Medication Questions

[akerswes]

Okay, I have a few questions regarding my current medications. (Hoping PDU answers as he seems to be extremely knowledgeable when it comes to meds). I have pretty severe OCD. I am currently on Anafranil 150mg/day, Risperdal 2mg at night, Klonopin 0.5 three 3x a day as needed.

I've been on the Anafranil for roughly a month, but only on 150mg for exactly one week. My doctor suggested the Risperdal to augment the anafranil. I feel better than I have in a long time, however, I'm still having lots of racing thoughts. I know that I haven't given my anafranil enough time to start fully working, but is the Risperdal/anafranil combo a good one? Is there a better combination? Such as Serequel? I don't feel as though the Risperdal is doing anything. The doc said I would only be on the Risperdal short term as I'm not/never was psychotic or anything, but it just doesn't seem to be doing anything other than making me sleepy. The doc also said I will be able to get off Klonopin once the anafranil really kicks in. I am looking forward to that day, as I know it will one of these weeks. I've never had such a positive experience with an antidepressant. So yeah, to make a long story short, is there a better combo to be on to comba OCD? Thoughts? Thanks!

[panic_down_under]

I know that I haven't given my anafranil enough time to start fully working, but is the Risperdal/anafranil combo a good one? Is there a better combination? Such as Serequel?

As a generalization, probably not, they all do the same thing, about equally well, or poorly, depending on the result. One of the Cochrane (http://www.cochrane.org/about-us) reviewers, Prof. Stefan Leucht, actually wrote a paper pointing out how dubious the claims about which antipsychotic is better are:

Why Olanzapine Beats Risperidone, Risperidone Beats Quetiapine, and Quetiapine Beats Olanzapine: An Exploratory Analysis of Head-to-Head Comparison Studies of Second-Generation Antipsychotics (https://doi.org/10.1176/appi.ajp.163.2.185)

One might be marginally better for you, but just increasing the risperdal dose would probably have bigger impact than switching.


but it just doesn't seem to be doing anything other than making me sleepy.

Which may be mostly why it was prescribed.

[akerswes]

As a generalization, probably not, they all do the same thing, about equally well, or poorly, depending on the result. One of the Cochrane (http://www.cochrane.org/about-us) reviewers, Prof. Stefan Leucht, actually wrote a paper pointing out how dubious the claims about which antipsychotic is better are:

Why Olanzapine Beats Risperidone, Risperidone Beats Quetiapine, and Quetiapine Beats Olanzapine: An Exploratory Analysis of Head-to-Head Comparison Studies of Second-Generation Antipsychotics (https://doi.org/10.1176/appi.ajp.163.2.185)

One might be marginally better for you, but just increasing the risperdal dose would probably have bigger impact than switching.



Which may be mostly why it was prescribed.

Thanks for the info, I'll stick with the risperdal for now. The thing is, I have no trouble with sleep, and never have. It was initially prescribed to augment the anafranil and I was told a low dose with help with intrusive thoughts. Like I said, I am feeling benefits, it's just difficult to tell whether said benefits are from the risperdal, or the anafranil, as it's still early.

One more question: AP's such as risperdal are supposed to work much like benzo's, correct? As in they start working quickly. Or, are they more like antidepressants, where there's a waiting period? Thanks.

[panic_down_under]

Like I said, I am feeling benefits, it's just difficult to tell whether said benefits are from the risperdal, or the anafranil, as it's still early.

It is probably mostly the risperdal.


AP's such as risperdal are supposed to work much like benzo's, correct? As in they start working quickly. Or, are they more like antidepressants, where there's a waiting period? Thanks.

Antipsychotics can begin having an effect almost immediately, especially as a sedative because they are fairly potent antihistamines. They usually begin having an impact on psychosis, or in your case intrusive thoughts, within a week or so, but it can take up to a month to get the maximum response. This is still faster than antidepressants which typically take 3-12 weeks to kick-in.

[akerswes]

It is probably mostly the risperdal.



Antipsychotics can begin having an effect almost immediately, especially as a sedative because they are fairly potent antihistamines. They usually begin having an impact on psychosis, or in your case intrusive thoughts, within a week or so, but it can take up to a month to get the maximum response. This is still faster than antidepressants which typically take 3-12 weeks to kick-in.


Thanks for the info, once again. If you don't mind I have one more question. If it's mostly the risperdal, will it be easy to tell when it is in fact the Anafranil?

[panic_down_under]

If it's mostly the risperdal, will it be easy to tell when it is in fact the Anafranil?

That's hard to say. It depends on how well Risperdal works.

[akerswes]

That's hard to say. It depends on how well Risperdal works.

Thanks, PDU. I think I'll be able to tell as I've already been on the Risperdal for a month, and while I feel better, I'm still dealing with a substantial amount of intrusive thoughts. Once those begin to diminish it'll be the anafranil, hopefully.

[panic_down_under]

Once those begin to diminish it'll be the anafranil, hopefully.

It should make a significant difference. Meanwhile if the thoughts become too difficult talk to your doctor about taking N-acetyl-cysteine (NAC) supplements.

A number of small scale studies have found NAC can reduce OCD intrusive and compulsive thought patterns and also boost the effectiveness of antidepressants for OCD (Oliver G, 2015, PDF (http://ro.uow.edu.au/cgi/viewcontent.cgi?article=2918&context=sspapers)). There is a large scale multinational study currently underway to test this. NAC is generally a safe supplement with few side-effects. It is used medically to protect the liver in cases of paracetamol, aka acetaminophen, overdose and has other medical uses (http://www.webmd.com/vitamins-supplements/ingredientmono-1018-n-acetyl%20cysteine.aspx?activeingredientid=1018). Doses of 1,800-3,000mg/day taken in 3 divided doses seems to work (start with one dose per day of around 500-600mg and increase by the same amount every 2-3 days to avoid triggering diarrhoea). NAC is best taken on an empty stomach about an hour before meals.

HOWEVER, be aware that a recent study (http://www.popsci.com.au/science/antioxidant-supplements-worsen-lung-tumors-study-finds) found NAC may increase the risk of lung cancer in smokers, or those with some specific lung diseases (note, it doesn't cause lung cancer, only maybe reduces the ability of the immune system to detect and destroy existing cancerous cells). This finding has been the subject of much debate because there are many other studies showing NAC protects against lung cancer so it is probably not the final word on the subject. FWIW, I'm a lung cancer survivor and have take NAC for over 11 years because it is the best thing I've found for reducing fluid buildup in my remaining lung.

[akerswes]

It should make a significant difference. Meanwhile if the thoughts become too difficult talk to your doctor about taking N-acetyl-cysteine (NAC) supplements.

A number of small scale studies have found NAC can reduce OCD intrusive and compulsive thought patterns and also boost the effectiveness of antidepressants for OCD (Oliver G, 2015, PDF (http://ro.uow.edu.au/cgi/viewcontent.cgi?article=2918&context=sspapers)). There is a large scale multinational study currently underway to test this. NAC is generally a safe supplement with few side-effects. It is used medically to protect the liver in cases of paracetamol, aka acetaminophen, overdose and has other medical uses (http://www.webmd.com/vitamins-supplements/ingredientmono-1018-n-acetyl%20cysteine.aspx?activeingredientid=1018). Doses of 1,800-3,000mg/day taken in 3 divided doses seems to work (start with one dose per day of around 500-600mg and increase by the same amount every 2-3 days to avoid triggering diarrhoea). NAC is best taken on an empty stomach about an hour before meals.

HOWEVER, be aware that a recent study (http://www.popsci.com.au/science/antioxidant-supplements-worsen-lung-tumors-study-finds) found NAC may increase the risk of lung cancer in smokers, or those with some specific lung diseases (note, it doesn't cause lung cancer, only maybe reduces the ability of the immune system to detect and destroy existing cancerous cells). This finding has been the subject of much debate because there are many other studies showing NAC protects against lung cancer so it is probably not the final word on the subject. FWIW, I'm a lung cancer survivor and have take NAC for over 11 years because it is the best thing I've found for reducing fluid buildup in my remaining lung.

Thanks for all the information. Definitely going to look into that! You're a wealth of knowledge PDU!