Treatment options

[noname_squirrel]

Hello all, I have some questions regarding treatment, just wondered if anyone can help.

1. Has anyone (in the UK) managed to get medication other than SSRI plus antipsychotic? Either NHS or private? If so, how?

2. Has anyone tried multiple SSRIs with little to no success, then tried another that does work for them?

3. Does anyone have any experience of Danger Ideation Reduction Therapy (DIRT), or know of a way to access it?

A brief background on me, in case it’s relevant. 33, female, OCD almost lifelong but generally very much in the background with occasional self-resolving minor flare ups. Started spiralling 7 years ago. Mostly contamination based. Been seeing a private online therapist for most of 6 1/2 years, for CBT with ERP, also some elements of compassion focussed therapy, ACT and EMDR. Also a psychologist through IAPT (lovely but admitted on first session she was out of her depth with me), then specialist service at Springfield. On SSRIs for most of that time, escitalopram (think this was 15 or 20mg), then fluoxetine (60mg), plus a trial of aripiprazole.

I know it’s the behavioural changes that are needed to improve, but currently I’m so stuck I just can’t do it. My insight is also dropping, and my motivation is rock bottom. I know there are things out there that have worked for some people, from reading (admittedly limited) studies, but because they’re not in the NICE guidelines, it feels like I have a snowball’s chance in hell of getting them. So how do I actually move forward?

Thanks for reading, and if anyone has any advice I’d be so grateful.

[THL1]

HiI tried many different SSRIs. I used to be fine on Sertraline then relapsed and afterwards was tried on several SSRIs but had bad side effects (mainly worsening of anxiety). I think it’s worth trying different antidepressants-response and side effects appear to vary considerably from person to person.

I now take Duloxetine and my OCD is generally better but I put the improvement down to CBT/ERP/mindfulness.

I think it’s hard to get ERP focussed treatment on the NHS in the UK.

[noname_squirrel in reply to THL1]

Thank you so much for your reply. My GP is waiting to hear back from a psychiatrist about medication options. If, as I suspect, they won’t do much I think I’ll go for trying another SSRI and just keeping everything crossed it does some good.

I’m really glad to hear your OCD is generally better 😊

[Sallyskins]

I too have been treated at Springfield - I spent four months there. I found it really helpful, though it wasn't a cure. I am also on SSRI + antipsychotic, in my case sertraline at 300 mg a day with aripiprazole at 5 mg a day.

Before I started on sertraline about 15 years ago I was on clomipramine, which was effective but made me constantly dopey.

It can be hard to get motivated, but once you are, it's a real help. Knowing that there are ways of improving is a good spur.

I don't know if you have heard of inositol - I haven't tried it myself, but studies have found it effective in really difficult to treat cases of OCD. It is for sale over the counter at some health food shops and chemists, it is safe and relatively free from side effects. Large doses are needed, as much as 18 g a day - and that is grams and not milligrams!

Here's a reliable source of information - from the hosts of this forum:

iocdf.org/expert-opinions/o...

But do speak to a professional first. And do the CBT and ERP exercises - perhaps get a book to help you that uses CBT techniques, like Overcoming Obsessive Compulsive Disorder or The OCD Workbook.

[noname_squirrel in reply to Sallyskins]

Thank you so much for your really thorough reply 😊

I did try inositol, at the huge dose, and didn’t find it any help unfortunately. However, that was several years ago so possibly it’s worth another try!

I’m working through an OCD workbook at the moment, based on ACT as I find I connect with that better than typical CBT. But I’ll have a look at the other ones you mentioned. It’s just tricky as I feel I’ve learned so much but I can’t make myself shift into action at the moment, I just feel stuck.

Anyway, thanks again for your suggestions 😀

[Sallyskins in reply to noname_squirrel]

Just to say that I've been where you feel you are right now. At one point I could scarcely move from the sofa. But it does get better. And once you start making headway it gives you more of an impetus as you want to do more.