Help and advice please

[Breatheart]

I have ocd /harm ocd and I had much success with lexapro and Ativan for 20 years til the lexapro stopped working 2 years ago. Now on Paxil 60 mg and Ativan and Paxil has not helped at all. Anyone else have this problem? Should I try adding low dose abilify as adjunct. I just worry about tardive akathasia and other side effects. I’m beyond stressed …now picking at my scalp and hair causing patches of baldness. I’m a mess.

[Carbon21]

hi sorry you are struggling, have you considered other options like therapy or TMS, maybe ask a therapist for some options…I find therapy mostly helping people but I certainly understand needing something to take the edge off as well. Chin up, feel better.

[Breatheart in reply to Carbon21]

thank you.

[Sallyskins]

I take aripiprazole (Abilify) myself alongside sertraline -300 mg of sertraline and 5 mg of aripiprazole a day. I find it really helps. It took me ages to decide to take it, as I had a bad experience with sulpiride (another anti-psychotic) that made me gain weight - 35 pounds!

There being supply problems recently with Abilify, I had to go without and it was not an easy thing to do! It came as a relief when supplies were restored and I could get back to my old self, flawed though it is!

I haven't had any side effects from Abilify so far.

I have skin picking and as I have psoriasis on my head it's a struggle not to pick! Try not to pick your scalp if you can as hair follicles can be damaged if the hair is pulled out too often and not grow back. But that takes quite a lot of regular picking!

Please don't call yourself a mess! There are worse things to be than someone with OCD!

[Breatheart in reply to Sallyskins]

Thank you so much. Do you have ocd also?

[Sallyskins in reply to Breatheart]

I do have OCD and have had it for many years. It's also good to have CBT alongside the medication, if you haven't already had that. Self help books can be useful, too!

[Breatheart in reply to Sallyskins]

yes. I’ve been thinking that. I have a therapist but she doesn’t do CBT

[Sallyskins in reply to Breatheart]

CBT is really necessary with OCD. It's one thing to spill out your heart and your guts in talking therapies - that can help - but to tackle OCD you really need CBT.

If there's any problem in getting another therapist, or if you don't want to stop going to the one you're currently with, then self help books can enable you to do some do-it-yourself CBT. Just make sure the ones you choose use CBT techniques. The ones I always suggest and that have helped me are Overcoming Obsessive Compulsive Disorder and The OCD Workbook but there are quite a few others. They have examples of different types of OCD based on case studies, and exercises that you can adapt to yourself.

Just starting on CBT gives you a boost - it makes you realize you can do something about your OCD and that in itself gives you a lift.

I should give the Abilify a go - it's hard to say what medications will suit you best, because each of us is different and it can be down to trial and error. If it isn't right for you then you can always come off it. I know it's off-putting to read the leaflet that comes with the medication outlining the side effects, but some are extremely rare.

[Breatheart in reply to Sallyskins]

Believe it or not I actually have some OCD CBT workbooks…. but haven’t even tried them because I can’t concentrate. I think I do need a cBT therapist…..I know ERP is what is suggested for ocd but I don’t want to do ERP. That’s too much for me

[Sallyskins in reply to Breatheart]

ERP is part of CBT and you're right, it is hard! I don't think there can be anyone with OCD who doesn't struggle with it.

But it's effective. The best way is to start small - make a list of your OCD wobbles and grade them from 1 to 10 with 1 being the easiest to do ERP with and 10 being the most difficult. Then start with the easiest. It's intensely liberating to break down just a little of the OCD.

I once had a bad shoulder - any movement was intensely painful and it aches from neck to wrist. I avoided movement in it as much as possible in case I did any further damage. I had quite a long wait for physiotherapy, but was told I could start on it myself by stretching it. So I did - and painful though it was, the stretching started to ease it.

And so it is with ERP. A little stretch, some pain - a lot of relief!

And get those books out. Digest them in bite sized chunks - no need to settle down for a marathon read. It does get easier.

[avoidingthebadthings]

I am so sorry you are going through this. When one's medication stops working, it is so incredibly frustrating. Especially as you have to endure the return of symptoms you thought you'd never have to deal with again, and the amount of time it takes to ramp up on new meds is such a drag. Please hang in there.

I strongly recommend that you switch to Celexa, if you haven't tried it already. (Celexa and Lexapro are manufactured by the same pharmaceutical company; Lexapro was put on the market by them just as Celexa was about to go generic, and is very similar in structure, though not identical. Lexapro was a way for the company to continue making money off a very successful drug with a small change that could get them a new patent.)

I take Celexa for my OCD, and whenever I try to go off of it, no other medication comes close to how well Celexa works. I think if you switch to Celexa, it will be similar enough to Lexapro to get you back on track. Paxil is not going to help with the OCD like Celexa or Lexapro do.

Seriously, make the call to your prescribing physician and get going with the taper from Paxil to Celexa. Better you try Celexa, which will definitely help with the OCD than adding Abilify to the Paxil. I was put on anti-psychotics early in my medication journey to treat OCD symptoms that were misdiagnosed as psychosis. My handwriting has never been the same, and my ability to play music with a steady beat was messed up by a jerking motion side effect.

Also, as someone else mentioned, the skin picking does indeed have long-term ramifications. All the picking I did on my scalp until I was 18 has left me at 52 with significant bald patches, through which one can see faint red scarring. It's very sad.

Definitely do as much talk therapy as you can while going through this medication change. It's so important to talk about the frustration of losing control when meds get messed up. Also, I find it really helpful to get one of those inflatable punching bags and kick it around when I think about hurting myself. Over time channeling that energy outside of myself has become almost as satisfying as harming myself. It's a long strange journey. You've got good instincts, so listen to what your body is telling you and let your doctor know what you want to try.

[Breatheart in reply to avoidingthebadthings]

thank you so much. Good advice 💜