down some processes, like digestion, to boost the ones that can help you escape. We don't usually notice this because it's meant to be brief, until you're free of danger. Unfortunately with anxiety disorders and depression, you can't just fight or flee the threat, so the state lingers. Hope the Sertraline gives you your appetite back soon. I tried sipping a lot of lukewarm herbal teas when I was last that bad to try and feel full. Chamomile with honey actually helps my nerves a bit! Ginger's good for nausea, and mint is soothing for the stomach.

Do you get migraines, Sufferer? As I think I mentioned in another thread, maybe consider the possibility you're mis-attributing symptoms of anxiety/sleep deprivation to side-effects. Or a mixture of side-effects and symptoms you're paying attention to now there's a new variable with the medication. The stiff shoulder muscles could be due to anxiety-tension? I don't notice I clench up when I'm stressed until my shoulders start aching! If you can take a warm bath, or use a wheat pack/hot water bottle on them, you might get some relief. It's easy to say, but try not to engage with rumination about how long you might take meds for. It's individual to everyone.

I get that. I only take Diazepam if I'm so anxious my chest hurts and I'm close to inconsolable. It's a last resort -- and I certainly wouldn't want to take it regularly since it can stop being so effective, but it's good to know it's there if I can't reduce intense anxiety by other means. I think I said in your other thread on appetite, it only took a couple of weeks after starting Sertraline again to be able to eat normally. Getting that sustenance inside me made the world of difference in being able to cope day-to-day.

I didn't phrase that particularly well -- I'm aware of the increased risk of suicidal thoughts in the early stages of taking SSRIs. It's why, as you observe, they should be used with care and monitoring by Doctors.

Sleep deprivation can do that too! And cause headaches. I know it's another medication, but you could consider asking your doctor to prescribe a short amount of diazepam/another benzodiazepine. Taking them long term can cause dependency, but a small prescription to take when you're intensely anxious can provide a bit of respite. It might help you relax a little and ease your muscles.

Ah, you poor thing. That really is familiar. I tend to realise I'm properly sick again once my appetite bites the dust and my stomach becomes upset. It's a clear signal to seek support. It's usually a mix of acute anxiety with depression tagging along that does that. Feeling physically rough also makes it harder to cope with the mental stuff. I had to really fight to get food in me in the morning, and could only manage things like smoothies, soup, yoghurt, mango, bananas. Anything cold and gentle. Fortunately, after roughly a fortnight back on Sertraline my appetite returned and my stomach settled. I hope the same happens for you.

As someone who had a full on meltdown about going back on meds last year, I hear you. I have a friend who takes an SSRI for depression, and she said two things that helped me come to terms with taking them again. Firstly that it was better to take the meds to reduce suicidal thinking and be more likely to live into old age, and then a glasses metaphor. Yes, you could probably make do without glasses, but why would you put up with suffering when they're available? That sort of shut the health anxiety up. Hope the Sertraline helps you -- it makes things more manageable for me, and I'm fortunate enough to have few side effects beside wakefulness for the first month or so of starting it. It doesn't stop the OCD, but it soothes the sharp edge of anxiety and depression. Definitely push for CBT. Check out the OCD-UK guides for questions to ask your therapist, to make sure they have experience treating OCD.

You write about crying, feeling hopeless about the future, not feeling how you think you should towards people you love, and you're ruminating like anything. These can all be symptoms of depression. Where would be the harm in speaking to a Doctor about these symptoms and seeing what they, with their experience and training, make of it?

Reading over your posts in this thread, there's a lot of signals you may be suffering Depression alongside/due to the OCD. Tackling that could make tackling the OCD easier. Seriously, go back to your GP. Or find another one for a second opinion. Ask if anyone at your GP surgery has an interest in mental health. Whatever the label attached to what you're experiencing might be, no-one deserves to suffer like it sounds you are.

A lot, however I try not to dwell on it too much (easier said than done) because it is what it is and I'm wary of beating myself up and bringing my mood down. It's good and important to acknowledge you're grieving for what might have been. OCD causes a lot of collateral damage in your life, and a therapist can help you to untangle and process such things.

Hi Orchid, have you looked at the NICE guidelines for OCD - it covers children and young people specifically, so may be useful. I think they're more reluctant to prescribe SSRIs in young people because of the risk of increased suicidal ideation, and would prefer to trial CBT/ERP (with family input) on its own first. I was prescribed low dose Fluoxetine (and monitored) by my GP at seventeen because of depression that developed alongside the OCD. The shortages and over-demand on services leading to long waiting lists is incredibly frustrating, but especially in CAMHs. I'm sorry you're all dealing with this.

Hi Don, Is it an appointment with an Improved Access to Psychological Therapies (IAPT) service? Or Community Mental Health Team (CMHT)? And is it an initial assessment, or the beginning of therapy? What county are you in? Being anxious about it is understandable.

Snap. I was never one for physical activity growing up, but I now find regularly keeping active - either brisk walking or cycling or, occasionally, yoga - provides a sense of wellbeing. When I'm well enough to. Sometimes depression makes it hard to find the motivation. Sertraline has taken the edge off the worst of the depression. I still have a lot of obsessions + compulsions, and am seeking further psychological therapy, but I dread to think how I'd be if I hadn't gone back on medication.

I remember reading about how people with OCD can have varying levels of insight into their condition. The degree to which they believe their fears are likely? Which shares features with delusional thinking/loss of touch with reality/psychosis. And that lack of insight could impact successful CBT outcomes. It might help explain why some people can do poorly even with multiple rounds of CBT.

I think the idea that OCD is (an exaggerated) evolutionary pattern comes from animals' "flight distance" behaviours. Roughly speaking, our brains evolved to have a "better safe than sorry" response to stimulus. Say there's a one 1/10 chance the rustling in the bushes is a predator. 9/10 times it's a bird, but our ancestors with a predisposition towards "better safe than sorry" lived to pass on their genes while less flighty ancestors got eaten before they could. In OCD, the parts of our brains that run that better safe than sorry pattern are wonky. Through genetic predisposition, something like PANDAS (if that's a thing), and learning. It doesn't stop it being a mental illness or it's treatment with CBT/ERP though, and I wonder at the motives behind denying it's a mental illness. I mean, depending on how you look at it pretty much everything arises from evolution, with the genes we inherited from all our ancestors interacting with our environment.

I don't disagree that it's an evolved pattern and some propensity to obsessive-compulsive behaviours exists across the population. However, it is a mental illness precisely because it can be done to excess, interfere with wellbeing, and cause significant impairment. That's kind of the definition of some forms of mental illness. Why are you so keen on not classifying it as such?