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The role of glutamate in OCD


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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

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Hi Emph, 

I’ve tried Lamotrigine in the past and found it never really helped tbh, as for Pregabalin I’ve been taking that for years and hasn’t really helped my OCD but is great for anxiety.

DRFCno1

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Drugs are not going to fix OCD. 

OCD is a thinking and behavior disorder. Drugs aren't going to help that. You have yo learn how to think and behave differently.

There are drugs out there that may help with the anxiety present with OCD.

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5 hours ago, PolarBear said:

OCD is a thinking and behavior disorder. Drugs aren't going to help that. You have yo learn how to think and behave differently.

Or they might... thinking is neural activity in a physical brain- that neural activity is affected by neurotransmitters and those are affected by drugs, hormones etc. 

Behaviour is also the result of neural activity and is formed from our thinking so anything that affects our thinking (including talking therapies, as well as the above) affects our behaviour.

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I agree with BelAnna, drugs have made a HUGE difference in my battle with OCD.  Yes there is more to it than just taking a pill, but the drugs don't simply mask the anxiety, they help my brain function more correctly.

 

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I was helped a lot by meds too. I had more than OCD going on. They definitely helped me see things clearer. Definitely set up a situation where I was able to change my thinking and behavior. Great stuff. Took meds, felt better and still had OCD. Whst got me from sufferer to ex-sufferer was the work done to change my thinking and behavior.

And don't forget that dome people simply don't do well on meds. For them the only fix is changing thrir thinking and behavior, which can be done wirhout meds.

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Sure, for some people meds are not an option.  And for other people, they are not necessary.  Both of those are valid situations.  But that doesn't change that for some people meds are necessary or significantly important for recovery.

I am a huge advocate for the effectiveness of CBT in helping people recover from OCD.  Anytime I talk to someone about their OCD I emphasize how important CBT is as a tool to helping them recover.  

But drugs are a well recognized, researched, and accepted part of treating OCD as well.  They are more than just something that helps with anxiety.  While we can't promise anyone a specific drug will give them the same results as another person, we can share our experience with medication to help one another seek recovery.  Significant research has been and continues to be done in the role that glutamate and glutamate affecting medications can play in treatment of people with OCD and I think there is nothing at all wrong with discussing that.

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My SSRI medication doesn't help with anxiety in any direct way. 

But it does provide "water wings" to deal with the secondary depression consequent upon OCD - and balances out mood swings. 

Then using my CBT knowledge has put the OCD out to grass, and mindfulness and being kind to myself keep me in a great place mentally - just mosying along in the present and feeling good about myself. 

A very potent combination that keeps me happy and doing nicely. 

We can - if not able to tolerate, or find benefit in - an SSRI, try St John's Wort. This can be bought from health food stores and has anti-depressant and mood improvement qualities but care must be taken regarding its interaction with certain types of medication so carefully reading and abiding by the information supplied with it is vital. 

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Another message from a senior who has been around the block a few times. 

Abnormal anxiety is caused by negative thinking distortions and OCD is one form of this. 

Our brain gets a false alarm alert because we believe what our brain is telling us is a fear or threat. 

Tackling that distorted thinking using CBT will also tackle the resultant anxiety. And we do want our brain to warn us of real alerts. 

So we treat abnormal anxiety by treating the thinking that is causing it - not by pill-popping. 

Edited by taurean
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And a simple way that we can improve our serotonin levels is to adjust our diet. 

Five a day, plus eating organic foods like wholemeal bread and rice, help - and so does oily fish. 

True superfoods in this respect are walnut or cashew nuts. A small amount per day, providing you don't suffer from nut allergy, can be very beneficial. 

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17 hours ago, taurean said:

A very potent combination that keeps me happy and doing nicely. 

A lot of great advice, I definitely agree that taking a wholistic approach is better than simply focusing on one area.  I certainly would never suggest that someone rely solely on medication and ignore all other tools available to them for example.  

My main concern on this post (and a few others) is treating medication as unworthy or those who use it as somehow not being good enough or hard working enough.  We should be encouraging people in their OCD recovery, and for many of us medication is a necessary part of that.  Its not for everyone, and I respect anyone who makes the choice to forgo medication for whatever reason.  I just want to be sure that for those of us whom medication is a part of our recovery we can discuss it without the impression we are doing something wrong.  While I don't believe that was the intent, unfortunately sometimes I feel like conversations about medication on the forum are treated that way.  I just hope that everyone will consider how their posts come across to others and that we accept that each persons OCD recovery journey is a little different and that honest, reasonable posts about the medication side of OCD treatment are given the opportunity to be discussed fairly.

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Woah, I certainly never said anything about people not trying hard enough. I'm on two meds. Have been for 5 years. Not going back. 

That said, I have not met a huge number of people whose OCD symptoms were significantly reduced by meds. Yes, there are some of us. Maybe there are a lot more and they just don't hang out on forums. 

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22 hours ago, PolarBear said:

Woah, I certainly never said anything about people not trying hard enough

I'm sorry if my comments came across this way, that was not my intent and you are absolutely right that you did not say that.  My intent was to express the frustration I feel at seeing medication related posts often called in to question, not just by you but others as well.  While I know it is not yours, or others, intent, the way it can come across can be discouraging to those of us who do rely on medication.  Again, apologies if I was not more clear on that point.  I genuinely do believe we are all trying our best to help each other.
 

22 hours ago, PolarBear said:

That said, I have not met a huge number of people whose OCD symptoms were significantly reduced by meds. Yes, there are some of us. Maybe there are a lot more and they just don't hang out on forums. 

I definitely fall in that bucket.  Medication has significantly reduced my OCD, and I consider myself very lucky to be in that group, I know its not true for everyone.  Ironically I also learned to value CBT the hard way because of it.  I came late to the CBT game specifically because the meds were so effective in helping me.  Perhaps it was my and my parents own lack of experience with OCD, perhaps my psychiatrist was overly reliant on medication, perhaps I didn't do a good enough job making it clear to her the struggles I was still having with OCD, probably all of the above, the end result was I did very little on the therapy side for about the first 10 years of my OCD journey.  It wasn't until I had a major relapse and was, by this time, working with a new psychiatrist due to moving, that I started doing therapy.  It was a game changer for me on my journey and I absolutely support therapy as a necessary tool in fighting OCD because medication, for all its benefits, isn't perfect and for various reasons can wax and wane in effectiveness.  While medication has been, for me, a way to live a mostly OCD free life a large majority of the time, having the tools and skill CBT provides has allowed me to MUCH better handle the times when the medication is not helping as much as it can for whatever reason.  So I want to be clear that I wholelheartedly support the importance of CBT for all OCD sufferers.  But, to get back to my original point, for me and others, medication can be, for a large percentage of the time a way to live life without having to think about OCD.  And honestly, if all it took for me to never have to think about OCD ever again was to take a pill every day for the rest of my life I'd take it in a heartbeat.  Current medication doesn't quite reach that level yet, but its pretty damn close for a lot of us.  

As to not seeing people on the forums for whom medication is super effective, I think thats a natural result of the medication being effective.  Support forums are rather self-selecting, those of us who go through more significant periods of struggle are more likely to seek out support, and those whose life is going well are less likely to spend time here.  Myself included at times.  Its too bad that more people with positive stories don't have the inclination/time to contribute, it might help sufferers to see more people who have been through what they have and made it through to the other side.  On the other hand, its hardly surprising that people who ARE in a better place are spending their time focused on living their life.

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 I understand Stanford University are making experiments re OCD using ketamine. The bottom line, I think, is even if there are some medicines out there (there may be something in the future), in terms of a philosophy, it's probably better to put minimal stock in them. Holding out hope, particularly tangential hope,  in potions, can often debilitate the mindset ... the hard work needed to beat the disorder.   

Edited by paradoxer
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Personally, I don't see that the discussion of meds should be frowned upon on the forum, seeing that this is a UK based forum and SSRI's are recommended as a treatment option for the severest of cases here in the UK by the NHS & NICE, and providing it is used alongside CBT.

If it were say promoting the use of highly addictive benzo's as a sole treatment for OCD, then I could understand there being a problem.

 

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1 hour ago, paradoxer said:

The bottom line, I think, is even if there are some medicines out there (there may be something in the future), in terms of a philosophy, it's probably better to put minimal stock in them.

I disagree with this very strongly, medication, specifically SSRIs have been proven to be effective at treating OCD for most people.  Studies have also shown that while CBT alone is also effective, for many patients CBT and medication combined is more effective than either alone in recovery.  Suggesting that people place minimal stock in medication is suggesting they set aside a valuable, potentially life changing tool.  While medication is not the answer for everyone, and it is the right of the individual to choose to forgo medication if they so choose, it is not something that is on the fringes of OCD treatment, it is one of the two key pillars (again, alongside CBT) and is well supported as such.
 

1 hour ago, paradoxer said:

Holding out hope, particularly tangential hope,  in potions, can often debilitate the mindset ... the hard work needed to beat the disorder.

Medication are NOT "potions".  They offer real solutions to real people based on medical science and proven research.  Yes, some treatments are still in the early stages, but there are also well established medications that are usable now to treat OCD and we should not be dismissing them or the help they can provide to sufferers.  So while I agree that it is also important to accept the reality that OCD recovery almost always requires hard work to overcome, it is incredibly frustrating to see a negative and dismissive attitude towards medication in each and every post where the topic is raised.  As Felix points out medication, particularly SSRI's are very much a part of the treatment methodology of OCD in the UK and around the world.  I simply ask that posters in the forums respect that and those of us for whom medication plays an important part in our management of OCD.

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1 hour ago, dksea said:

As Felix points out medication, particularly SSRI's are very much a part of the treatment methodology of OCD in the UK and around the world.  I simply ask that posters in the forums respect that and those of us for whom medication plays an important part in our management of OCD.

Here here. SSRI medication has been an important part of my journey towards recovery, alongside CBT mindfulness and love kindness meditation. 

 

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2 hours ago, dksea said:

I disagree with this very strongly, medication, specifically SSRIs have been proven to be effective at treating OCD for most people.  Studies have also shown that while CBT alone is also effective, for many patients CBT and medication combined is more effective than either alone in recovery.  Suggesting that people place minimal stock in medication is suggesting they set aside a valuable, potentially life changing tool.  While medication is not the answer for everyone, and it is the right of the individual to choose to forgo medication if they so choose, it is not something that is on the fringes of OCD treatment, it is one of the two key pillars (again, alongside CBT) and is well supported as such.
 

Medication are NOT "potions".  They offer real solutions to real people based on medical science and proven research.  Yes, some treatments are still in the early stages, but there are also well established medications that are usable now to treat OCD and we should not be dismissing them or the help they can provide to sufferers.  So while I agree that it is also important to accept the reality that OCD recovery almost always requires hard work to overcome, it is incredibly frustrating to see a negative and dismissive attitude towards medication in each and every post where the topic is raised.  As Felix points out medication, particularly SSRI's are very much a part of the treatment methodology of OCD in the UK and around the world.  I simply ask that posters in the forums respect that and those of us for whom medication plays an important part in our management of OCD.

I was on SSRIs myself for OCD. And I'm not knocking them. I guess I was being a bit extra - my 'potion' reference was drawn from my memory of some sufferers I knew, who seemed, to me in part, almost to be substituting - the latest rumoured 'remedy' for hard work. Indeed if science can mitigate the hard work, roll on the day. Apologies if I overshot the message. 

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Whilst it is very important to discuss medication and the benefits it can provide in the battle to manage OCD, it is equally important to be honest with people and stress that it's an aid to recovery rather than an elixir that will cure OCD.  So often I see people who do believe (hope) that they can be prescribed a medication to cure them.

On the other side of the coin, I think it's also important that for some medication is not effective, in fact it can have intolerable side effects.  It is not unusual to see someone who's already struggling with intolerable anxiety pushed to an unacceptable level by the effects of prescribed medication.  SSRI medication is frequently prescribed in a first, ten minute GO appointment before any other avenues have been explored.  This is done as doctors see it as the only tool they have to offer in the absence of being able to offer effective psychological support.  That's not a good reason for doing so.

Using medication, if it works well, can be a huge benefit but if it doesn't work well, or worse, that feedback should be considered and investigated properly.  This doesn't always happen, with the sufferers concerns being dismissed.  Sadly, that has been my experience.

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38 minutes ago, Caramoole said:

Whilst it is very important to discuss medication and the benefits it can provide in the battle to manage OCD, it is equally important to be honest with people and stress that it's an aid to recovery rather than an elixir that will cure OCD.  So often I see people who do believe (hope) that they can be prescribed a medication to cure them.

On the other side of the coin, I think it's also important that for some medication is not effective, in fact it can have intolerable side effects.  It is not unusual to see someone who's already struggling with intolerable anxiety pushed to an unacceptable level by the effects of prescribed medication.  SSRI medication is frequently prescribed in a first, ten minute GO appointment before any other avenues have been explored.  This is done as doctors see it as the only tool they have to offer in the absence of being able to offer effective psychological support.  That's not a good reason for doing so.

I whole heartedly agree that any discussion about treatment should be realistic and rational.  When it comes to medication that means admitting to the limitations, such as varying degrees of success between sufferers and possible side effects.  Being well and fully informed when taking medication, for any reason, is necessary for well being and safety.  I would never suggest, and I hope I have not given the impression, that we ignore the limitations that medication can have.  Nor that there won't be times where a poster expresses attitudes towards medication that are unhealthy, such as believing taking a pill will just fix everything, or engaging in compulsive research to find some magic bullet for their OCD, in which case its the right thing to do to step in and remind them of the realities of the situation.

However, my concern remains that often when a post is made on the topic of medication, such as this one, that the first reaction of some posters is a negative one.  Using this post as an example, Emphyrio's initial question seems very reasonable and worth discussing.  Having had a negative experience with SSRI's, he is curious if anyone has any experience with another type of medicine based treatment (namely glutamate modulating drugs) that research has showed promise for as an alternative for those who can't tolerate or see little benefit from SSRIs.  Unfortunately, the second response already takes a negative and dismissive tone towards medication.  To be clear, I don't mean to single PolarBear out, I have seen other posters in other threads whose reactions on the topic of medication are similar.  

I fully respect that medication does not work well for everyone, that some people prefer not to use medication, and that CBT is vital to recovery from OCD.  What I am hoping for as a result of raising the issue on this thread, though, is that people will take a moment to consider how these types of responses can come across as negative and discouraging to those of us for whom medication is a part of our recovery.  

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1 hour ago, Caramoole said:

SSRI medication is frequently prescribed in a first, ten minute GO appointment before any other avenues have been explored.  This is done as doctors see it as the only tool they have to offer in the absence of being able to offer effective psychological support.  That's not a good reason for doing so.

Quite agree. There are other avenues to help, not least our charity. 

They shouldn't just reach for the prescription pad. These drugs, if they are to be beneficial, need some time to build up in the system and initial side effects can be challenging. 

Then there is going to be at some point the question of withdrawal from them. 

What's wrong with a doctor "prescribing"  a CBT self-help book if there is no clear immediate medical need for medication? 

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I believe in evidence based medicine.

The NICE site provides detailed guidance on OCD treatment involving specific SSRIs and CBT treatment. It is based on peer reviewed evidence.

The prescription of medication and the prescription of CBT from high intensity intervention to low intensity intervention. The intensity of intervention is basically measured by the number of hours therapy the patient receives. The patient receives more hours of treatment the greater his or her functional impairment.

Patients with little functional impairment should go on low intensity CBT. No mention of medication in this case.

Unfortunately we live in an imperfect world. GPS are busy. Budgets are stretched. So a system to help a GP judge functional impairment would help: such as a training school for clinical psychologists providing supervised training in GP surgeries for trainee clinical psychologists under supervision. They can administer and score the standard OCD questionnaire.

When SSRIs should be recommended is clearly stated on the NICE site as is the intensity level of CBT required for degrees of impairment.

Edited by Angst
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1 hour ago, taurean said:

What's wrong with a doctor "prescribing"  a CBT self-help book if there is no clear immediate medical need for medication? 

Being the old cynic that I am :devil2:  I would like in the first instance for GP's to prescribe themselves a good self-help book about OCD.  Things are improving but it's still hit and miss with many doctors knowledge being very basic.  I have a lovely GP but even there, it seems their in-depth knowledge isn't that great.  They appear to understand OCD in terms of contamination, checking, cleaning etc but if you got into some of the less obvious manifestations I doubt they would fully understand.

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I agree Caramoole. And also I suppose it would be  against their practice to be dispensing books outside of their scope of operation. 

But it just doesn't seem right to me to start people off straight away on these powerful drugs unless there is a clear clinical indication they are needed.  

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