The Serotonin Reuptake Inhibitors, SSRI’s, remain the number one choice for the treatment of OCD. All people with OCD have some abnormalities of the brain neuromodulator serotonin - some are high and others are low. Some types of OCD are effected by the brain modulators dopamine and/or norepinephrine. Frequently more than one medication is needed to help get back to normal. The FDA studies of medications for OCD focus on getting better, but not well. In order to achieve full recovery from symptoms one medication may not be adequate. If a medication is not working try something else. TMS, brain stimulation, or surgery may be effective if all else fails.

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OBSESSIVE COMPULSIVE DISORDER MEDICATIONS
Primary
Paxil*, Zoloft*, Prozac*, Luvox*, Effexor XR, Celexa, Lexapro, Anafranil*
Second Line
Klonopin, Abilify, Zyprexa, Risperdal, Stimulants, Geodon, Seroquel
Others
Wellbutrin SR, Xanax, Buspar, Trazodone, Remeron, Lithium, Clonidine, Anticonvulsants, Ativan
*FDA approved

OBSESSIONS
• Contamination
• Harm
• Symmetry
• Religious
• Sexual
• Hoarding
• Unwanted Urges

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COMPULSIONS
• Checking
• Cleaning/washing
• Repeating
• Mental Rituals
• Ordering
• Collecting
• Counting

Are you sure it’s obsessive compulsive disorder? What if it won’t go away? You better check.? (This is “OCD think.”)

Almost everyone has obsessive thoughts, worries too much, dwells too long on something, or has to do a task “just right.” Since most people don’t have OCD, where is the line drawn between normal and irrational?

People do not have OCD, OCD has them!  Thoughts and actions control the person instead of vice versa.  Addiction to compulsive rituals often results.  “Just one more time and I will stop!”  Some people have OCD symptoms that are secondary to a larger problem such as Post Traumatic Stress.  There are also different types.  Classic OCD and perfectionistic OCD have similarities, but in some ways are opposites.

OCD can overlap with other conditions.  Some of these include the following: Aspergers, Tourettes, Bipolar Mood Disorders, ADHD, and Social Anxiety Disorder. 

DSM IV Guidelines

OBSESSIONS

• Recurrent/persistent unwanted thoughts, impulses or images
• Not simply excessive worries about real-life problems
• Recognized as a product of one’s own mind
• Attempts are made to suppress, control, or neutralize the worry

COMPULSIONS

• Repetitive behaviors or mental acts that the person must perform
• Aimed at reducing distress or preventing a dreaded event

Behavioral and medical treatment combined is the most effective treatment in decreasing both obsessions and compulsions.  OCD treatment has more scientific validity than any other mental disorder.  Overall treatment success has proven to be very positive!

?It’s ALL IN YOUR HEAD!??
That’s where your brain is-the most important organ in the body. The tendency to worry too much is usually inherited. In this world, there is a lot to worry about-we could all worry constantly… and people with GAD do just that!
Worriers overproduce serotonin, a brain transmitter that functions as a modulater in the brain. Serotonin provides “brightness,” just as a TV or computer has a brightness control for the screen. The brain is like a complex computer system where everything is interconnected. High Serotonin may cause an increase in norepinephrine, another brain modulater that is like the “contrast” control. Norepinephrine levels go up with arousal which leads to increased vigilance.
Norepinephrine also stimulates the release of cortisol, the stress hormone. As a result, growth hormone and immune function are reduced.
Brain levels of dopamine, which is the motivation and focus system of the brain, go down during times of acute chronic stress.
These brain transmitter changes, as shown on Chart 2 to the right, cause multiple changes in the body and prepare us for “fight or flight.” In today’s complex, demanding, but often sedentary world, the excessive or prolonged physical changes in the body can cause physical illnesses.
The body becomes like an automobile that is accelerated all day, but only in neutral or first gear. Wear and tear is the ultimate result?especially for the excessive worriers.

Worry is the cognitive, or thinking component of anxiety. Just as each individual has a healthy range and extreme range of body weight, each also has a healthy and extreme range of worry.
Too little worry can often be more harmful than too much worry. We see many examples of the consequences of this in behavior. It is the people that say things that are hurtful, or spend too much money, or drive recklessly, or are sexually promiscuous without considering the outcome. These people always seem to be a disaster looking for a place to happen!
At the other end of this anxiety spectrum are the worriers and the “what if?” people. They tend to be the “nice” people among us that feel over responsible for outcomes. They struggle with obsessive thinking and
exaggerated fears. The worry can be about health, or jobs, or relationships, or finances, etc.

When ‘stress overload? meets the person that is prone to worry, trouble is inevitable. If this condition goes on for over six months and is serious enough to cause multiple symptoms, it is “Generalized Anxiety Disorder” or GAD. Milder or briefer episodes are referred to as Adjustment Disorder with Anxiety. If stressors are not identified or not clearly excessive, the stress is
Anxiety NOS (not otherwise specified).
Unfortunately, many people either ignore the earliest warning signs of stress overload, or self-treat with substances such as alcohol and smoking. (Stress is the number one reason smokers give for not being able to quit). Another very common early response is to see a primary care doctor for one or two of the symptoms. A visit to the doctor will typically get the symptoms treated without uncovering the main problem that is causing symptoms.
Successful treatment can be pinpointed by asking a few simple questions:
• What are the current stressors in the person’s life?
• Are there too many changes, too many conflicts?
• Can the stressors be slowed down or resolved?
• Can stress management be improved by more relaxation or “healthy escapism” instead of TV all night or doing dreaded exercising that causes more pressure and stress?
• Can worry habits be changed?
• Would counseling be helpful?
If stress can’t be managed or a healthy state achieved, medication, at least short-term can protect your health and improve quality of life.

Brain neurotransmitters (chemical messengers) serotonin, norepinephrine, and dopamine are changed when stress overload occurs. Antidepressants restore the balance of neurotransmitters. They lower them if too high and raise them if too low. A point to note: SSRI’s only help serotonin levels. Many stress disorders also need norepinephrine/dopamine readjusted for full remission.

• Depression is not a feeling, but an actual change of activity in the brain that can be measured and seen on a PET scan
• As many as 25% of women and 15% of men will be clinically depressed at some time in their life
• Because depression is usually expressed in the doctor’s office as physical symptoms like fatigue, GI problems, pain, insomnia, it is often overlooked or misdiagnosed
• Over 50% of untreated mild depression becomes full blown severe depression
• As early as six months after birth, babies of depressed mothers show patterns of electrical activity in the brain that are completely different than babies of happy mothers
• Traumatic events in childhood (divorce, death, etc.) can damage neurons in the brain, creating susceptibility to depression
• Depression doubles the risk of having a heart attack and increases risk of death from a heart attack by 3 1/2 times
• A mildly depressed person may be angry, irritable, stressed, overwhelmed, frazzled, have no fun, detached, unmotivated
• Insomnia is often a key warning sign of stress overload. If left untreated it usually leads to more severe anxiety symptoms.

Medication has shown in studies to always be the first line treatment for moderate to severe depression. For mild to moderate depression therapy can be beneficial. Therapy and healthy stress management (especially aerobic exercise) combined with medication can often make a dramatic difference in the outcome of treatment.
Three types of therapy have shown to be useful:
Cognitive - Helps correct distorted thoughts and attitudes that are hindering change. Negative and exaggerated thinking often make depression worse.
Interpersonal - A structured treatment that deals with improving relationships. The depressed person often withdraws from others, causing social and personal impairment. Self-esteem is also addressed.
Behavioral - Many depressed people have developed patterns of behavior that need to be acknowledged and changed. When this occurs, the positive reinforcement that results often helps encourage change and lessens the depression.

It is unfortunate that these drugs are called antidepressants. They can be used very effectively for many other symptoms and disorders. The list below gives some of the treatment options for the newest antidepressants.

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SSRI’s - Effexor XR(at 37.5-75mg), Zoloft, Prozac, Paxil, Celexa, Lexapro
Non-melancholic depression, OCD, PTSD, panic disorder, premature ejaculation, social anxiety disorder, PMDD, irritability

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Wellbutrin SR
Depression with low interest, mental energy, motivation and pleasure; smokers, weight gain, low libido, delayed orgasm

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Remeron
Mixed depression, insomnia, underweight

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Effexor XR (at 150-225mg)
Melancholic depression, excessive worry and
anxiety (GAD), irritability, chronic pain, ADHD