Doctors Lounge - Psychiatry Answers
"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."
Forum Name: Psychiatric Topics
|self_help - Mon May 11, 2009 5:48 am|
in my last year in university (2004), i started suffering from Obsessive-compulsive disorder and depression, i was repeating washing and cleaning and could not control myself till i felt i will get insane, then i new that i am sick and visited a psychiatrist, he gave me Solian and lecital 40 mg each once a day, i felt better a little, and mother helped me a lot to not listen to Obsessive thoughts and i could control my behaviours, but actually it turned into another kind... feeling guilty and blaming myself for anything. Depression never goes 100% , you can say that i get used to live with it. After almost 2 years, my doctor told me to stop solian, and since then i take lecital once a day (for 6 years). yesterday, i visited another psychiatrist, he is an old man with long experiance, he told me that im still suffering from obsessive thoughts and depression, and he told me that i need to do a brain scan so he can determine what drug i need to get.
honestly, I am afraid from short and long term side affects for these drugs ... and i really hope that one day i can get rid of all.
so waht shall I do now... shall i take his advice and do the scanning... and start a new treatment???
I think it is very important to tell you something about my history, when i was 11 years old, (before period), i went through a hard diet, and lost 18 kilo grams, and kept going through this diet myself for years even when i used to do strong sports as Karate and fitness.... Actually everything in me changed... my hair fell dow, the rest is 1/3 of my hair....my chest didnot get bigger ,........
And now... i am so sensitve emotionally, wishing my mind to stop thinking for 1 minute maybe.... caring a lot for people's opinion..... and upset ... i say why shall i be happy and build my life while there will be an end of this world....
please, maybe your advice will rescue me and help me to start my life over.....
Thanks a lot
|Jeffrey Junig MD PhD - Thu Jul 09, 2009 7:21 pm|
There is a guy in California, USA (I take it from your medications that you are from a European country-- we call 'lecital' citalopram, and the other medication you refer to is an antipsychotic medication not typically prescribed in the US) who does PET scans for mental illness-- I am blanking on his name, which is just as well so I don't get sued for calling him a crook.... he (and his followers) do these expensive scans and give the patient reports saying 'your hippocampus needs work' or 'your left temporal lobe is a bit slow'... total garbage. You don't need a scan, unless you are having severe symptoms and you are being prepared for surgery (which is done for severe OCD that does not respond to medication). The treatment of choice in the US is luvox, or fluvoxamine, or to push the dose of any other SSRi as high as tolerated. There are also behavioral treatments; a hospital near me (Rogers Memorial in Oconomowoc, WI, USA) has a residential treatment center for OCD, where patients are treated for several months at a time.
I cannot speak to practices in your area, but brain scans are really not the point-- the issue in a person who is not getting better is whether the diagnosis is correct, or whether something else is going on. I would recommend sticking with an approach as standard and as 'mainstream' as possible, to avoid those who prey on the desperation of others. There ARE good treatments, though--- ask someone about fluvoxamine, and push the dose as high as you can tolerate-- that is the general approach here.
|Dr. E. Seigle - Fri Jul 10, 2009 7:12 am|
I agree that the "scan" that you have mentioned most likely refers to a PET scan, which is a way to measure blood flow or metabolism in various brain regions. While this is a good research tool, it in now way, to my knowledge, will enhance the ability to diagnose or treat your OCD and depression. I also agree that the treatments of choice for you are to be taking an SSRI medication at maximum doses (your dose of citalopram could have been raised higher)- these include medications such as fluoxitene, fluvoxamine, sertraline, clomipramine and others. In addition, there is an excellent therapy called cognitive-behavioral therapy for OCD, and this helps people learn ways of thinking and behaving which lower OCD symptoms as much as medication! It is likely that the combination of both medication and the therapy is best. So, I would seek out this therapeutic treatment, as well as going back to a psychiatrist and being sure you are receiving a maximal dose of one of the SSRI medications for OCD; often, one has to take more of the medication than is usually used. Good luck, and be wary of the promise of PET scans at this point.
-Eliot Seigle MD
|Faye Lang, RN, MSW - Fri Jul 10, 2009 1:29 pm|
I would like to add to the doctors' replies to your concerns. There are reputable psychiatrists who do like to us PET scans, but it is generally for their own research, and is not generally accepted as a diagnostic tool. However, whether you decide to pursue that or not, I would recommend that you see a psychologist for testing. Such testing would help define if you have an obsessive-compulsive disorder or an obsessive-compulsive personality disorder. That would help direct appropriate treatment. Such testing would also help define the depression vs dysthymia. Behavioral treatment may help, and it can be done on an outpatient basis.
Good luck to you,
|Andrea Schulz, LCSW - Fri Jul 10, 2009 10:36 pm|
OCD is kind of like a skipping record where you get stuck on the same thought over and over, and/or an electrical glitch in your brain which signals you there's danger when there is none.
What kind of things do you do compulsively or feel compelled to do? What kind of thoughts do you obsess about?
It sounds like the diet you were on at age 11 was an episode of OCD, so you have quite an early onset, it appears. Chemical imbalances, or brain disorders, like OCD, Bipolar, Schizophrenia,etc, often have a genetic component, so if you have family members with mental illness, you are at higher risk of developing one over your lifetime.
Have you heard of National Alliance for Mental Illness? It's a self help and advocacy organization, and has some of the best classes about mental illness and treatment which I've ever taken. And the classes are free. Are you located in Canada? I know they have a NAMI chapter, as do a few other countries.
Sometimes early childhood trauma such as abuse and frequent placement changes can cause a type of complex developmental brain disorder, which does not yet have a name/classification in the DSM. Dr. Bruce Perry has done extensive research into the changes in brain development and chemical/neurological pathways caused by early childhood trauma. I'm wondering if you've endured trauma when you were a child, prior to age 11?
If this is the case, the traumatic experiences may have caused a set of symptoms which are commonly diagnosed as reactive attachment disorder, bipolar disorder, post traumatic stress disorder and borderline personality disorder. If so, there is a wonderful web-based free course on Trauma Focused Cognitive Behavioral Therapy, which in conjunction with medication, may be of immense help. Also dialectical behavioral therapy may be beneficial because it helps with gaining control over regulating emotions, instead of being high-jacked and held hostage by your emotional flooding.
I agree that a psychological evaluation, especially a neuropsychological evaluation, would assist in accurate diagnosing and treatment planning, and help rule out any physiological causes of your brain disorder. For instance, thyroid imbalance or sleep apnea can exacerbate or cause mental illness symptoms. There are several rule outs for your clinician to explore with you, including those previously mentioned by other clinicians in this thread. Knowledge is power, so the more you know about your illness, the better you can choose treatments and interventions to try.
The main thing to remember is that currently mental illness is diagnosed and treated based on self report. So if you describe a set of symptoms, then your diagnosis flows from that, rather than scans or blood work, etc. And treatments are implemented or discarded based on your self-reported response.
It is very helpful for your psychiatrist and clinician, as well as for your own greater understanding of yourself, if you keep a mood journal where every day you write down in a calendar or date book one or two words to encapsulate your mood for that day. Over the course of a month, 6 months, and a year, you and your providers will be able to identify the pattern of your mental illness. This helps in narrowing down your diagnosis and helps in relapse prevention planninng, as well as tracking your response to various med changes.
Remember, keep trying different interventions until you find the right combination of medications, therapy and lifestyle changes that allow you to achieve your personal best. You are your own detective seeking to unravel the mystery of yourself. Your job is to keep trying and never give up, and know that you will have symptom free times in your life and you will also have painful episodes of your mental illness. This is the nature of mental illness. It can be an overwhelming thing for a young person such as yourself to grapple with and reconcile yourself to accepting. Seek out a support system of people who understand mental illness and get it when you are having a rough patch in your illness. They will help you get through these times, and you will help them get through their tough times too.
|Sabine H, RN - Sun Jul 12, 2009 12:08 pm|
Hi! I would like to add to the previous comments that you should not worry about long term side effects of antidepressant drugs. You have to take care of the problem first. If you don't have side effects right now after taking the medication for 6 years, you don't have to worry about it. Just keep seeking help if you feel the medication is not working and, as previously mentioned, you could give a try to CBT, cognitive behavioral therapy.
Sabine H. RN
|| Check a doctor's response to similar questions|
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit online articles.
Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.