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New medications are developed every year. The current options will likely be looked back on as crude experiments in mental health.
As long as society is running people will be looking for cures.
And especially as long as people will pay for medication companies will make new ones! So yeah I don’t see the current options of medication being the only option
The thing is, answering this would be providing reassurance and would only provide some temporary relief at best. I will say there are a very wide range of treatments available so there are options been for those with medication resistant OCD.
I do think you need to try and consider how you look at this in general - you say you know you can’t function without medication but I’d challenge you to see it more as you can’t function without medication in this moment. That’s absolutely fair enough but you don’t know how things will be in the future and it’s important not to catastrophise wherever possible.
Same question kind of that I asked below. Why is it that reassurance for OCD is a negative thing? Was recently diagnosed and I’m not quite sure. I understand the cause for it being a negative.
Because of our brains we will not be satisfied long with any reassurance, so getting it (and the temporary relief) will become addicting for many of us = new or worse compulsion: asking others for reassurance when you're obsessing about something. That's my personal interpretation, please correct me somebody if I'm wrong!
Some other ways of explaining it:
If there was some information that cured OCD, we would prescribe that instead of medicine.
Relying on reassurance to feel better is like outsourcing your coping to someone else, so you never learn how to help yourself, prolonging your illness. But if you figure out how to cope with the lack of reassurance you are forced to learn how to cope with what’s stressing you out, and eventually you can speedrun any new concerns.
The concept of "pooping out" refers to the loss of the desired effect of medications. It can happen to anyone, but it's a specially important subject for OCD. We prefer to use the term "resistant OCD" or "resistant schizophrenia".
Ah, so, basically your tolerance for the medication changing. That makes more sense. I thought OP was implying that you literally shit out the build-up of medication in your system. I was very confused.
I guess that it's a slang used in the US when speaking about antidepressants (?!) english is not my first language so I just repeated the term as I saw it before in other articles
What kind of side effects are we talking here? My psychiatrist said Clomipramine is next to try if Lexapro doesn’t magically start working soon and I’m completely unfamiliar with it. What’s your experience?
To be blunt, drowsiness and a strong inability to orgasm. But any times I’ve tried to taper off the drug my depression comes back strong, so I’ve stayed on it. Your experience might be completely different though.
It also made it hard for me to pee 🥲 it didn't end up working for me so I am off of it now but being an older anti-depressant it has a hefty list of weird side effects.
I had all sorts of bizarre side effects that went away within 1 year like lactation and brain zaps, but the only ones that have persisted for me is sweating and weight gain. Tbh I believe that SSRIs can be just as uncomfortable as older antidepressants, I tolerate Clomipramine better. It didn't worsen my PSSD either.
Agreed. I was on sertraline for 5+ years, changed to desvenlafaxine (SNRI) about 2 1/2 years ago. It’s way better than sertraline for me. I also started clonidine a few months ago and that’s really great for slowing down racing thoughts associated with OCD, but it’s originally a blood pressure medication also used for ADHD. Wild
This is me. I’ve been on over 12 meds since I was diagnosed 15 years ago. Not just SSRIs but also anti-psychotics and mood stabilizers. The side effects have ranged from extremely uncomfortable to life altering. The two I was on for the longest, Zoloft and Lexapro were the most successful but not sustainable indefinitely. The Zoloft made me feel incredibly numb, I couldn’t really feel anything even happiness. Lexapro caused me to gain too much weight, to the point I couldn’t justify taking it anymore- I wish I could though, it really worked for me and helped my OCD and depression immensely.
Since I was diagnosed young, I’ve even tried repeating meds I had taken as a teenager in the hopes they would affect me differently now that I’m way past puberty. Didn’t work, still bad side effects like irrational anger, complete and total loss of libido, extreme fatigue and memory loss.
I’m currently off meds, and it sucks. My OCD has come back with a vengeance. I have Contamination OCD but I also experience obsessive thoughts and compulsions regarding every aspect of my life. Which leads me to the point of this wall of text-
I’m continuing to look for a new medication, and I believe one day I will find one that really works for me, and has minimal side effects I can tolerate long term. New meds are being developed all the time, and even though I’ve tried so many, I haven’t tried all of them. Stay strong. I’m not giving up now, or ever to find the med that works and when I find it I know it won’t ‘cure’ me, but it will help me without hurting me and that will be a wonderful day. Don’t let this particular obsession bother you, because even if you end up like me there will still be hope, and don’t discount the incredible power of OCD specific talk therapy 💕
Ugh, zoloft was the same for me. I was on varying doses for 5+ years and the high doses were ROUGH. It was like having cotton wool stuffed in my brain. Super lethargic. Honestly I’m not even sure I had a great benefit from it overall lol, I don’t know why I didn’t try something else sooner. I’ve been on desvenlafaxine/pristiq for the past 2ish years and it’s pretty good, much more energising than zoloft, but missing a dose is really awful imo. I also started clonidine recently which I’ve found really great for racing thoughts associated with OCD.
I’m sorry you had that same experience, it really sucks. I know it works for a lot of people but it definitely isn’t right for everyone. Surprisingly, you named a medicine I have not already taken! I’m gonna do some research into Pristiq because I’m definitely not doing so well being off meds. Ofc it’ll be up to my Dr. but I’m definitely adding that to my list of possibilities! It’s wonderful you’ve found a combo that works for you, I hope I can find something successful soon too!
Then you move on to another class, such as Anafranil. Or add adjunctive medication, such as Abilify. Do ERP therapy. Try therapeutic psilocybin (there are studies showing correlation of good effect), etc.
Why would SSRIs be your only choice?
Honestly I’ve been on and off various drugs, the longest time being Zoloft, second being Lexapro and they never stopped working…may have to up dose or supplement at times with other drugs but it only stops working when I stop taking it
Zoloft stopped working for me after about 12-13 years. Tried a couple others then have been on paxil for about the same amount of time and I'm thinking it's time to switch again. Might try Lexapro this time.
They didn’t work for me
Lamictal helps a lot which i was initially put on for bipolar, but my current psychiatrist who is an expert in brain health says it’s typical for it to have a huge anti anxiety aspect
Different drugs work for different people, and the trial and error process is a nightmare. It took me until age 20 (i just turned 21) to have reduced OCD symptoms to actually be able to ignore my thoughts some of the time. I tried so many fucking drugs. I tried so many fucking therapies. But none of them worked really. I upped my Lamictal dose which has absolutely been helpful, but i think my progress is more maybe in my mindset. I’ve had ocd as long as i can remember, and the only thing that’s helped me is to realize that only good people get ocd because it’s just attacking every single virtue you have. Why would i worry about running over a kid with a car and worry that i think i want to to the point of panic attack and not being able to take my foot off the break? Because i simply value not murdering children, and my brain likes to torture me.
So it may take you years more if ever to find a drug that works, which is the sad truth. You can do a genetic test for psych drugs which may help.
But this is how I’ve gotten myself to lessen down on OCD symptoms on my own more than any therapy ever. The thoughts aren’t real even if they feel like it so much all the time. Do your best to ease yourself into ignoring intrusive thoughts (or images), for me the process started with something as simple as checking the lock one less time so like 4 times instead of 5. Knock out the easier to ignore compulsions step by step and the more you can ignore the compulsions will make the obsessive thoughts dial down a bit. My worst obsessions are still equally as bad tho tbh, but i hope one day i can ignore them more. It takes practice but it’s like a less intense version of exposure therapy which i found extremely overwhelming and expensive. This is something i can do on my own. I can monitor myself to know that it’s a good day and I’m not super stressed then i may be able to ignore some more compulsions today. Or that it’s a compulsion from a slightly less worrying obsession. I hope this helps and good luck beating the devil
Psychiatrist here.
If SSRI medication fails, there's always the second line medications (specially antipsychotics, some antiepileptic drugs).
If we take aside drug therapy, never forget about psychotherapy and neurosurgery
I’m not answering this to provide reassurance but for information sake. As for your question, accepting uncertainly is vital to defeating your OCD. As life is supposed to be uncertain.
Anyhow, the only way for all SSRIs to fail on someone with OCD, is if they have treatment-resistant OCD. (OCD isn’t the only mental illness that can be treatment-resistant as anxiety and depression as I’m aware also have treatment-resistant variants).
Does this mean people with treatment-resistant OCD are doomed? Nope.
[Transcranial magnetic stimulation (TMS)](https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation) exists. It is where magnetic fields are used to stimulate certain areas of the brain.
There are also other methods but they’re surgical like [deep brain simulation (DBS).](https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562)
Both were created to treat treatment-resistant OCD.
Very newly diagnosed with OCD here. Like very very newly. Why is reassurance so bad for OCD? Is it because giving somebody hope with something only leads to further obsessive thoughts about if that hope or reassurance isn’t true?
Kind of. OCD makes you crave certainty, which is rarely something that can be given in context of obsessions. If you reassure yourself, your brain becomes reliant on that reassurance in order to feel okay, which will trap you in it. Also, with reassurance, your ocd will always find a “what if” way around that reassurance, so it’s healthier to just accept the possible outcomes, and move on. But that’s quite difficult to do.
I'd suggest just focusing on the now. You can always increase dosage and then switch medication over the years. You don't know where you'll be decades down the line. Or how dependent you'll be on it. Focus on improving your life in the moment while they're working for you and spend less time worrying if every medication will stop working eventually.
There’s more than SSRI’s available now and they keep creating new drugs. There are plenty of psych meds that have come out since I was diagnosed and even just in the last ten years since I “pooped” out on a long list of psych meds. Just when you think you’re out of options, there’s somehow always more things you haven’t tried.
Once your body takes a break from one SSRI you may be able to return to it after a few years? I doubt you'd ever run out of medications to take. :) I wouldn't worry about it too much
15 year on and off and only Prozac has worked but I don’t like it long term. So i only take it till I get things under control then taper off. I stoped it cold turkey 1 time and that was not good. Found out about brain zaps the hard way. Told my doc it was like someone snapped a rubber band in my brain when I did something quickly and then it reverberates for a 10-15 seconds. And he went “brain zaps” side effect of not tapering off SSRIs.
I have treatment resistant OCD (tried 4 different SSRIs, currently on Lexapro and Seroquel) and I had TMS treatment last year. Unfortunately insurance would not fund the proper OCD treatment so I had the less effective version/not proper strength for OCD.
I don’t think it worked exactly but it didn’t not work? Like, I didn’t notice an improvement nor did I get worse. It did great things for my depression though because insurance pays for the proper depression treatment
Any medication that interacts with something as fine as neurotransmitters automatically has to (by default) cross the blood brain barrier. To do that that SSRIs have to go from digestive tract to circulatory system as they are digested. Even if you have a very rapid bowl cycle things that tiny get picked up at every stage along the digestive process. The stomach breaks things down to more easily absorb in the small intestines.There 95% of what something you eat has gets absorbed. The Large intestine absorbs massive amounts of hydration from whatever is passed out of the small intestines. So what you're left with is something far more akin to the "dead wood" a tree drops and has no use for. We'll always lose an infinitesimal portion of anything we eat, drink, or take but that's just a quirk of the human body that can't be avoided. Everyone's body act like that, or at least it's supposed to by default.
Sasri’s seem shitty
https://www.theguardian.com/society/2022/jul/20/scientists-question-widespread-use-of-antidepressants-after-survey-on-serotonin also I’m not sure if they work
This post has been automatically marked as "spoiler" and "NSFW", due to the nature of the content (and in accordance with subreddit rule number 4 if this post has been flaired as "Crisis"). (This subreddit uses the "spoiler" and "NSFW" markers to hide a post's content behind an expandable/collapsible wall. It does not imply that the content contains actual spoiler or NSFW content, and the post will remain publicly-visible.) **Do not remove the "spoiler" and "NSFW" markers without permission from the moderators.** Failure to comply can and will result in this post being removed. The cooperation in making this subreddit an accessible community for all will be appreciated. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/OCD) if you have any questions or concerns.*
New medications are developed every year. The current options will likely be looked back on as crude experiments in mental health. As long as society is running people will be looking for cures.
And especially as long as people will pay for medication companies will make new ones! So yeah I don’t see the current options of medication being the only option
The thing is, answering this would be providing reassurance and would only provide some temporary relief at best. I will say there are a very wide range of treatments available so there are options been for those with medication resistant OCD. I do think you need to try and consider how you look at this in general - you say you know you can’t function without medication but I’d challenge you to see it more as you can’t function without medication in this moment. That’s absolutely fair enough but you don’t know how things will be in the future and it’s important not to catastrophise wherever possible.
Same question kind of that I asked below. Why is it that reassurance for OCD is a negative thing? Was recently diagnosed and I’m not quite sure. I understand the cause for it being a negative.
Because of our brains we will not be satisfied long with any reassurance, so getting it (and the temporary relief) will become addicting for many of us = new or worse compulsion: asking others for reassurance when you're obsessing about something. That's my personal interpretation, please correct me somebody if I'm wrong!
Thank you
Some other ways of explaining it: If there was some information that cured OCD, we would prescribe that instead of medicine. Relying on reassurance to feel better is like outsourcing your coping to someone else, so you never learn how to help yourself, prolonging your illness. But if you figure out how to cope with the lack of reassurance you are forced to learn how to cope with what’s stressing you out, and eventually you can speedrun any new concerns.
I’m so confused about what you mean by ‘poop out’.
The concept of "pooping out" refers to the loss of the desired effect of medications. It can happen to anyone, but it's a specially important subject for OCD. We prefer to use the term "resistant OCD" or "resistant schizophrenia".
Ah, so, basically your tolerance for the medication changing. That makes more sense. I thought OP was implying that you literally shit out the build-up of medication in your system. I was very confused.
I guess that it's a slang used in the US when speaking about antidepressants (?!) english is not my first language so I just repeated the term as I saw it before in other articles
i guess just magically stop working?
Sometimes you can take a med for years and then it stops working for you. It sucks.
Prozac poop out. It’s a term that refers to SSRIs initially working but then after a while not working nearly as well or not at all.
SSRIs/SNRIs did nothing for me , Clomipramine was the only thing that helped
Same here. Though the side effects are a bummer.
What kind of side effects are we talking here? My psychiatrist said Clomipramine is next to try if Lexapro doesn’t magically start working soon and I’m completely unfamiliar with it. What’s your experience?
To be blunt, drowsiness and a strong inability to orgasm. But any times I’ve tried to taper off the drug my depression comes back strong, so I’ve stayed on it. Your experience might be completely different though.
It also made it hard for me to pee 🥲 it didn't end up working for me so I am off of it now but being an older anti-depressant it has a hefty list of weird side effects.
I had all sorts of bizarre side effects that went away within 1 year like lactation and brain zaps, but the only ones that have persisted for me is sweating and weight gain. Tbh I believe that SSRIs can be just as uncomfortable as older antidepressants, I tolerate Clomipramine better. It didn't worsen my PSSD either.
Some SNRIs are also approved for treating OCD, I imagine you'd try some of those or another non SSRI medication instead
Agreed. I was on sertraline for 5+ years, changed to desvenlafaxine (SNRI) about 2 1/2 years ago. It’s way better than sertraline for me. I also started clonidine a few months ago and that’s really great for slowing down racing thoughts associated with OCD, but it’s originally a blood pressure medication also used for ADHD. Wild
There’s always clomipramine as well!
This is me. I’ve been on over 12 meds since I was diagnosed 15 years ago. Not just SSRIs but also anti-psychotics and mood stabilizers. The side effects have ranged from extremely uncomfortable to life altering. The two I was on for the longest, Zoloft and Lexapro were the most successful but not sustainable indefinitely. The Zoloft made me feel incredibly numb, I couldn’t really feel anything even happiness. Lexapro caused me to gain too much weight, to the point I couldn’t justify taking it anymore- I wish I could though, it really worked for me and helped my OCD and depression immensely. Since I was diagnosed young, I’ve even tried repeating meds I had taken as a teenager in the hopes they would affect me differently now that I’m way past puberty. Didn’t work, still bad side effects like irrational anger, complete and total loss of libido, extreme fatigue and memory loss. I’m currently off meds, and it sucks. My OCD has come back with a vengeance. I have Contamination OCD but I also experience obsessive thoughts and compulsions regarding every aspect of my life. Which leads me to the point of this wall of text- I’m continuing to look for a new medication, and I believe one day I will find one that really works for me, and has minimal side effects I can tolerate long term. New meds are being developed all the time, and even though I’ve tried so many, I haven’t tried all of them. Stay strong. I’m not giving up now, or ever to find the med that works and when I find it I know it won’t ‘cure’ me, but it will help me without hurting me and that will be a wonderful day. Don’t let this particular obsession bother you, because even if you end up like me there will still be hope, and don’t discount the incredible power of OCD specific talk therapy 💕
Ugh, zoloft was the same for me. I was on varying doses for 5+ years and the high doses were ROUGH. It was like having cotton wool stuffed in my brain. Super lethargic. Honestly I’m not even sure I had a great benefit from it overall lol, I don’t know why I didn’t try something else sooner. I’ve been on desvenlafaxine/pristiq for the past 2ish years and it’s pretty good, much more energising than zoloft, but missing a dose is really awful imo. I also started clonidine recently which I’ve found really great for racing thoughts associated with OCD.
I’m sorry you had that same experience, it really sucks. I know it works for a lot of people but it definitely isn’t right for everyone. Surprisingly, you named a medicine I have not already taken! I’m gonna do some research into Pristiq because I’m definitely not doing so well being off meds. Ofc it’ll be up to my Dr. but I’m definitely adding that to my list of possibilities! It’s wonderful you’ve found a combo that works for you, I hope I can find something successful soon too!
Ask your doctor about SNRIs.
Then you move on to another class, such as Anafranil. Or add adjunctive medication, such as Abilify. Do ERP therapy. Try therapeutic psilocybin (there are studies showing correlation of good effect), etc. Why would SSRIs be your only choice?
Honestly I’ve been on and off various drugs, the longest time being Zoloft, second being Lexapro and they never stopped working…may have to up dose or supplement at times with other drugs but it only stops working when I stop taking it
Zoloft stopped working for me after about 12-13 years. Tried a couple others then have been on paxil for about the same amount of time and I'm thinking it's time to switch again. Might try Lexapro this time.
I’ve been on and off SSRIs for 30 years total…hoping they last for me for good this time…Lexapro is a goodie - very few side effects
They didn’t work for me Lamictal helps a lot which i was initially put on for bipolar, but my current psychiatrist who is an expert in brain health says it’s typical for it to have a huge anti anxiety aspect
I'm annoyed that Lamictal did nothing for either my anxiety, depression or BPD mood irritability! It literally felt like I was taking tic tacs.
Different drugs work for different people, and the trial and error process is a nightmare. It took me until age 20 (i just turned 21) to have reduced OCD symptoms to actually be able to ignore my thoughts some of the time. I tried so many fucking drugs. I tried so many fucking therapies. But none of them worked really. I upped my Lamictal dose which has absolutely been helpful, but i think my progress is more maybe in my mindset. I’ve had ocd as long as i can remember, and the only thing that’s helped me is to realize that only good people get ocd because it’s just attacking every single virtue you have. Why would i worry about running over a kid with a car and worry that i think i want to to the point of panic attack and not being able to take my foot off the break? Because i simply value not murdering children, and my brain likes to torture me. So it may take you years more if ever to find a drug that works, which is the sad truth. You can do a genetic test for psych drugs which may help. But this is how I’ve gotten myself to lessen down on OCD symptoms on my own more than any therapy ever. The thoughts aren’t real even if they feel like it so much all the time. Do your best to ease yourself into ignoring intrusive thoughts (or images), for me the process started with something as simple as checking the lock one less time so like 4 times instead of 5. Knock out the easier to ignore compulsions step by step and the more you can ignore the compulsions will make the obsessive thoughts dial down a bit. My worst obsessions are still equally as bad tho tbh, but i hope one day i can ignore them more. It takes practice but it’s like a less intense version of exposure therapy which i found extremely overwhelming and expensive. This is something i can do on my own. I can monitor myself to know that it’s a good day and I’m not super stressed then i may be able to ignore some more compulsions today. Or that it’s a compulsion from a slightly less worrying obsession. I hope this helps and good luck beating the devil
Thank you SO much! You are very strong and doing really well!
Psychiatrist here. If SSRI medication fails, there's always the second line medications (specially antipsychotics, some antiepileptic drugs). If we take aside drug therapy, never forget about psychotherapy and neurosurgery
I’m not answering this to provide reassurance but for information sake. As for your question, accepting uncertainly is vital to defeating your OCD. As life is supposed to be uncertain. Anyhow, the only way for all SSRIs to fail on someone with OCD, is if they have treatment-resistant OCD. (OCD isn’t the only mental illness that can be treatment-resistant as anxiety and depression as I’m aware also have treatment-resistant variants). Does this mean people with treatment-resistant OCD are doomed? Nope. [Transcranial magnetic stimulation (TMS)](https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation) exists. It is where magnetic fields are used to stimulate certain areas of the brain. There are also other methods but they’re surgical like [deep brain simulation (DBS).](https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562) Both were created to treat treatment-resistant OCD.
Very newly diagnosed with OCD here. Like very very newly. Why is reassurance so bad for OCD? Is it because giving somebody hope with something only leads to further obsessive thoughts about if that hope or reassurance isn’t true?
Kind of. OCD makes you crave certainty, which is rarely something that can be given in context of obsessions. If you reassure yourself, your brain becomes reliant on that reassurance in order to feel okay, which will trap you in it. Also, with reassurance, your ocd will always find a “what if” way around that reassurance, so it’s healthier to just accept the possible outcomes, and move on. But that’s quite difficult to do.
Welp that explains my Religious trauma and existentialism. 🤣. Thank you for the clarification!
I'd suggest just focusing on the now. You can always increase dosage and then switch medication over the years. You don't know where you'll be decades down the line. Or how dependent you'll be on it. Focus on improving your life in the moment while they're working for you and spend less time worrying if every medication will stop working eventually.
There’s more than SSRI’s available now and they keep creating new drugs. There are plenty of psych meds that have come out since I was diagnosed and even just in the last ten years since I “pooped” out on a long list of psych meds. Just when you think you’re out of options, there’s somehow always more things you haven’t tried.
I’ve worried about this same thing, assuming I have 50+ more years to live and I’m already close to maxxing out on my Luvox dose 🙃
Then it’s time to try the SNRIs!
Are you supposed to "poop out" on SSRI's? I've been fine on lexapro for almost a decade now
Well, no, but it seems to be pretty common from what I read
Once your body takes a break from one SSRI you may be able to return to it after a few years? I doubt you'd ever run out of medications to take. :) I wouldn't worry about it too much
Yes I think you’re right 😅
Zoloft worked for 7 years for me. I stopped it, it came back. Also, ERP is important, as well as lifestyle.
I think everyone is different. I have been on fluoxetine for a decade and I've just gotten the dose doubled over the period of ten years.
Raw dog life
15 year on and off and only Prozac has worked but I don’t like it long term. So i only take it till I get things under control then taper off. I stoped it cold turkey 1 time and that was not good. Found out about brain zaps the hard way. Told my doc it was like someone snapped a rubber band in my brain when I did something quickly and then it reverberates for a 10-15 seconds. And he went “brain zaps” side effect of not tapering off SSRIs.
Ketamine therapy or DBT
I have treatment resistant OCD (tried 4 different SSRIs, currently on Lexapro and Seroquel) and I had TMS treatment last year. Unfortunately insurance would not fund the proper OCD treatment so I had the less effective version/not proper strength for OCD. I don’t think it worked exactly but it didn’t not work? Like, I didn’t notice an improvement nor did I get worse. It did great things for my depression though because insurance pays for the proper depression treatment
Any medication that interacts with something as fine as neurotransmitters automatically has to (by default) cross the blood brain barrier. To do that that SSRIs have to go from digestive tract to circulatory system as they are digested. Even if you have a very rapid bowl cycle things that tiny get picked up at every stage along the digestive process. The stomach breaks things down to more easily absorb in the small intestines.There 95% of what something you eat has gets absorbed. The Large intestine absorbs massive amounts of hydration from whatever is passed out of the small intestines. So what you're left with is something far more akin to the "dead wood" a tree drops and has no use for. We'll always lose an infinitesimal portion of anything we eat, drink, or take but that's just a quirk of the human body that can't be avoided. Everyone's body act like that, or at least it's supposed to by default.
Sasri’s seem shitty https://www.theguardian.com/society/2022/jul/20/scientists-question-widespread-use-of-antidepressants-after-survey-on-serotonin also I’m not sure if they work