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happysmile

Should I take antidepressants?

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Hello to everybody out there! I have been diagnosed with OCD since 2014! I followed Cbt therapy all these years! I am still on therapy. Everything was ok , and I was OCd free from 2015 until 2018. This year I start again to have obsessions, and the last month I ended completely boundary in my home, afraid being even alone. So even my therapist thinks that I will be ok, I have start to feel exhausted from my mental problems. I just want to go out and live my life again ! So I am thinking to try antidepressants! Do you have any experience of them ? Any advice, is welcomed . 

 

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Hi Happy, 

The drug of choice for OCD is an SSRI (selective serotonin reuptake inhibitor) which is also an antidepressant. 

Take a look at Gingerbreadgirl's Fluoxetine thread for benefits used for OCD. 

I use another one, Citalopram, as I had ongoing side effects with Fluoxetine. 

The drug balanced out my mood swings and the secondary depression caused by the OCD, and helped me better engage with cognitive behavioural therapy. 

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Hello @happysmile and welcome to the forums.  Sorry to hear you are having a tough time with your OCD, I understand how frustrating that can be, especially after a period where things go so well.  It sounds like you are doing a lot of the right things to manage your recovery though, so thats a great start!  I'm glad to hear you are aware of CBT and practicing it, thats a key component to OCD recovery and the sooner you start doing it the better, so you are a head of a lot of people in that regard.  
As to medication, whether or not to take it is a very personal decision.  For some people they have no reservations, others are more skeptical of drugs, so in the end it will really come down to what you want and what you and your doctor decide is right.  So I can't tell you whether you should or shouldn't take an SSRI for OCD, but I can offer some things to think about and information to know.

  • Medication for OCD can be effective in treatment, and combined with CBT is generally more effective than either treatment alone.  However results will necessarily vary from individual to individual
  • Its (sadly) not a cure, you'll probably have to take it for awhile if you want to see any benefit, and if/when you stop taking it you won't keep getting the benefit.  Thats not to say you have to be on it forever, some people take it short term to help them manage particularly rough periods, or until they can get experienced enough with CBT to no longer need it.  But for many people its a long term commitment.
  • For most people it takes a few weeks to start seeing significant benefit from the medication, as it builds up in your system and your body adjusts.  During this period some people experience initially increased anxiety and side effects.  Most of the time these die down as you adjust, but its possible you may have to change medication if the side effects prove to troublesome.  Which brings me to the next point.
  • Which medication works best for one person may not be the same for another, its a bit of a trial and error process sometimes.  With luck you'll be one of the many people who do well on a variety of medications and have minimal side effects.  However you may have to try a couple different options before you land on the right one, so just be aware of that.
  • To avoid problems its important to take your medication on a regular schedule.  While missing a dose isn't the end of the world, the more often it happens, the more likely you are to experience OCD symptoms.  Its a good idea to find a way to make taking the medication part of your daily routine.  Depending on any side effects (drowsiness for example) it might be better to take it at night, or in the morning, etc.  Having a weekly or monthly pill case so you can see at a glance whether or not you have taken your medication for that day is a good idea as it takes out any guess work.
  • Be open and honest with your doctor and therapist about how things are going, they are there to help you and can best do so when they are well informed.

If you decide to take medication I hope you find it helpful.  Of course its also important to consider employing CBT techniques.  Remember that CBT isn't just something you do for a few weeks and then finish, they are lifelong skills you can apply to continue to keep the OCD at bay and the more you practice and use them the better you will be at it and the easier it will be to handle situations where you need to use them.

Hope that was something like what you were looking for!

 

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@dksea thank you very much for your reply! It was really helpful!!! Maybe the problem with me right now, it’s that I cannot accept easily that I have to win an Ocd battle again!  And maybe I am looking for  miracle or a pill that will make me again to going out and enjoy my life ! I know how this maybe sound, ( a little silly maybe) as I have passed Ocd’s path before!!! But, thank you again for you reply and your time! 

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1 hour ago, happysmile said:

Maybe the problem with me right now, it’s that I cannot accept easily that I have to win an Ocd battle again!  And maybe I am looking for  miracle or a pill that will make me again to going out and enjoy my life ! I know how this maybe sound, ( a little silly maybe) as I have passed Ocd’s path before!!!

I don't think that sounds silly at all, I think its an unfortunately common experience for those of us who suffer from OCD, find relief in treatment, things get better, then we suffer our first spike/relapse/setback.  Its natural to think/want it to be a thing you deal with and get over and its gone, I know I fell in to that same trap with my own OCD.  Its frustrating and demoralizing to first realize that this may be something that happens again, and again.  Chronic conditions, especially ones that are relapsing/remitting are frustrating due to their unpredictability!  But I've found that once I came to terms with the chronic nature of OCD, that I was able to move forward.  I've gotten much better at handling incidents with experience and CBT so now even if things start to get noticeably troublesome again I can prevent them from spiraling out of control.  Sure I still have periods where the OCD bothers me more than others, but its small bumps in the road, not giant mountains.

And I think its totally understandable to hope for a miracle cure.  I think it would be odd NOT to have those kind of thoughts.  Who wouldn't want to just get better overnight?
But then I'd also love to win the lottery and be able to retire now and never work again right?  Its natural to feel that way, but I shouldn't just spend all my money on lottery tickets, I shouldn't just quit my job and assume I'll win the next jackpot.  If someday I do win? Great!  But in the meantime I should go to work, do my job, spend my money wisely, etc.  Same with OCD.  Its fine to hope for a future miracle cure, but in the meantime its best to focus on what you can do to make things better, even if it takes a little longer than you'd like.

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This is one of the best common sense posts about medication I have seen a long time.

8 hours ago, dksea said:
  • Medication for OCD can be effective in treatment, and combined with CBT is generally more effective than either treatment alone.  However results will necessarily vary from individual to individual
  • Its (sadly) not a cure, you'll probably have to take it for awhile if you want to see any benefit, and if/when you stop taking it you won't keep getting the benefit.  Thats not to say you have to be on it forever, some people take it short term to help them manage particularly rough periods, or until they can get experienced enough with CBT to no longer need it.  But for many people its a long term commitment.
  • For most people it takes a few weeks to start seeing significant benefit from the medication, as it builds up in your system and your body adjusts.  During this period some people experience initially increased anxiety and side effects.  Most of the time these die down as you adjust, but its possible you may have to change medication if the side effects prove to troublesome.  Which brings me to the next point.
  • Which medication works best for one person may not be the same for another, its a bit of a trial and error process sometimes.  With luck you'll be one of the many people who do well on a variety of medications and have minimal side effects.  However you may have to try a couple different options before you land on the right one, so just be aware of that.
  • To avoid problems its important to take your medication on a regular schedule.  While missing a dose isn't the end of the world, the more often it happens, the more likely you are to experience OCD symptoms.  Its a good idea to find a way to make taking the medication part of your daily routine.  Depending on any side effects (drowsiness for example) it might be better to take it at night, or in the morning, etc.  Having a weekly or monthly pill case so you can see at a glance whether or not you have taken your medication for that day is a good idea as it takes out any guess work.
  • Be open and honest with your doctor and therapist about how things are going, they are there to help you and can best do so when they are well informed.

Thank you for posting this dksea.

 

11 hours ago, happysmile said:

So I am thinking to try antidepressants! Do you have any experience of them ?

I am not sure where in the world you are Happysmile, but I thought it may be helpful to list which medications we use here in the UK. The NICE guidelines which are based on evidence are recommendations for our NHS.    As dksea points out we are all different, so these are just general guides.  

Selective Serotonin Reuptake Inhibitors (SSRI)
SSRI medications are usually tried first. The SSRIs usually recommended for the treatment of OCD in the UK are:

Generic Name / (Brand Names)

  • Citalopram (Celexa, Cipramil)
  • Escitalopram (Cipralex, Lexapro)
  • Fluoxetine (Prozac)
  • Fluvaxamine (Faverin, Luvox)
  • Paroxetine (Paxil, Seroxat)
  • Sertraline (Lustral, Zoloft)

If these medications fail to work, a non-selective SRI may be prescribed.  The non-selective SRI most commonly used for treating OCD is:

Tricyclic Antidepressant (TCA)

  • Clomipramine (Anafranil)

Whilst people do report good results from Clomipramine, because of the strong side effects not everybody can tolerate and so it's only recommended to try after an adequate trial of at least one SSRI (I would actually suggest trying two SSRI's first) has been ineffective or poorly tolerated, or if the patient prefers Clomipramine or has had success in using the medication before.

Beyond that some Dr's try augmenting anti-psychotic medications alongside an SSRI, however that is controversial in that some evidence suggests anti-psychotics are no better than placebo.  Another Dr we work with sometimes did suggest he finds anti-psychotics can help, but usually there is a 4 week window in that if the medication is not helping by week 4 it's unlikely to help. 

So that's the medications generally used for OCD. That's not to say other medications can not help, but just what we generally start with here.  If you do take medication, regardless of the medication you take refer back to dksea bullet list for the common sense usage of chosen medication. 

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7 hours ago, dksea said:

 Chronic conditions, especially ones that are relapsing/remitting are frustrating due to their unpredictability!  But I've found that once I came to terms with the chronic nature of OCD, that I was able to move forward.

 

Thank you @dksea!!!! Your words make me feel, strong again! 

 

54 minutes ago, Ashley said:

Beyond that some Dr's try augmenting anti-psychotic medications alongside an SSRI, however that is controversial in that some evidence suggests anti-psychotics are no better than placebo.  Another Dr we work with sometimes did suggest he finds anti-psychotics can help, but usually there is a 4 week window in that if the medication is not helping by week 4 it's unlikely to help. 

@Ashley Thank you for your reply! About Antipsychotics, I have read in some academic surveys, that it is possible to increase the compulsions.

Have you ever try Saffron? I just read this article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640576/ or any other supplements?

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14 hours ago, happysmile said:

Have you ever try Saffron? I just read this article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640576/ or any other supplements?

Fascinating study!  I am glad to see continued research into OCD treatments being done.  It would be great if more effective/less side effect causing options were found!

That said, you should absolutely discuss any supplements you are thinking of taking with your doctor and/or pharmacist.  While most will be fine, there are some, such as St. Johns Wort, that can cause adverse reactions in people who are taking SSRIs.  Better safe than sorry in those situations.

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9 hours ago, dksea said:

 While most will be fine, there are some, such as St. Johns Wort, that can cause adverse reactions in people who are taking SSRIs

Especially women on the pill, I once read (years ago, so may need checking) St Johns Wort can make the contraceptive pill ineffective!  

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I don’t take any medication because of the side effects & placebo effect. Placebo effect accounts for a large amount of the positive effect (Harvard) too. The posts don’t mention this & where are the side effect lists? 

It’s certainly worth a shot  

There is a film Eight about a gal who can’t get outside because of her OCD.  You might find It interesting. 

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1 hour ago, Handy said:

Placebo effect accounts for a large amount of the positive effect (Harvard) too. The posts don’t mention this & where are the side effect lists? 

We don't mention it because its not true, SSRI's are more effective than placebos.  There has been ample research proving this.
We also don't discuss specific side effects because they vary from person to person, but you would note if you read what I posted I mentioned that side effects can occur, can occur with greater intensity during the initial period, and can be too great for a person to want to stay on a particular medication.  I also encouraged talking with your doctor about your progress.

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5 hours ago, dksea said:

We don't mention it because its not true, SSRI's are more effective than placebos.  There has been ample research proving this.

In fairness , saying it's not true is very black and white. There are people who believe otherwise. Irving Kirsch is someone who has written a book and is well known for his findings of antidepressants being little more than placebos.  

 

AF Moderator Note:  Please remember we are a discussion forum, and therefore we discourage the posting of random unmoderated external links and videos. But as this was already posted I will let stand, 

Edited by Ashley
Moderator Note above

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I don't know enough to comment fully on this but I do know that there was a significant systematic review carried out recently which showed all the SSRIs in the study were more effective than placebo. 

The placebo effect accounts for at least some of the effectiveness of many drugs and antidepressants are not unique in this regard. 

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SSRI drugs are pretty powerful and I looked up some research before I committed to taking one, so I was under no delusions as to what were the chances of them helping, if I were able to get through any initial side effects. 

I like Handy's compatriot Jeffrey Schwartz's take on this - he likens benefits from them as providing "water wings" to help keep the patient afloat and better able therefore to engage with therapy. 

This is what I sought - and exactly what I think I get - from Citalopram; and it, for me, made a big difference - and still keeps my moods nicely in the central zone between low and high. 

And I do think it has helped my resilience to getting "spooked" by intrusions, which in any case, thanks to CBT plus mindfulness, don't happen very often now - whereas at my worst, triggers seemed all around me. 

Edited by taurean

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35 minutes ago, Carooba Manooba said:

In fairness , saying it's not true is very black and white. There are people who believe otherwise. Irving Kirsch is someone who has written a book and is well known for his findings of antidepressants being little more than placebos.

People are free to believe what they believe, but the scientific evidence overwhelmingly supports SSRIs as being more effective than placebos.  You can pretty much always find someone who will claim things are different, but that doesn't mean they have the actual evidence to back it up. See for example anti-vaxxers, flat-earthers, climate change denialists, etc.  OCD-UK bases its guidance on the NICE guidelines, which recognize the effectiveness of SSRIs in the treatment of OCD as supported by scientific consensus and study.  The evidence based approach to treatment is one of the reasons I, a non-UK citizen, donate to this charity.

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2 minutes ago, dksea said:

OCD-UK bases its guidance on the NICE guidelines, which recognize the effectiveness of SSRIs in the treatment of OCD as supported by scientific consensus and study.  The evidence based approach to treatment is one of the reasons I, a non-UK citizen, donate to this charity.

Thank you for posting this Dksea. It sums up exactly what I feel about this. 

And the evidence, as within my post above, is pretty convincing. 

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22 minutes ago, dksea said:

People are free to believe what they believe, but the scientific evidence overwhelmingly supports SSRIs as being more effective than placebos.

I agree most people believe antidepressants are effective.

23 minutes ago, dksea said:

   You can pretty much always find someone who will claim things are different, but that doesn't mean they have the actual evidence to back it up.

Absolutely. However, Irving Kirsch is not someone you would ever say doesn't have the evidence to back it up.  His book "The Emperor's New Drugs – Exploding the Antidepressant Myth"  is based on much detailed analysis.

As  you say, we are all free to believe what we want.  I've been in enough debates over the years to know that medication topics can drag on forever. I can no longer be bothered getting caught up in them like I once did. 

Each to their own.  I'm just putting it out there that there are people who have other views.  I'm not going to tell someone to not to take medication (and I'm not suggesting anyone here is) . But I'm also never going to encourage it as I believe it hinders more than helps in true recovery. 

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I am always wary of books or articles with controversial or one-sided titles clearly designed to grab interest (and sales). The author is invested in proving their point rather than necessarily considering both sides of the debate. If the book was called something like "a meta analysis of the current evidence for and against antidepressants" and it still reached the same conclusion I would be more convinced. 

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The real value of meds is how they can change sufferer’s lives, especially when therapy alone may not have been sufficient. 

In my own case, I could have written a book on CBT, I had had so much one-to-one private, specialist, treatment. 

However, to tackle the secondary depression of my own horrible OCD, and build some mental resilience, and overcome constantly-repeating intrusions, I needed to add an SSRI plus mindfulness to the treatment plan. 

Edited by taurean

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1 hour ago, taurean said:

The real value of meds is how they can change sufferer’s lives

Yes although an improvement in symptoms in an individual doesn't prove efficacy. It could be any number of factors which may or may not be related to the drug (such as the placebo effect, or an unrelated improvement). The only thing that really proves anything is a randomised controlled trial. 

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49 minutes ago, taurean said:

However, to tackle the secondary depression of my own horrible OCD, and build some mental resilience, and overcome constantly-repeating intrusions, I needed to add an SSRI plus mindfulness to the treatment plan. 

As you are able to distinguish so clearly between the two, i.e., the SSRI tackled the secondary depression, and CBT subsequently fixed the OCD, are you saying that any antidepressant would have done, such as those not recommended for OCD too?

 

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There is controversy over psychiatric drugs with competing claims made by both sides to the debate even with regard to  double  bind randomised controlled trials. I believe that psychiatry is  the most contested area of medicine.

 

 

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3 hours ago, felix4 said:

As you are able to distinguish so clearly between the two, i.e., the SSRI tackled the secondary depression, and CBT subsequently fixed the OCD, are you saying that any antidepressant would have done, such as those not recommended for OCD too?

 

No I am only able to say what I think they contributed. 

And with SSRI meds, any one may not work, or work in some way, for different people. 

Though experienced healthcare professionals may have their favourites based on the perceived experience of their patients. 

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