Increase medicine for OCD

[Louisa]

Hi,

 

My son used to have mild OCD. But last summer, his OCD increased significantly. Dr. T found he had PANDAS and prescribed him with various kinds of antibiotics, which, unfortunately, made his OCD worse. Later, the Cunningham test showed he had autoimmune disorder and was prescribed with Prendisone, which even made his OCD much worse. So we stopped all these medicine. And later, with increased probiotics, his OCD was relieved. Although it was still significant, it was within a tolerable level.

 

Last week without a clue again (or maybe due to increased social anxiety in school), his OCD increased back to the high level like that in summer. So his school psychiatrist wanted to increase his medicine for OCD because he has been very late for school due to OCD during morning routine. His current medicine for OCD is zoloft 200mg. He is also taking zyprexa for his paranoia.

 

Personally, we do not want to add any medicine. He has been seeing Dr. Greenblatt, an integrative psychiatrist, who give him several supplements. His paranoia has been reduced to minimal and zyprexa reduced from 30mg to 10mg in two years since he started taking the supplements. A recent Kryptopyrrole test indicated he had elevated pyroluria and Dr. Greenblatt has just prescribed him with Zinc and Vit B6, hopefully to reduce his anxiety. We would like to see how the new supplements work before changing his medicine.

 

Anyway, his school psychiatrist proposed three options for us to consider for treating his OCD

 

1. to increase zyprexa from 10mg to 15mg in order to boost up the effect of zoloft.

2. to add another SSRI, such as Prozac, on top of 200mg zoloft

3. to add another tricyclic , such as Anafranil, on top of 200mg zoloft.

 

Any feedback for the medicine options and any suggestion relating to what happened to my son's OCD are greatly appreciated

 

Thanks for your time

 

Louisa

 

 

 

 

 

 

[MomWithOCDSon]

In our experience, zinc and B6 are great supplements for combatting anxiety, so I would think you'll see some boost there soon via that. How much B6 is your DS taking? Ours took 1,200 mg in the morning and another 600 mg at night initially, though he has scaled back some in the last year or so to no ill effects.

 

We tried zyprexa and didn't like it for a host of reasons. In our experience, though they are being used more and more frequently for a "quicker fix" for anxiety than SSRIs may provide, these heavy-hitter antipsychotics are not a proper (especially in the long-term) intervention for anxiety/OCD. I think Dr. Greenblatt's reduction plan on this (and hopefully elimination eventually) is great. Both my DS and another "non-PANDAs" family member suffer from anxiety/OCD, and antipsychotics (zyprexa, abilify, Seroquel, etc.) have not proven to be effective and, rather, unfortunately, have tended to take things the other, less positive, direction.

 

Our original psych, when things got back with our DS several years ago and the psych couldn't seem to find an effective med, put him on anafranil. It was not the right medication for him. When we changed psychs and found our current one, she said anafranil was contra-indicated for a kid like our DS and was precisely the WRONG medication for him.

 

I don't know about adding Prozac on top of the Zoloft as I've never seen this strategy employed unless the patient was going to be transitioned from one SSRI to another. Is it the case that your DS has been on Zoloft for an extended period, and so it possibly has ceased to have the effectiveness it once did? SSRIs do have a reputation for "burning out" over time. My family members have responded very positively to both Prozac and Zoloft, though not at the same time. My only concern would be potential for serotonin syndrome, in the event inadequate serotonin is NOT at the root of your DS's increased OCD of late, and the Prozac just increases serotonin levels beyond what's beneficial.

 

I think it's still something of a mystery why certain meds work for certain people, and don't work or even seem harmful for others. That's why these genetic tests like GenoMind are getting increased marketshare, I think, as they're supposed to help identify meds that are best for your particular situation. I will say, though, too, that my DS and yours sound somewhat similar (pylouria, OCD, some of the same compulsion sets, like a necessary routine/ritual that threatened at one point to make him late for everything in his life!), and here's what my DS took that worked well for him: Zoloft, Lamictal, B6, NAC, zinc, D3, evening primrose oil, probiotics (mixed strain), quercitin.

 

All the best!

[Louisa]

In our experience, zinc and B6 are great supplements for combatting anxiety, so I would think you'll see some boost there soon via that. How much B6 is your DS taking? Ours took 1,200 mg in the morning and another 600 mg at night initially, though he has scaled back some in the last year or so to no ill effects.

 

We tried zyprexa and didn't like it for a host of reasons. In our experience, though they are being used more and more frequently for a "quicker fix" for anxiety than SSRIs may provide, these heavy-hitter antipsychotics are not a proper (especially in the long-term) intervention for anxiety/OCD. I think Dr. Greenblatt's reduction plan on this (and hopefully elimination eventually) is great. Both my DS and another "non-PANDAs" family member suffer from anxiety/OCD, and antipsychotics (zyprexa, abilify, Seroquel, etc.) have not proven to be effective and, rather, unfortunately, have tended to take things the other, less positive, direction.

 

Our original psych, when things got back with our DS several years ago and the psych couldn't seem to find an effective med, put him on anafranil. It was not the right medication for him. When we changed psychs and found our current one, she said anafranil was contra-indicated for a kid like our DS and was precisely the WRONG medication for him.

 

I don't know about adding Prozac on top of the Zoloft as I've never seen this strategy employed unless the patient was going to be transitioned from one SSRI to another. Is it the case that your DS has been on Zoloft for an extended period, and so it possibly has ceased to have the effectiveness it once did? SSRIs do have a reputation for "burning out" over time. My family members have responded very positively to both Prozac and Zoloft, though not at the same time. My only concern would be potential for serotonin syndrome, in the event inadequate serotonin is NOT at the root of your DS's increased OCD of late, and the Prozac just increases serotonin levels beyond what's beneficial.

 

I think it's still something of a mystery why certain meds work for certain people, and don't work or even seem harmful for others. That's why these genetic tests like GenoMind are getting increased marketshare, I think, as they're supposed to help identify meds that are best for your particular situation. I will say, though, too, that my DS and yours sound somewhat similar (pylouria, OCD, some of the same compulsion sets, like a necessary routine/ritual that threatened at one point to make him late for everything in his life!), and here's what my DS took that worked well for him: Zoloft, Lamictal, B6, NAC, zinc, D3, evening primrose oil, probiotics (mixed strain), quercitin.

 

All the best!

 

Thanks for taking time to respond

My son takes B6 50mg x2 now and will increase the doze in a couple of months. What was the doze you son started off and how long did you start see the effect?

Do you remember what was the reason why your psychs said anafranil was the WRONG medication for your son? If I am right, anafranil is the only medicine that is used to specifically treat OCD.

My son has taken Zoloft for 3 years, which initially was for his “atypical depression” labelled by his doctor (although we did not see any depression in him). After 1 year, when his OCD emerged and increased, it became the medicine for his OCD although I do not feel it is really helping him at all. However, since we have been trying to work on reducing Zyprexa in these two years, so we just leave Zoloft alone. In fact, my son had genetic test with GenoMind, which suggested Zoloft was not a good match for my son.

The following are supplements my son is now taking

B6, B12 (liquid), Niacinamide, VitC, NAC, lithium orotate, D3, fish oil, CurcumaSorb Mind, probiotics (mixed strain), Zinc.

How did your son do with the supplement he is taking? How did you come up with these supplements for your son’s OCD?

[MomWithOCDSon]

Louisa --

 

Unfortunately, I don't remember the specific reason our psych felt anafranil was not appropriate for our DS, specifically. What does Genomind say about anafranil for your DS? Our psych is a big fan of Genomind and uses it to guide her treatment frequently, particularly in cases with patients who appear to be treatment-resistant. Our DS never had the Genomind as it has come along more recently, and her treatment regimen of Zoloft and Lamictal, without the benefit of genetic testing, seems to have been right on point. She's come to using it more recently, however.

 

I came to the supplements we use with him by a variety of sources, including the PANDAs forum here. But one main source was Dr. Carl Pfeiffer's Biochemical Subtypes matrix which lays out, in very easy terms for the not-so-medically-inclined, what supplements and interventions are likely to be beneficial or contra-indicated for the under-methylated (histadelia or high histamine) or over-methylated (histapenia or low histamine), as well as conditions such as pyroluria, high copper, etc.

 

It may be that, given my DS's presentation, behaviors, thinking/processing, etc., the psych took similar clues as to the anafranil not being appropriate for him. I know it impacts both serotonin and dopamine receptors, while Zoloft doesn't have an affinity for dopamine receptors. So, perhaps that's the difference?

 

My DS has always had a high histamine response -- eczema, seasonal allergies, acid reflux, etc. And the matrix also places OCD under the under-methylated/high histamine column. So it all seemed to add up. Beneficial supplements for this condition, according to Pfeiffer, include B6, zinc, omega 3's and a few others. The NAC I added because of discussions and research shared on the PANDAs forum, including a Yale/NIMH study that used it to treat OCD. I tried sublingual B12 tablets with him, and they seemed to make his panic worse, so I stopped and decided to keep B12 out of his regimen.

 

I started my DS out on 600 mg. of B6 per day initially, and we worked up to the 1,200 mg in the morning and 600 mg. in the evening over the course of a couple of months. It's hard for me to separate the impact of each medicine and/or supplement very specifically, especially something like the B6. But he slowly improved over time, and the B6 seemed to continue to support him over the next few years. The dosage, as I recall, same from some research similar to the NAC dosage coming from the Yale/NIMH study, but I can't seem to lay my hands on the B6 research at the moment. I have a massive library, but I unfortunately failed to label things as clearly as I should have.

 

I will also say that lamictal was, at my DS's worst point, life-changing for him. It didn't impact the OCD directly, but what it did do was give him greater objectivity about it. Once the lamictal kicked in, the rituals and obsessions no longer had the power to drive him to melt down or fall apart if they were interrupted, or when he tried to take more control of his choices and options himself. It gave him a lot of leverage against the "being stuck" OCD can create and helped him get on with what needed to be done.

 

Let me know if you're interested in the Pfeiffer matrix and don't already have it or cannot find it on-line. You can always PM me with an email address, and I'll send it to you, in that case.

 

All the best.

[GinaT]

Nancy,

 

I have seen several of your posts, and I would love to get your email address. You seem to be very knowledgeable, and we are in the beginning stages of OCD with my niece. Any suggestions or support systems you might have would be greatly appreciated.

 

Gina

[MomWithOCDSon]

GinaT --

 

I just PMed you.

 

Nancy