Lithium and clomipramine

[Daniel E.]

One way of looking at depression is that it is the result of avoidance behavior. Most people with anxiety tend to chronically avoid certain situations since they often trigger anxiety. So some form of exposure therapy can be helpful. In the case of depression, the emphasis is often on just being more active as in behavioral activation.

BTW, regarding "pure O," ruminating can be just as compulsive a behavior as handwashing, if not more so. So with OCD, there are usually other compulsions as well, though they may not feel distressing since, like all compulsions, they are used to relieve or prevent anxiety.

---------- Post added at 05:58 PM ---------- Previous post was at 01:22 PM ----------

Regarding depression as secondary to OCD:

OCD patients display low QoL [quality of life] that in some studies matches or even falls below scores obtained from chronic and disabling conditions such as schizophrenia. QoL is most consistently associated with depression, a disorder which is present in ~50% of these patients. To a lesser degree, QoL correlates with obsessions, and in some studies also with compulsions. Our Internet survey shows that patients have multiple social and work-related problems associated with OCD. While our study mainly involved adults, similar problems have been reported among children and adolescents.

Reasons for low QoL are multidimensional and may largely vary across subjects. Initiation of treatment is often started at a point in time where the illness has progressed and important resilience factors and resources (eg, social support and employment) have already been compromised.

http://www.uke.eu/kliniken/psychiat...psychotherapie/cns_spectrums_Suppl_Moritz.pdf

 

[stringbean]

Thank you for this, i am definately try to take on board behavioral activation. I really appreciate all your replies.
I spoke to my Dr yesterday and he has upped my clompramine to 225gm and also low dose lithium to augment it.

I wonder if you know how long will it take for the upped dose to take affect is it similar to when you first start the drug, its just i seem to feel a little wired today but hope its just settling in process.

 

[Daniel E.]

Have you considered viewing your medications more like supplements rather than the primary treatment? I usually don't say that about medications, but you seem -- over the course of time in your posts -- to put more hope in the medications than in yourself. Are you seeing your psychiatrist more frequently than your therapist?

 

[stringbean]

Thanks Daniel. I wish I could look at the meds as supplements but to be truthful i have a real problem with taking tablets and in the past have taken them and as soon as well stopped! so trying to be optimistic about them and more positive.

I have suffered from ocd for over twenty four years and had bad spells that i have treated with medication and my last spell started nearly a year ago and that prompted me to see a psychiatrist who in turn has been trying me on the meds that i have mentioned and for the first time i have commited myself to take exactly what i am told.
He also thinks that the psychologist is what i need most to change the way i react to what i think(if that makes sense) so I am seeing the psychologist more regularly than the psych.

 

[stringbean]

question re lithium

Sorry Dr Baxter if this needs to be merged but wanted some advice re lithium.
I am now on 400mg for 12 days- I have been given this to augment my clomipramine and also help my recurrent depressive disorder (from ocd battles) I was wondering when I would start feeling the benefits as of yet have not felt any.
I read in one of the stickys re resistant depression and adding a second med and that article sounding promising and hoping that this will be the case with me.

 

[David Baxter PhD]

Re: question re lithium

12 days is not very long at all when starting medications or increasing dosages. I know it's frustrating but you'll need to have patience and trust that your doctor knows what s/he is doing.

 

[stringbean]

thank you for replying, patience is hard when you are feeling so rubbish, and also having a bit of trouble having trust in my physician.
I read your sticky re thinking the unthinkable and it was really informative and I could recognise my pure o traits straight away and it was reassuring (oops) that it backed up that it can take all day for someone to try and put the answers to things,
.

 

[stringbean]

can anti depressants or mood stabilsers make you feel worse, or make your symptoms worse

 

[David Baxter PhD]

Not usually but yes, it's possible. If so, the remedy is to change the medication to something similar.

 

[Daniel E.]

BTW:

The more you are able to recognize that your fears are unfounded, exaggerated or irrational, the more likely you are to respond to treatment with medication.

About.com - Will OCD Medication Work for Me

It seems to go without saying, though, since that would predict a better outcome even without treatment.

Anyway, from a new study:

Depression was not predictive of treatment response in any of the treatment modalities for up to 5 years of follow-up. Changes in OCD symptoms largely predicted changes in depressive symptoms but not vice versa...

Treatment of OCD with comorbid depression should focus on amelioration of OCD symptoms. When OCD treatment is successful, depressive symptoms are likely to ameliorate as well.

ScienceDirect - Journal of Affective Disorders : The impact of depression on the treatment of obsessive?compulsive disorder: Results from a 5-year follow-up

 

[stringbean]

Thanks Dr Baxter and Daniel, I appreciate the replies.
I have had a few better days so I dont think the medication is making me worse as if it was I wouldnt be having better days would i??

 

[David Baxter PhD]

No, not likely. Glad to hear things are improving.

 

[stringbean]

Spoke too soon, had a humdinger today but am sure that is to be expected, some good, some bad. I need to believe that this is working for me as from yours and Daniels posts i feel that if i dont think positively i am likely to not have positive responses from medication.

 

[AmZ]

Sorry to hear that you are having troubles with the medication there and for seeing if it works for you.

You're right, it's always good to be in a positive mode of thinking, but it's obviously not all about that - The medication needs to be good for you too.

I am also going through the process of finding what works for me so I totally empathise with the frustrations that it brings.

Wishing you the best.

 

[stringbean]

thanks Amz, how are you doing?

 

[AmZ]

thanks Amz, how are you doing?

You are welcome - I hope the medications get sorted out very soon.

I'm OK thank you, doing a bit better for a few days which has been a relief. I won't jump in on your thread though

 

[stringbean]

I am pleased you are feeling better even if it is only a few days, it hopefully gives you more hope for better days. Do you find that you have some good days but also some really bad days?

Also so kind of you to reply to my thread i am grateful that anyone reads my ramblings and worries.

 

[AmZ]

I am pleased you are feeling better even if it is only a few days, it hopefully gives you more hope for better days. Do you find that you have some good days but also some really bad days?

Also so kind of you to reply to my thread i am grateful that anyone reads my ramblings and worries.

Of course people read and reply to you You are worrying yes, but that's only natural, don't be so hard on yourself. And you are far from rambling... Just look at my 1000+ posts here!

Most of my days have been bad days with maybe a few hours here and there of feeling a little better. We're still working on the medications.
But how I have been feeling in the last few days was the way I was feeling when I last left the hospital twice, but then relapsed and returned back. It's like the sun came out of the clouds... I don't know how else to put it. But my head is feeling clearer, my mood has lifted and for the first time in a good couple of months, can I genuinely smile. So, I hate speaking too soon, but maybe my med combo is finally where it needs to be.

How are you doing? Tell me a little, if you like, about what is going on with you

 

[stringbean]

oh bless you, I am so pleased that you are feeling better, I will keep my fingers crossed for you.

Mine is a long old story, had ocd for twenty odd years and been on and off meds for a good while. Had a bad relapse last xmas and since then been seeing a psychiatrist.
He took me off all previous medication and has been trying me on clomipramine and now augmenting it with lithium and have upped the clomipramine to the max dose about two weeks ago and have had some good days but the bad days scare me.

Anyway you try and keep positive, I did read some of your posts when you were in hospital and so pleased that you are feeling well now, I will send a prayer out for you(not really religous, but trying everything lol) and for me and hopefully our positive vibes will help each other x

 

[AmZ]

Bad days are scary, I agree.

I am wishing you better days too!

Thank you very much.