Methylphenidate & OCD

[lammers1980]

I have a question regarding medications and OCD. I have suffered from this condition more or less continually, with varying degrees of severity for almost ten years now. I have seen several psychologists and taken many different SSRI's as well as one type of MAOI. None of these medications ever made an impact on my OCD. It would seem that I would get a mild placebo effect for a couple of weeks and then the obsessions would return, leaving me with only the unpleasant side-effects and none of the benefits. Although I was functional on the job, my obsessions distracted me to the point that my performance was always mediocre and I was not likely to be a candidate for promotion.

One day, I had not slept much the night before and needless to say I was very tired. I decided to take one of my son's generic methylphenidate tablets (10mg). I know I shouldn't do it, but I just wanted to get through the day. I did not get a "high" from it, and that was not the intention anyways. I did, however, notice that I was able work through the day with remarkable clarity, and most shockingly, had no obsessions whatsoever. This coming from a man who had not spent a day in the last five years without worrying for hours over becoming infected with AIDS.

A few months later, I decided to do an experiment. I took one tablet in the morning before work, and then another half tablet at lunch for one week. For that entire week, I was once again without obsession. Whenever I stopped, the obsessions would return.

I know I can not go on taking my son's medication, because it is illegal and irresponsible. I just want to know if you knew of any medical research that indicated that methylphenidate had a positive effect on people with persistent OCD. I am afraid of telling any doctor that I did this because my explanation sounds strange, and I don't want to be accused of "drug seeking". I need to know if what I am anecdotally experienced has any medical backing.

 

[David Baxter PhD]

To bring you up to date with a private discussion we had, here is the substance of the messages we exchanged:

The literature that I know about suggests the opposite - that there is a risk of methylphenidate making OCD worse.

That said, if you feel your symptoms have improved using methylphenidate, it might be worth seeing your doctor and asking him to prescribe it for a short time. One possibility is that your symptoms are not true OCD but a symptom of something else - maybe that's why the SSRIs didn't help and the methylphenidate seemed to help.

Of course, another possibility is that the methylphenidate simply created an altered state (whether or not you actually felt "high") that masked the OCD symptoms.

The only way to know for sure would be to try it for a few weeks.

Do you know of any other conditions that would result in OCD-like obsessions? I've experienced for the most part just the obsessive aspect, with only a little bit of compulsive behaviour. The reason I ask this is because when I was suffering from a more intense episode, merely seeing a band-aid on the sidewalk on the way to work would be enough to distract me to the point that I was maybe only performing at about 60% of my potential, or less.

I also wondered if I did indeed have a certain amount of ADHD-type behaviour, or some other issue. I remember as a kid growing up I would often be prone to doing very annoying things to other people. I knew it was disruptive, but for some reason, I just couldn't "resist" doing so. This behaviour even sometimes continues to this day, especially when I am tired. I will sometimes feel compelled to sing in a mock "opera" voice early in the morning, even though I know it annoys other people at times. Its just that there is this urge to do so that at times I can't seem to resist. What confuses me though, is that I was placed in the "gifted" program as a kid, and always had above average (but not exceptional) grades.

Why don't you post this in the forum? There are some issues I don't claim any expertise with - one possibility might be Tourette's but I'm not sure of that. You may get a wider range of answers in the forums (in particular from TSOW regarding Tourette's).

 

[Retired]

Ritalin has a paradoxical effect in that although it is actually a central nervous stimulant, it acts to calm children with ADHD.

There are two information resources I can offer, both of which are based in the National Institutes of Mental Health and can be considered credible.

http://www.nida.nih.gov/Infofacts/Ritalin.html

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682188.html

Of course you physician should be consulted before taking any medication, especially methylphenidate (Ritalin) because the medication carries risks if not dosed correctly.

You mentioned seeing Psychologists, and having tried several medications. Do you live in a jurisdiction where Psychologists prescribe medications?

Have you ever consulted a Psychiatrist for another opinion on your diagnosis and treatment options?

Looking forward to your comments.

 

[^^Phoenix^^]

I also wondered if I did indeed have a certain amount of ADHD-type behaviour, or some other issue. I remember as a kid growing up I would often be prone to doing very annoying things to other people. I knew it was disruptive, but for some reason, I just couldn't "resist" doing so.

I still do it
I get in moods where I get really lively, and I'll tickle my boyfriend (for example), we'll muck about for a bit, but then he'll want to stop and I keep doing it, laughing hysterically. I used to do it alot as a kid too, and was always told that I "always had to take it one step to far" I find when i get in moods like this I have to tell myself that, but sometimes its just too funny!! - now that I am older, I am a little more sensitive about stopping before I really get on someones nerves, however... its usually a little further than the person thinks. lol... it must be me.

 

[lammers1980]

I actually get my meds prescribed by my family physician. I've tried various anti-depressants such as Wellbutrin, Celexa, Trazodone, and another which I can't seem to remember at the time, and none of them had any lasting effect on my obsessions/intrusive thoughts, other than my above mentioned initial placebo effect. When I conducted my "experiment", the dosage I took was actually much lower than what my son takes for his adhd. I took 15mg in a day (I weight about 190lbs) and he takes 45mg a day (he weighs 70lbs tops).

 

[Retired]

Steve,

Have you considered consulting a Psychiatrist, whose training is specialized in treating OCD and the use of psychotropic medications.

When a series of treatments seem not to help, a specialist with greater clinical experience in the area we need help would be a wise choice to seek out.

Even if one's local comminity might not have the specialized expertise needed, it might be worth considering travelling to the nearest mental health teaching center or specilaized unit for a consultation.

Our quality of life should be what determines to what extent we seek out treatment that is more likely to bring success, in my view, and it sounds to me like you might not be satisfied with your current quality of life.

 

[David Baxter PhD]

I think that TSOW's advice is right on, stevel.

I would also add that there are other medications to treat OCD (if that's what you have) that are not on the list of "Wellbutrin, Celexa, Trazodone and another". In fact, none of those would be my first choice for someone with obsessive intrusive thoughts. One option would be Luvox (fluvoxamine) - perhaps you could talk to your doctor about that - with the caution that the generic version of Luvox has been shown to be significantly less effective than the brand name version for reasons unknown.

 

[ThatLady]

I actually get my meds prescribed by my family physician. I've tried various anti-depressants such as Wellbutrin, Celexa, Trazodone, and another which I can't seem to remember at the time, and none of them had any lasting effect on my obsessions/intrusive thoughts, other than my above mentioned initial placebo effect. When I conducted my "experiment", the dosage I took was actually much lower than what my son takes for his adhd. I took 15mg in a day (I weight about 190lbs) and he takes 45mg a day (he weighs 70lbs tops).

How long did your trials of these various medications last? It takes time for most of them to have an effect, and that time varies somewhat from individual to individual. If you didn't take them long enough, that could have been why you didn't see a measurable difference in your OCD behaviors. It's really hard to have the patience to endure this "build-up" time when all you want is for the behaviors to subside.

It seems to me I've read something that said that taking methylphenidate for OCD had showed (for some people) positive effects for a few days then, for unknown reasons, began to exacerabate the symptoms rather than alleviate them. I can't for the life of me remember where I saw that!

 

[David Baxter PhD]

It seems to me I've read something that said that taking methylphenidate for OCD had showed (for some people) positive effects for a few days then, for unknown reasons, began to exacerbate the symptoms rather than alleviate them. I can't for the life of me remember where I saw that!

I have also read anecdotal reports to that effect, TL, although I'm not aware of any systematic research into the question.

 

[lammers1980]

I've taken most of those anti-depressants for many months, or even a couple of years, often upping the dose. I did not find there to be much of a difference in the different meds, except for a marked decline in sexual performance and pleasure. In other words, all the meds I have taken that affect serotonin levels seem to result in a net negative effect. In fact, some, such as Wellbutrin and Trazodone in fact made the anxiety much worse. I'm not saying I am hung up on taking methylphenidate as I am aware there are risks in taking any kind of stimulant (high blood pressure, chance of dependence, etc.). All I am saying is that it is the first med to:

A) "Quiet" all the background noise in my head regarding obsessions. Also, classic triggers, such as seeing a discarded band-aid, a dirty seat on a bus or any reddish looking stain in a public place no longer even occurs to me as a threat requiring a response.

B) Allowed me to experience all the emotions that a "normal" person gets to take for granted.

C) Gave me the ability to do a better job at work due to the above points.

Anti-depressants resulted in the following:

A) Blunted emotions, especially the ability to experience pleasure, both emotional and physical

B) Either had no effect on intrusive thoughts, or made them worse.

I would rather have no medication at all, than conitinue experimenting with anti-depressants. Every new anti-depressant results in several months to build up, many adjustments to dosage, then when no positive effect is achieved, several weeks to wean off such med. This pattern has been repeated many times since 1999.

Perhaps all the methylphenidate did was create an altered state which masked the symptoms, but then again, that is what SSRI's and other drugs affecting neurotransmittors do? From what I've read, mpd is a dopamine reuptake inhibitor. I will continue researching the subject. I've seen a few articles by googling the topic.

I also plan on consulting a psychiatrist, to see what he thinks.

 

[ThatLady]

I think consulting a psychiatrist is an excellent idea, stevel. If you can explain to him your background with various medications and the difference you noted with just a dose or two of MPD, perhaps he will have some ideas as to how you might safely try something different to see if you get a better response. I do think it's important that you be under close medical supervision while doing so.

 

[Retired]

Steve,

Though there are many good reasons for consulting a specialist to help manage drug therapy and specifically in response to the problem you stated:

I've taken most of those anti-depressants for many months, or even a couple of years, often upping the dose

Each medication is different in the way it performs in the body, even different meds within the same class, such as SSRI's for instance.

Increasing the dose does not necessarily increase effectiveness, and often simply increases adverse effects. That is to say not all medications have a linear response to dose in their effectiveness, which is why drug therapy should be managed by a specialist with clinical experience in those meds and related disorders.

 

[Halo]

Hi Stevel,

I can somewhat relate to the frustration with finding the right medication or combination of medications but I know that after years of trying different ones and upping doses etc., I was sent by my psychiatrist to a psychopharmacologist who specialized in medications who gave a report to my psychiatrist of the medication options to try that we (both she and I) had never thought of. I think that it was well worth the trip to see him.

I know you said that you plan on consulting a psychiatrist which I think is the first step in the right direction. I would definitely start there and then see what happens but remember that there are other options like the one I described above if you are still unable to find the right med.

Good Luck and let us know how it goes.