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Does SSRI treatment actually help?


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Hi everyone,

Do anti-depressents really help much with OCD/OCD extra symptoms such as depression?  I tried to get help years ago but nothing really came of that and I haven't tried since.  I am sure I do have OCD and my brother does too.  I have checking rituals with certain things, feeling anxious/paranoid esp about appearence, intrusive thoughts over different things, seems to be a wide spectrum.

I'm in a position where I have battled through and tried to control rituals etc with exposure to it....probably similar to CBT.  I'm still struggling with OCD and feel that I might have depression too from it made worse because of strugging to find work and from OCD.

I'm thinking of going back to the doctors and I would try CBT properly, but I am more wary of taking medication if it is not that effective. 

I know people respond differently but is the trend generally a positive experience and help for OCDepression?

Thanks

 

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I've never seen statistics to give you a proper answer. I would say most sufferers are helped to varying degrees, with a lessening of overall anxiety and a reduction in depression symptoms. A few people do really well and quite a few get no benefit or bad side effects.

To me they are worth a try. Note that it takes 4 to 6 weeks for an SSRI to really take effect.

However, meds are not a substitute for CBT.

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Hi Rucker

I'm sorry to hear you're finding things difficult atm. I would advise you share how you are feeling with your GP and ask for a referral for counselling etc. This will hopefully help support your recovery and give you some reassurance/diagnosis.

As for SSRIs I can only give you my opinion based on my journey so far. I think I am one of the lucky ones. I was prescribed a SSRI approx 10wks ago now and the first one I've tried seems to be working. It did take 5wks for even the slightest change to occur and I did have to have my meds increased to support progress. The side effects were awful at times and I can understand why people give up, bit the result is a calmer me, my thoughts are a lot slower and I find I can now concentrate on things better as my brain isn't as busy. I didn't have depression but my mood has been enhanced giving me the strength and motivation to continue my ERP with amazing results. I would say the meds dont cure the issues but they work as stabilisers and mood enhancers to help you get through the day and think positively about things. They haven't removed my intrusive thoughts or stopped my compulsions but atm they help me cope. It's still early days and I may need another increase but I've certainly seen huge benefits. However please remember not everyone is this lucky.

I was reluctant to take meds in the beginning and unfortunately it got to the point that I ran out of options, bit I wish I'd trusted my GP earlier as I'd be further down my path to recovery. 

Only you can make the decision about what's right for you. Good luck with your recovery, hope this has helped.

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I have heard that they might be a placebo with regards to depression but not sure about anxiety, they may help some people. I do know that they are really hard to get off of and some people react differently to them than others. Have you tried reducing sugar and caffeine? Some people may have food intolerances that may affect anxiety. I'm working on this myself but having trouble giving up chocolate! It's good to find out why you are anxious, for myself I developed OCD a few years after getting chronic fatigue syndrome, when I'm more tired, I'm less anxious, when my energy picks up, my anxiety increases. Good luck and hope you feel better soon. :)

Not sure if it's okay to include links but it is written by a psychiatrist/MD.

http://kellybroganmd.com/4-things-to-check-before-taking-an-antidepressant/

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Hello

Thanks a lot for the replies.  That's one of my concerns about medication Orange.  I have no problem taking medication if it is genuinely proven but I am more wary when the link may be more tenuous if there are side effects/difficulties coming off it.  My brother too Prozac years ago (he has ocd symptoms, but I believed it was proscribed for depression) and he didn't think it made much difference.

I tried to get help years ago and did get referred to a mental health team and filled out a questionnaire.  However I was fobbed off after a few sessions and I felt that unless i ticked the box about having suicidal thoughts then they didnt take things that seriously.  However, it is more complicated than that I feel.

If I go back I think that it is likely an SSRI would be offered, and CBT.  I've had some success at times with trying to do CBT on my own.  I think it helps with compulsions/checking and I've stopped asking for reassurance etc.  I've found it harder to deal with intrusive thoughts though.  It is bound up with my appearence and I feel anxious and odd when I go out.  I look young for my age too, been a problem all my life and had caused issues and really crushed my confidence but it's all  I think about 24/7 and the intrusive thoughts are really difficult.  I have no idea how I look anymore.  This I constantly as for reassurance for.

Exposing myself to situations makes this worse however.  It had the opposite effect than happens with rituals/checking things and reinforces the obsessive thoughts I have about it.  I now avoid things that will reinforce it, but that is difficult as an 'adult' but facing it genuinely reinforces it.It would be an issue had I not think this way but it would not be as bad.  I expected at 37 that this wouldn't be an issue anymore (thats what I told myself when I was younger). 

I've tried reducing sugar and caffeine and that definitly helps to a degree, execise helps a lot too.  I just can't seem to work past aspects of this, and the options that may help don't sound too effective.

I know it sounds a bit unusual :0/

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Actually, as you mention food intolerance  I could have a problem with gluten.  Someone mentioned that I might have symptoms of it and as I'm of Irish descent apparently is is more common than the general population.  I've cut most gluten out of my diet but I haven't been 100% strict and I've noticed some improvement but I will need to get tested to be sure.

I love bread too:bash:

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2 hours ago, Rucker said:

Exposing myself to situations makes this worse however.  It had the opposite effect than happens with rituals/checking things and reinforces the obsessive thoughts I have about it.  I now avoid things that will reinforce it

This is why doing ERP alone (just the 'B' of CBT without the 'C')  can lead to a failure of therapy.

Change the focus to the cognitive side. This enables you to change how you view things which overcomes the problem of exposure making things worse instead of better. 

2 hours ago, Rucker said:

I know it sounds a bit unusual

Actually what you describe is not unusual. Common as mud in fact! :) 

I personally don't think medication makes a huge difference and to my mind the problems it adds outweigh the benefits. But each to their own and if it helps someone then I'm pleased for them. With medication the response is very individual and the only way to find out if you're one of those who'll benefit or have problems with it is to try it. Therein lies the difficulty of deciding whether to give it a go or not.

Whether you decide to give medication a try or a miss, make sure you get CBT, with an emphasis on the Cognitive part. Explain to the therapist how you've found exposures can make you worse and over which issues. This will be a good starting point for addressing change. 

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Edit: Apologies that this is not a very positive post, I just wanted to share my thoughts regarding something that was said further up the thread about how helpful the cognitive part of CBT can be. 

 

On 28/08/2017 at 17:10, snowbear said:

This is why doing ERP alone (just the 'B' of CBT without the 'C')  can lead to a failure of therapy.

I had CBT on the NHS recently. It was the first time I'd had CBT since 2012, when I used it to get well (no one thought I could get well as my OCD was so severe but I did it!) However I got ill again over the last couple of years, hence the recent CBT. The recent therapist was very focused on exposure (with some mindfulness), and didn't want to do any cognitive work. I worked very hard, it was really difficult, but it didn't 'stick' like it did in 2012, when I had started with the cognitive work. I kept suggesting that I needed a more cognitive approach but the therapist was determined to stick with exposure as she was worried that cognitive therapy could feed into the OCD. Eventually I had to tell her that I wasn't prepared to do any more exposure without the cognitive support, and she accepted that we could do some cognitive stuff based on what worked for me in the past. Unfortunately by this point we had used 16 of the 20 sessions I was given by the NHS, and there wasn't enough time to make much progress. I ran out of sessions in May and now my OCD is the worst it's been since pre-2012. 

 

Edited by LizzyHoy
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I'm really sorry to hear you had an unhelpful therapist, Lizzyhoy. :( But thank you for sharing your experience.  

It's so sad that a trained therapist would believe cognitive therapy 'feeds into' the OCD. That suggests to me she doesn't understand what the cognitive approach is about, which begs the question whether she's applying it correctly even when she does offer it. :unsure: 

Your experience illustrates some of the problems we face when therapists are taught to focus on ERP instead of CBT. I think it's a fault of the training system when they do this. Although there's been a wealth of research on the benefits of CBT for OCD in the last decade many of the therapists working now will have trained back in the day when professionals believed it was just a matter of doing ERP.

It's going to take time for awareness of the change in thinking on OCD treatment to trickle through the ranks of those already 'trained'. Which means that for now we may have to play our part in educating them, and support our OCD-UK charity as it pushes for better awareness amongst the professionals. :) 

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Can I ask what happens when the 20 sessions of therapy are up? It seems quite a fixed number considering people are different and have different compositions of OCD. 

I don't want to sound negative but therapy, and access to it, sounds like it can be a minefield.  I think that's why I never tried after trying to get some help years ago.

Also, isn't there national guidelines regarding ERP/CBT?  Or is it just up to individual trusts?

(I'm not brushed up on the therapy)

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Thank you both for your replies. Apologies again that this is a bit of a rant(!) I'm having a hard time at the moment.

Snowbear - thank you for your thoughts on cognitive therapy. It was difficult for me at the time because when I pointed out that exposure alone wasn't helping she suggested it was because I wasn't willing to jump in with both feet on it. But I was trying harder than I did on the occasion I actually recovered! 

She is quite young so I'm not sure if it will be due to her training being only ERP based. Her training in OCD might not be extensive enough to help someone who has very severe OCD and who already has a lot of insight into their own condition. To be honest I think that there is an issue with the way things are being done with IAPT - there's more low level support than there used to be but if you have severe mental illness then it's still difficult to access the appropriate level of help. I am a bit unfairly biased against IAPT because they used to train in the building I worked in and they were noisy when I was trying to work!

I do research in the area of Psychology and I have colleagues who look at how therapy is delivered, and how there is often an assumption that if therapy doesn't work then it's the client's fault, not the therapist's. It probably feeds into the disparity between mental and physical healthcare - if you have treatment for a physical problem and you don't improve very much, then they will try another treatment. Admittedly I did improve from the beginning to the end of therapy, but nowhere near as much as I had in the past (and which I knew was possible for me). Yet therapy ends when you run out of NHS sessions, not when you're better. 

 

Rucker - Please don't let my experiences stop you from seeking help. I have had some excellent CBT on the NHS in the past - it partly depends on who the therapist is and how much you can learn from them about how to deal with the OCD. 

Regarding 20 sessions - I think they aim to give only 6, and then they extend it to a maximum of 20 if the person needs it. I think it's to do with funding. I would assume the next step in my case would be to refer me to high intensity therapy, but they haven't suggested that, they've just left me to 'be my own therapist' - which is the ideal if you can do it, but at the moment my OCD is too severe for me to manage successfully on my own. I think if I spoke to the GP again they would hopefully refer me for high intensity therapy, but apparently the waiting list for that is 12 to 14 months in my area at the moment. I think the sort of therapy I had is probably great for people with moderate OCD and other mental health conditions, or for people with severe OCD who haven't had experience with therapy before. It teaches you skills to manage your mental health better. It just wasn't very helpful for me as I have about 15 years' experience of reading about OCD and have seen many therapists in the past, so I knew most of the techniques, I was looking for someone to work with me to apply them.  

 

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59 minutes ago, LizzyHoy said:

Yet therapy ends when you run out of NHS sessions, not when you're better. 

Pretty sure this is against the founding principles of the NHS...  I could see the logic in having a certain number of sessions then time away to work on things as the sessions could become a crutch that people rely on so breaks could be useful.  But just ending them doesn't sound right.

For me the biggest help in clarifying I have OCD is seeing the opposite to what I have in other sufferers.  It's hard to explain but my brother has OCD, however it is connected to different things.  Some of the symptons are the same (checking) but over different things.  The thought patterns are pretty much exactly the same.  Whereas I check things that can cause harm cooker, handbrake, doors, taps etc, intrusive thoughts over appearence, that I've done things wrong etc whereas his is mostly intrusive thoughts that he's done something wrong but the object of focus is different etc.

I think what he does is irrational and he thinks the things I do are bonkers.  But the patterns just jump out and it is easier to talk about it and point out when you can see the symptoms in others but be rational about it because it isn't something that you do.

Maybe they should train OCD therapists who have had OCD and pair them with patients who have different focus to their own.  Complete understanding but rationality of focus too.

 

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Rucker - that's an excellent idea regarding pairing therapists with people seeking treatment. The less stigma associated with OCD the easier it'll be to achieve. 

I know what you mean about people with different manifestations of OCD helping you to see your OCD for what it is. It is so strange that the brain goes wrong in such a specific, and wildly irrational(!) way. My mum also has OCD, one of her things is making sure the door is locked. For me on the outside of her OCD I can see that it's irrational but I can also understand how she is feeling. 

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I check the door, although it is mostly things like the cooker or the iron that really gets me.  I can see it's irrational to keep checking and I can force myself to check once then leave but I can imagine that I've seen it on and it's worrying (often I will go back to check and check again) but dealing with those thoughts it often will pass. I can't trust what my eyes see... sometimes I will sit and repeatedly check the cooker dials...then have to start again and again and again.  I often count too 6,8 or 10 quite usually for checking the tap is off.... go to leave and go back to count again.... it is bizarre.

Yet I don't have hand washing problems, or fears of contamination etc and watching people who have that issue I am totally rational about it.  That's bizarre.   I find it interesting how there are common themes with OCD yet people have different objects of focus that is their issue.

They aren'tt the bits I'm stuck on though :bash:

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11 hours ago, LizzyHoy said:

Yet therapy ends when you run out of NHS sessions, not when you're better. 

This is true, but is actually not what is meant to happen, and I urge all forum users to challenge this if it happens. Demand more therapy, point out NICE recommends 10 hours (I..e 10 sessions) and then stepped up for another 10 hours if needed. 

If this happens, complain to your local NHS trust, and CC me in on the complaint so I can push them too.

Don't accept being discharged until you are ready to be discharged (within reason of course). 

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9 hours ago, Rucker said:

train OCD therapists who have had OCD

Not sure this is a good idea. Some people with OCD may make very good therapists, but I would suggest this is a minority (I do actually know a couple).  I for one would only want my therapist to be someone whose had OCD if they are 100% over OCD, no management of OCD, I would want them to be 100% recovered.... only then would I welcome a therapist who used to have OCD.

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On 02/09/2017 at 23:34, Ashley said:

This is true, but is actually not what is meant to happen, and I urge all forum users to challenge this if it happens. Demand more therapy, point out NICE recommends 10 hours (I..e 10 sessions) and then stepped up for another 10 hours if needed. 

If this happens, complain to your local NHS trust, and CC me in on the complaint so I can push them too.

Don't accept being discharged until you are ready to be discharged (within reason of course). 

I had 20 sessions in total, but it wasn't a big help. I think they had me on the wrong level of therapy, it wasn't the PWP level but it was the one above that, rather than specialist/high intensity support. 

I worked so hard on those 20 sessions and I feel like I haven't got the energy to do another lot of them right away, especially as I'm trying to write up a PhD thesis at the moment. 

What do you recommend if you have the 20 sessions and you are still very unwell? (I'm also on a high dose of sertraline which I've been on for a few years now  - it doesn't seem to help but when I tried to come off it OCD got even worse). 

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5 hours ago, LizzyHoy said:

I'm trying to write up a PhD thesis at the moment. 

Good luck on the thesis!! Its the proof reading that I hate!!  I finished a master's degree last year as a 'mature' student and I'm considering punishing myself further :lol:

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22 hours ago, LizzyHoy said:

What do you recommend if you have the 20 sessions and you are still very unwell? (I'm also on a high dose of sertraline which I've been on for a few years now  - it doesn't seem to help but when I tried to come off it OCD got even worse). 

Well in all honesty, I understand you feel you need a break and have to focus on your studies, but the fact remains we have to keep trying, and push for more therapy, but perhaps with a different therapist (ideally one with more skills in treating OCD... but accessing them is hard).

The fact remains, there will never be the perfect time to fight OCD, so we can't wait for that perfect quiet time in our life... if OCD is impacting on our life, then that is the time to fight it. today, not tomorrow. 

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On 05/09/2017 at 06:20, Rucker said:

Good luck on the thesis!! Its the proof reading that I hate!!  I finished a master's degree last year as a 'mature' student and I'm considering punishing myself further :lol:

Thank you! It wasn't the best decision for my mental health but I do enjoy research and hopefully it will turn out to have been the right decision for my long term career satisfaction. Good work on finishing your Masters - they are intense!

 

On 05/09/2017 at 23:15, Ashley said:

Well in all honesty, I understand you feel you need a break and have to focus on your studies, but the fact remains we have to keep trying, and push for more therapy, but perhaps with a different therapist (ideally one with more skills in treating OCD... but accessing them is hard).

The fact remains, there will never be the perfect time to fight OCD, so we can't wait for that perfect quiet time in our life... if OCD is impacting on our life, then that is the time to fight it. today, not tomorrow. 

Yes I know what you mean, I was more asking what I should do in terms of getting more help? My mum and partner have offered to help me pay for private treatment, so I am in a privileged position because that's not an option for many people. But if I do try to stick with the NHS what should I ask them to do? At the moment they have just left me to ring the CBT therapist for a follow up when I choose but that would only be one session and I am worse now than I was before I started CBT, so I feel like attending for only one session would just be demoralising. I believe I was on step/level(?) 3, the one that is above help from a PWP.  

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20 hours ago, LizzyHoy said:

It wasn't the best decision for my mental health but I do enjoy research and hopefully it will turn out to have been the right decision for my long term career

Sorry to hear that.  I've heard they can be a little isolating... but well done on doing it, it will be quite an achievement. I'm quite surprised I'm considering it.

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