Archive for the ‘Obsessive Compulsive Disorder (OCD)’ Category

Will I always need Lexapro and Klonopin if I successfully go through cognitive behavioral therapy?

It partly depends on what you’re taking the medications for.  Uncomplicated panic disorder without agoraphobia has the highest rate of complete remission.  Severe obsessive compulsive disorder, agoraphobia, or social anxiety disorder may require some long term medication to maintain remission.  Generalized anxiety without serious depression may respond fully to CBT.  A lot will depend on how good the CBT is and how hard you are willing to work on it.  For OCD I recommend Brainlock by Jeffrey Schwartz.  For panic disorder proper breathing is essential.  The following link has instructions for proper breathing.

test.askdrjones.com/wp-content/uploads/2006/06/Anxiety_Handout.pdf

For social anxiety stimulants are frequently helpful.

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How Does Deep Tissue Stimulation Help OCD?

Question: I recently saw a special on deep tissue stimulation for OCD. It worked in this patient. How does deep tissue stimulation work? – Lea

Answer: I have not seen anything about that.  However, I recommend the Brain Lock technique to all my OCD patients – preferably to listen to the audio tape version of the book.
In the book Dr. Schwartz describes a cognitive behavioral technique used in a successful study done at UCLA.  The most important step in the technique is to shift your focus to something else.  At any given moment your focus is in your mind, in the environment, or in your body.  When stuck in obsessive thoughts or compulsive rituals, you need to shift focus.

  • In your mind: thinking about something else or visualizing.
  • To the environment: listening to music, watching a movie, playing a video game
  • Into your body: exercising, yoga, etc. 

Deep tissue stimulation at the least would help shift focus to the body.  If combined with breathing or other relaxation techniques, it could also facilitate a shift into a more relaxed state of brain activity (alpha rhythm – slower and bigger waves than the usual beta activity of the awake state).  In the alpha state, the mind is more creative and not distressed which facilitates more positive thinking and imaging.  The same state can be achieved through long aerobic activity like running or meditation.

So, I can see where deep tissue stimulation could be useful for anyone with stress overload symptoms.  The problem that I would expect to see is that it works that day and the benefit lasts for awhile, but next week or next month, significant symptoms may return and deep tissue stimulation may not be available or feasible.

Brain Lock

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OCD & SSRI's

Question: I am 34 years old and a couple of years ago I had an onset of horrible anxiety now diagnosed as OCD (intrusive thoughts). I tried Paxil, with no luck, and was on Zoloft with about 50% control combined with therapy. Two months ago my therapist encouraged me to wean from Zoloft. I am now having terrible relapse and want to begin medication again.
Have you had any experience with Effexor helping with OCD? Do you feel one SSRI is better at controlling OCD than another?
Answer: There is limited research that compares one SSRI to another for OCD. There is some evidence that Anafranil (Clomipramine) is better because it combines the SSRI effect with a norepinephrine reuptake inhibitor effect. But Anafranil also has more side-effect issues.

There was one study where people with OCD responded fairly well to Effexor XR. At doses of 150 to 225mg Effexor has the benefits of Anafranil without all the extra side-effects.
I have patients who have benefited from all of the above but there’s no way to predict who will do best on what.
It’s always important to also do the cognitive behavior techniques described in the book Brain Lock (available at Amazon.com). I prefer that people listen to the tape because the author not only tells you what to do he shows you how to talk to yourself.
A lot of patients don’t get an adequate response to an SSRI or Effexor XR even after 12 or more weeks and even doing the Brainlock techniques. Often adding Clonazepam (also available as Klonopin wafers-quicker acting sublingual) or Abilify usually low dose of 2.5mg (or other atypicals) can help get symptoms under control. Sometimes stimulants help because they increase your control of what you focus on.
The bottom line is you keep making adjustments until you find what works. In the rare instance that nothing works adequately you won’t have to wait long. There’s always something new coming.


This article originally appeared in the Q&A section 06/17/2005.

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OCD & SSRI's

Question: I am 34 years old and a couple of years ago I had an onset of horrible anxiety now diagnosed as OCD (intrusive thoughts). I tried Paxil, with no luck, and was on Zoloft with about 50% control combined with therapy. Two months ago my therapist encouraged me to wean from Zoloft. I am now having terrible relapse and want to begin medication again. Have you had any experience with Effexor helping with OCD? Do you feel one SSRI is better at controlling OCD than another? Answer: There is limited research that compares one SSRI to another for OCD. There is some evidence that Anafranil (Clomipramine) is better because it combines the SSRI effect with a norepinephrine reuptake inhibitor effect. But Anafranil also has more side-effect issues. There was one study where people with OCD responded fairly well to Effexor XR. At doses of 150 to 225mg Effexor has the benefits of Anafranil without all the extra side-effects. I have patients who have benefited from all of the above but there’s no way to predict who will do best on what. It’s always important to also do the cognitive behavior techniques described in the book Brain Lock (available at Amazon.com). I prefer that people listen to the tape because the author not only tells you what to do he shows you how to talk to yourself. A lot of patients don’t get an adequate response to an SSRI or Effexor XR even after 12 or more weeks and even doing the Brainlock techniques. Often adding Clonazepam (also available as Klonopin wafers-quicker acting sublingual) or Abilify usually low dose of 2.5mg (or other atypicals) can help get symptoms under control. Sometimes stimulants help because they increase your control of what you focus on. The bottom line is you keep making adjustments until you find what works. In the rare instance that nothing works adequately you won’t have to wait long. There’s always something new coming.


This article originally appeared in the Q&A section 06/17/2005.

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OCD Overview – Sane People Doing Insane Things

Are you sure it’s obsessive compulsive disorder? What if it won’t go away? You better check.? (This is “OCD think.”)

Almost everyone has obsessive thoughts, worries too much, dwells too long on something, or has to do a task “just right.” Since most people don’t have OCD, where is the line drawn between normal and irrational?

People do not have OCD, OCD has them!  Thoughts and actions control the person instead of vice versa.  Addiction to compulsive rituals often results.  “Just one more time and I will stop!”  Some people have OCD symptoms that are secondary to a larger problem such as Post Traumatic Stress.  There are also different types.  Classic OCD and perfectionistic OCD have similarities, but in some ways are opposites.

OCD can overlap with other conditions.  Some of these include the following: Aspergers, Tourettes, Bipolar Mood Disorders, ADHD, and Social Anxiety Disorder. 

DSM IV Guidelines

OBSESSIONS

  • Recurrent/persistent unwanted thoughts, impulses or images
  • Not simply excessive worries about real-life problems
  • Recognized as a product of one’s own mind
  • Attempts are made to suppress, control, or neutralize the worry

COMPULSIONS

  • Repetitive behaviors or mental acts that the person must perform
  • Aimed at reducing distress or preventing a dreaded event

Behavioral and medical treatment combined is the most effective treatment in decreasing both obsessions and compulsions.  OCD treatment has more scientific validity than any other mental disorder.  Overall treatment success has proven to be very positive!

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Most Common Types of OCD

OBSESSIONS
• Contamination
• Harm
• Symmetry
• Religious
• Sexual
• Hoarding
• Unwanted Urges


COMPULSIONS
• Checking
• Cleaning/washing
• Repeating
• Mental Rituals
• Ordering
• Collecting
• Counting

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Medical Treatment

The Serotonin Reuptake Inhibitors, SSRI’s, remain the number one choice for the treatment of OCD. All people with OCD have some abnormalities of the brain neuromodulator serotonin – some are high and others are low. Some types of OCD are effected by the brain modulators dopamine and/or norepinephrine. Frequently more than one medication is needed to help get back to normal. The FDA studies of medications for OCD focus on getting better, but not well. In order to achieve full recovery from symptoms one medication may not be adequate. If a medication is not working try something else. TMS, brain stimulation, or surgery may be effective if all else fails.


OBSESSIVE COMPULSIVE DISORDER MEDICATIONS
Primary
Paxil*, Zoloft*, Prozac*, Luvox*, Effexor XR, Celexa, Lexapro, Anafranil*
Second Line
Klonopin, Abilify, Zyprexa, Risperdal, Stimulants, Geodon, Seroquel
Others
Wellbutrin SR, Xanax, Buspar, Trazodone, Remeron, Lithium, Clonidine, Anticonvulsants, Ativan
*FDA approved

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Behavioral Therapy for OCD

I always insist that my OCD patients listen to or read Brainlock, by Jeffrey Schwartz. The book not only explains effective cognitive behavioral techniques, but also teaches how to do “self talk.” This helps reduce OCD behavior. Schwartz and his UCLA colleagues also demonstrated that doing these techniques not only decreases OCD symptoms, but actually changes the biochemical abnormalities in the brain. This is verified by brain scans.
The basic concept is easy to learn. But like playing tennis, knowing what to do is a lot easier than being able to consistently do it. It takes hard work and persistence.
Think of OCD as a bully that wants to run your life. Develop an attitude of aggressiveness that you are going to be in charge.
BRAINLOCK:
STEP ONE: Relabel
•It’s not me, it’s my OCD!?
STEP TWO: Reattribute
•It’s my high serotonin!?
STEP THREE: Refocus
Shift the mind to an activity that is of interest to you.
STEP FOUR: Revalue
This is not a real danger. It is an irrational thought. Compulsive rituals are a waste of time!
The most important and also the hardest step is refocusing.
Experiment with approaches:
• Visual (read something)
• Auditory (listen to music)
• Kinesthetic (exercise)
• Combine any of the above
Each person has to find what works best for them. It also helps to get a spouse, friend, or family member to listen to the tape or read the book. This will ensure a good support system for staying with the program until an improvement of symptoms is achieved.
Behavior therapy has proven to be effective in 60 to 90 percent of OCD patients.

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Medications and OCD

Classic OCD starts with a thought, “what if?”. Obsessive thoughts lead to compulsive behaviors. The serotonin system in the brain is overactive. Medications that increase serotonin make OCD worse. Every medicine that significantly helps OCD is a Reuptake Inhibitor of serotonin, or SSRI.
When an SSRI is taken initially, (within the first 24 hours), serotonin is increased. This happens because there is an increase of serotonin in the synapse between nerve cells. After taking the medication for several weeks the serotonin down regulates (reduces) the receptors and production of serotonin decreases. Patience is required to see the full effect of the medication because it sometimes takes 3-4 months to achieve. However, high doses are frequently needed.
Adding Klonopin is often helpful because it helps decrease serotonin activity. Studies show a success rate of between 50 and 80 percent improvement by individuals treated with medication only. However, medication works best when combined with cognitive and behavioral therapy.

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OCD: Did You Know?

? OCD is like the brain getting ‘stuck in gear? unable to shift to another thought
• 2% to 3% of Americans, or 1 in 50 are affected by OCD
• Onset of OCD is usually in adolescence or early adulthood
• Studies show a gap of 17 years between onset of symptoms and treatment
• OCD is more common than asthma or diabetes

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