OCD Action

tizzkins
Member

Hi all not sure if i have already posted this before or not so apologies if i have. I have been on and off prozac for quite some years now but i have never had to go above 40mg a day until around about six months ago. My doctor agreed to let me go on to 60mg a day as i was struggling. Thing is i dont really think that 60mg is working for me. I am still bad with the ocd, not sure if it would be worse if i wasnt taking the prozac (probably would be). I did wonder if i have somehow become immune or something to the prozac. The other thing i thought about was the house move and not being in a job and i sometimes wonder if my mind has too little to do.

Hope all are well.

Liz x

Sat Jan 14 2012 20:05:40 #
slogsweep
Member

Hello Liz,

A good friend of mine on here, Citaloman, he switched meds this week and feels much better. Maybe it's time to do the same. There's lots of possible medications for OCD. Perhaps your body has built a resistance up to Fluoxetine. Another option is to give the increased dosage more time. Perhaps another six months. It could be that spending so long on the same dosage means it'll take more time to adjust.

If you feel your mind has too little to do and you feel it wandering into OCD territory, switch on a good album, read a good book or watch something mentally stimulating, making you think of wider issues outside the OCD bubble. Think of your mind as something that needs nurturing and looking after, after all it's been through hell with OCD!

Hope you're doing ok tonight Liz, and have a good day tomorrow,

Slog

Sat Jan 14 2012 23:14:12 #
Cuthbert ffoliott
Moderator

Hullo Liz -

the brain does not build up a resistance to SSRI-type medications, such as Prozac (fluoxetine, or Flx in shorthand, not to be confused with fluvoxamine by the way). Nor does it require ever larger doses of it (as is the case with addictive substances, such as alcohol and cocaine), to achieve the same effect. Flx is a compound alien to the body, but it raises free levels of a molecule already present in the brain, namely serotonin. Increased serotonin then is the 'natural first step' in a chain, at the end of which another of your 'own' molecules is also raised: BDNF (= 'brain-derived-neurotrophic-factor'). This is something of a 'super-stuff': it is able to nurture and guide your nerve cells. As a result, these nerve cells develop many more contacts between them, and the production of new nerve cells is increased also. Simply stated: important brain areas become 'richer': under the microscope, in the situation 'before' Flx, you see nerve cells that look like poor, malnourished trees with few branches; and 'after' Flx, you see sprightly and rich trees, with many branches (that touch upon the branches of many adjacent trees). That is important: because all contacts between branches mean better communication between cells, and in the end: better mood and better flexibility in thinking and feeling in case something in life goes wrong.

Now, you say you've been on and off Flx over the years. I don't know how long at a stretch you persisted in taking the stuff; months? years? If you want to elaborate here, please do so. Using meds should be a sustained affair with little or no variation if possible. Sometimes they are at their best after a couple of months, sometimes it takes a few years. Depends on the person.

Finally: how's the propanolol working out?

____________________

So: there is no immunity against the meds in question. I guess the move and not being at work combined play a major role in your present OCD problems. 'My mind has too little to do', you write, and that may be pivotal here (not that you're lazy, heaven forbid that anyone would think that). Thing is: it's only a couple of years that researchers have a concept of the so-called 'default network in the brain'. That's a couple of areas that work together and become active when a person is not occupied with something outside him/herself. These areas are important in our 'sense of self', our 'feeling of ego', our identity and our consciousness. Even in people without OCD, if this system is active too long, ruminating and sad thoughts come to the forefront, and depressive feelings get the upper hand. In people with mental problems, this effect is even more palpable: and in our cases (I expressly include myself here, because I experienced what I write here), OCD may rear its ugly head whenever we don't occupy ourselves with things and/or activities outside ourselves. I'm not really talking fleeting distractions here, more: meaningful activities. Cooking, gardening, painting, drawing, singing in a choir, whatever. That, together with faithfully taking the meds on a sustained basis, helps against OCD.

Long post, hope it helps a bit.

Cheers, Cuthbert.

Sun Jan 15 2012 10:02:58 #
wannabefree
Member

Hi everyone... I too wonder if I've built up a resisistance, but going by what you say Cuthbert, maybe this doesn't happen. I'm gonna ask my psychiatrist about it in February, see if I should change, but I'm sometimes thinking that no medication will help me, I've tried so many over many years. I am hopeful that the CBT will help, but I'm still waiting for that to happen.
Wannabe

Sun Jan 15 2012 12:10:26 #
BT
Member

Hello Liz, I don't share Cuthbert's view. I developed a tolerance to an SSRI. Some doctors say this cannot happen, but many agree it does. A psychiatrist told me that it occurs in about 1 in 4. However, this figure seems to be disputed. I was interested in the first paragraph below (from Stanford University) where the lowering of the dose is mentioned.

Here are some interesting views from doctors:

Q. Can someone build up tolerance to Prozac or other anti-depressants so that they stop working after a while?

A. Tolerance to Prozac and the other SSRIs is a relatively rare phenomenon. What looks like tolerance may develop because the SSRIs also have effects on the dopamine systems of the brain, and these effects can slow one down dramatically. When an SSRI seems not to be working as well as it once did, it often can be helped to work once again by adding small doses of a dopaminergic agonist such as dextrroamphetamine, Ritalin, or bromocriptene. Also, certainly with Prozac, and possibly with other SSRIs, too much of the drug is as ineffective as too little. If raising the dose does not help, and certainly if it makes things worse, a lowering of the dose may do much to bring back a response.

I am convinced that many patients respond best is they are treated with one of the SSRIs + a tricyclic antidepressant such as desipramine (Norpramin), or nortriptyline (Aventyl). Such combinations are often effective when an SSRI by itself fails to do the job.

--------------------

Antidepressants and "tolerance" or "poop-out"

After some time, the drug is no longer working and many begin to experience the tolerance... At this point, the doctor usually doubles the dose of the drug (which allows for it to work a year or two more), or he switches the antidepressant to another….antipsychotic can also be added into the mix…

Tolerance may take different forms; the patient’s condition may gradually worsen over the course of years, or the worsening may occur quite abruptly, sometimes as fast as within a few weeks or months.

----------------
And this from a forum:

Q. How likely is developing a resistance to Prozac?

A. It's called medication resistance, Some people call it "poop out." I burned out on all SSRIs long ago. They simply have no effect on me.

Some people can take the same antidepressant for 15 years and it keeps working for them (lucky dogs)

I am now almost 100% medication resistant. My system has become so efficient at eliminating the therapeutic effects of all classes of antidepressants that taking them is like taking a sugar pill.
---------------

This from another person on a different forum:

I have a doctor who is brilliant at answering my questions. Apparently, Prozac like any other drug, can lose its helpfulness. I was also told that the more times you go on it the less it helps.

------------

I was interested in this last comment, because I know of someone who was helped by Prozac, but discontinued the drug a few times, believing he could cope. He is now back on it and not finding it beneficial at all. Sounds similar to your situation, Liz.

Sun Jan 15 2012 12:20:47 #
wannabefree
Member

Hi BT, this strikes a chord with my situation... In fact I seem to remember, some years ago just stopping one of my medications, all in one go, for about six months, with no change to my thoughts at all. I can't remember which one it was though. It is interesting to read that too much can be as ineffective as too little... I've never heard of that before, but it could be something to check out, cos I'm now on the top dose of Fluoxetine, and it doesn't feel like it is doing anything, even though it probably is. I daren't come off it in case I make my symptoms worse. It is worrying me a little...
Wannabe

Sun Jan 15 2012 12:34:38 #
Cuthbert ffoliott
Moderator

@BT and Wannabefree -

thanks to the both of you for your thoughtful replies. I still can't really agree with your POVs, since I never came across phenomena like 'desensitization' (the becoming less sensitive of a molecule on which a medication acts). SSRIs block the transporter molecule that usually gets serotonin back into the nerve cell, namely, and this does not seem to get more active again the longer it's blocked, nor do many more of these transporters emerge when SSRIs are used for a prolonged time (I mean, there might be some more in theory, but normally the dose of SSRI is sufficient to cover these also).

However, I don't claim too much authority on this, because I did not do specific literature research upon the matter. I will have a good look the coming week.

What is possible IMHO is a psychological effect (think of placebo, for instance). When SSRIs really become active and do their job 100%, people experience a sensation of novelty, mental renewal, and possibilities, of which they were deprived for (sometimes many) years. Inevitably, this feeling will wear off eventually, because the limitations of life itself, imposed by reality, will be felt for what they are. Perhaps expectations were too high initially, and must be adjusted. That could be a reason why people feel the pharmacological effect decreasing, where it does not in any biological sense.

Suppose someone spends 2 hours/day on checking or washing alone. Suppose medication, after having settled in in a satisfying way, gets that down to 20 minutes. I would believe in a 'resistance', i.e. in 'less effect', if after a longer time that duration of compulsions would approach 1.5 to 2 hours again.

Well, my two cents, as they say...

Cuthbert.

Sun Jan 15 2012 12:59:41 #
wannabefree
Member

Hi Cuthbert, you could be right, I just wonder sometimes... That is the reason I won't come off my meds, just in case they are doing something. We are all in this together anyway, so we'll carry on as best we can...
Wannabe

Sun Jan 15 2012 13:10:14 #
tizzkins
Member

Thanks to everyone for your replies, i certainly need to re-read the posts before i comment.

Although Wannabefree from what you say you do seem to be in the same predicament as me with the prozac. You say you are on the top dose what is that? as i have never known although my doctor did say that i was on a high dose(60mg) although it doesnt feel like it is working as well but also as you say i have also had the thought that if i did try to come off of prozac i may just find out to my cost that the prozac is working.

Not sure what to do anymore.

Liz x

Sun Jan 15 2012 14:10:50 #
Cuthbert ffoliott
Moderator

Hi Liz -

good to see you replying. From my point of view, I would say that getting off of Prozac at this very stage surely carries dangers for you. Even with it, you experience anxieties, and you have a sharp insight as to the reasons. Stopping might mean: falling into a severe hole, because the reasons for your problems would not go away, but the cushion that the meds provide you with, even if it's become smaller, surely would. I myself would find the unpredictability of what might happen in itself very unsettling.

And: there is no evidence whatsoever that Prozac has negative effects on your moods. As far as I know a swing to the negative is only possible at the very first stage of going onto SSRIs; and only small children can feel really bad with selected SSRIs, sometimes, and that is why these are not prescribed to these little patients anymore.

Cheers, Cuthbert.

Sun Jan 15 2012 14:22:33 #
wannabefree
Member

Hi Cuthbert, Hi Liz, my dose is 60mg which my psychiatrist informed me was the top dose for Fluoxetine. I will be staying on it cos just as you say Cuthbert, it could have detrimental effects for me too...
Wannabe

Sun Jan 15 2012 16:11:04 #
BT
Member

Wannabe, I think 60mg is usually the highest dose, but I was on 80mg and I know two others who are also.

Mon Jan 16 2012 13:13:04 #
Cuthbert ffoliott
Moderator

Hiya Wannabefree -

good call. Two remarks from me:

- the difference (in terms of real activity) between 60 and 80 mg in all probability is much less than that between 20 and 40. Has to do with the 'relative increase in dose', so to speak. 60-to-80 means a 33% increase, 20-to-40 a 100% one.
In other words: people with moderate depression benefit from 20 mg considerably, because the relative 'step-up' is large, in terms of blocking the uptake of serotonin. Raising the intake to 40 mg would add to the effect, but less that the initial dose did.

- going down to zero with the SSRI almost certainly will mean: not only taking away any potential beneficial effect, even if this is smaller than it was in the beginning, but also something of an 'overshoot' in the negative sense, in that one's mood may get even lower than that fitting to 'zero intake'. That is partly a chemical thing, but also a psychological one: the patient can really get frightened about what happened to her/his mood, which may mean an extra burden.

Rule of thumb: don't quit in times of extraordinary stress and anxiety. If you want to at all cost, do so on a nice and peaceful coast on the Maldive Islands, in a hammock, at sunset, just after you won the lottery jackpot.

-

Mon Jan 16 2012 15:26:59 #
wannabefree
Member

Hi BT, Hi Cuthbert, Oh to win the lottery jackpot! Mind you I'd give all the money in the world to be rid of this demon OCD... I will stay on the Fluoxetine, I think, at least for now. I tried to sort out my CV for future work today, and it makes me realise how much my life has fallen apart. How's it going with you guys? And you, Liz?
Wannabe

Mon Jan 16 2012 17:45:02 #
tizzkins
Member

Cuthbert i think i understand what you are saying regarding the dosage of prozac. Should i discuss with my doctor about going back down to 40mg to see if it has more effect than the 60mg as going from the 40mg to 60mg didnt seem to make any difference so i am just wondering if there is any point on being on 60mg. The beta blockers dont really seem to be working either but my doctor wanted me to try them rather than give me valium again which although it did work my doctor says that valium can be quite addictive.

How are you doing Cuthbert?

Regards Liz x

Tue Jan 17 2012 16:53:10 #
max
Member

i have been on prozac 20m for last 3years,
but ocd and my panick slowley come back.
my gp ask me to take 40m every otherday now 7days
i feel strenge and tired,anyone has same experience,
how long i have to suffer before see any benefit?

Tue Jan 17 2012 17:10:24 #
wannabefree
Member

Hi everyone, Hi Max, I believe it can take anything up to twelve weeks before therapeutic effects kick in, even when changing a dose of medication. Which is very frustrating I know, and even then it is not necessarily what we're hoping for... Are you reading any books on the OCD? Someone on here told me that knowledge is power against te OCD. Books on CBT, even re-read can help too...
I intend to pick up my books tomorrow...
Wannabe

Tue Jan 17 2012 20:37:00 #
Cuthbert ffoliott
Moderator

Hi Liz -

thank you for inquiring. My personal experience is that a moderated dose of paroxetine (40 mg/day) does the job better than did 60 mg/day. I think that is because for me, too high a dose can elicit forms of overactivity in the brain, in the guise of exaggerated thinking: lack of real rest, and ideas and thought that stumble over each other, and that can lead to unnecessary fears. I guess that is because the thoughts don't really get 'processed' and finished as they should. Lots of loose ends, in other terms.

As for valium: it does have highly addictive properties, that is right. It should be taken in moderation and not for longer than 2-3 weeks at a stretch. Addiction means: it will continue to have some soothing effects, but one's hooked to it. Suddenly stopping then means: intense fears, sweating, trembling, and feeling 'out of oneself' (depersonalisation) in a major way. And this can last for days, or even weeks. Valium belongs to the class of benzodiazepines, and these were widely abused the world over for decades. Not that patients really decided on abuse, it just happened because the stuff came in convenient for doctors and patients alike, to get some immediate sedative effect, and well, it masked the real problems underlying the fears in question for quite some time and very effectively.

Hope that everything is well with you, Liz, best,

Cuthbert.

Wed Jan 18 2012 12:23:12 #