Zoloft – OCDx4

“OCD was once called ‘la folie du doute’ (‘the madness of doubt’), highlighting the central role of self-doubt in its symptomatology (Janet, 1908).” – Yes, I know it’s French.

So, what is it? There’s science behind all this and it’s not just – “Oh, hey, I can’t make a decision.” – or – “I need to touch things an even number of times” (or if you’re someone else – obsessive hand washing, hoarding, over-the-top house cleanliness and order, excessive lock checking, self harm thoughts, etc).” There is plenty of discussion on what causes something that affects 2-3% of the U.S. population (~3.3 million). What it is, when you get right down to it – It’s part of anxiety disorder and brought on by part of a broken system in the brain.

Some thoughts are that it’s causes are possibly hereditary, it might be a spontaneous mutation, perhaps some stress that caused a gene to switch on as a child, maybe an illness like streptococcal infections causing an autoimmune response that causes injury, or perhaps environmental factors. Maybe various combinations of all the above. The brain is an organ after all. That being said decades ago, there was little to know but as of late, study into OCD has increased significantly. I’m lucky, to an extent, as my OCD is less worse than a lot of other sufferers.

Anyway, I feel it best to pull quotes to help describe medical thoughts on OCD, as I’m not a medical professional, and then link to the original articles if you want to explore more. It’s a lot to read, and perhaps boring, but I’ve highlighted some text that I feel best describes things, some in layman’s terms, more scientific in others, or that just resonate the most with me:

“…OCD produces profound morbidity. Difficulties with decision-making and intolerance of uncertainty are prominent clinical features in many patients. The nature and etiology of these deficits are poorly understood. We used a well-validated choice task… to investigate differences in valuation and value-based choice during decision making under uncertainty…Participants’ choices were used to assess individual decision-making characteristics. OCD participants did not differ from healthy controls in how they valued uncertain options when outcome probabilities were known (risk) but were more likely than healthy controls to avoid uncertain options when these probabilities were imprecisely specified (ambiguity). Compared to healthy controls, individuals with OCD were less consistent in their choices and less able to identify options that should be clearly preferable. These abnormalities correlated with symptom severity. These results suggest that value-based choices during decision-making are abnormal in OCD. Individuals with OCD show elevated intolerance of uncertainty…”

“… Of note, the circuitry that is linked to valuation (Bartra et al, 2013) is abnormal in OCD (Maia et al., 2008; Menzies et al., 2008). This raises the possibility that abnormalities in valuation may contribute to decision-making difficulties observed clinically in patients…”

“Individuals with (OCD) often exhibit indecisiveness, pathological doubt, and avoidance of uncertainty (Rasmussen and Eisen, 1992; Reed, 1985; Tolin et al., 2003), even when the task at hand is unrelated to their primary symptomatology (Hamilton, 1957).”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562025/

“In OCD and compulsive individuals, some decision making acquires an abnormal emotional valence, because of abnormal activity in the OFC.” This leads to abnormal activation of the ACC and prevents an individual from making a quick or automated decision. Individual ends up in a vicious cycle where anxiety about decision making increases activation in the OFC which makes it increasingly hard to make a decision. The DLPFC is implicated in the executive function that terminates a compulsion. It is no coincidence that dysfunction of orbitofronto-striato-thalamic circuits are a cause of pathology in OCD, since these areas play a key role in decision making (Heekeren et al., 2008).”

http://sites.tufts.edu/emotiononthebrain/2014/12/06/ocd-the-decision-making-model/

0cd_petscan_ucla001

“…brain scans of people with OCD are different than those of people without it – the prefrontal cortex of the brain is overactive in people with OCD….

…It also appears to be related to an imbalance in the levels of the neurotransmitters serotonin and dopamine, with serotonin levels being abnormally low and dopamine levels, abnormally high. Certainly, though, the OCD brain, specifically the prefrontal cortex, uses far more energy than the non-OCD brain.”

https://www.quora.com/Is-there-a-physical-brain-based-defect-linked-to-Obsessive-Compulsive-Behaviour-disorder

“The loop is of particular relevance to hyper- and hypo-kinetic movement disorders, such as Parkinson’s disease and Huntington’s disease,^[2] as well as to psychiatric disorders of control, such as ADHD,^[3] OCD,^[4] and Tourette syndrome.^[5]

In OCD, the loop may be dysfunctional, with an imbalance between the indirect and direct pathways resulting in unwanted thoughts, getting “stuck”.

^{https://en.m.wikipedia.org/wiki/Cortico-basal_ganglia-thalamo-cortical_loop}

05onfire1_xp-master768-v2

In a world where constant rumination, non-stop cyclical replaying of things done and where at times anxiety prevails, it’s pretty obvious that it’s not sustainable in the long term even if I’ve lived with it for decades. Seriously, who wants to deal with that sort of stuff for the rest of their lives? It’s tiring and the thought that “This is fine” isn’t an option at this point now that the genie is out of the bottle. It has to be addressed (full disclosure, I told a lovely woman once, that I needed to do some “Soul Searching”. It wasn’t a throwaway line, I knew something was wrong with my decision-making processes. I just didn’t know what). So, after setting up my story, I’ll write about a part of what this blog is about and that is that OCD…is like a douchey roommate thats always creating trouble, leaves dirty dishes in the sink, leaving unlocked doors, doesn’t flush…uhhh…I mean, it’s about seeking assistance and working on stuff…

Therapy – It won’t get better without professional help because how do you change something that is not completely fixable on your own? What are the treatment options? First off, after I’ve done quite a bit of research, and after a few tries, I found a therapist that deals specifically with OCD and Anxiety-related conditions (So, I work on both OCD and Social Anxiety). It won’t happen overnight and will take a lot of effort. So…here we go…

ERP – Exposure Response Therapy (the below quotes pulled from IOCDF.org):

“OCD takes over your body’s alarm system, a system that should be there to protect you. But instead of only warning you of real danger, that alarm system begins to respond to any trigger (no matter how small) as an absolute, terrifying, catastrophic threat.”

“The Exposure in ERP refers to exposing yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions. While the Response Prevention part of ERP, refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been triggered. All of this is done under the guidance of a therapist at the beginning — though you will eventually learn to do your own ERP exercises to help manage your symptoms.”

“That said, this strategy of purposefully exposing yourself to things that make you anxious may not sound quite right to you. If you have OCD, you have probably tried to confront your obsessions and anxiety many times only to see your anxiety skyrocket. With ERP, the difference is that when you make the choice to confront your anxiety and obsessions you must also make a commitment to not give in and engage in the compulsive behavior. When you don’t do the compulsive behaviors, over time you will actually feel a drop in your anxiety level. This natural drop in anxiety that happens when you stay “exposed” and “prevent” the compulsive “response” is called habituation.”

So, this involves slowly introducing scenarios that might trigger OCD, in essence confronting them directly and sitting through them. For instance, I’d need to purposely put myself in an uncomfortable thought position that requires making a choice. Let’s say – “going out and purchasing a shirt” and experiencing the uncomfortable feeling of choice, or driving my car, in the rain, after I washed it the day before (I’ve cancelled plans because of worrying about getting my car dirty). It could be deciding on a phone without getting lost in over-thinking the purchase, or forcing myself to step on sidewalk seams or catching myself doing even number movements when anxiety spikes. Let’s add – avoid seeking “reassurance” from others that “everything is fine” over and over again (which you will hear about later) or maybe just choose take a vacation to a specific location without over-thinking and, hopefully, in the end being somewhat “comfortable” that there is not a 100% answer to everything. So, you just sit with that uncomfortable scenario, acknowledge it and experience it till you start to inoculate yourself against that particular obsession/compulsion/anxiety spike after doing it so many times. Seems counter-intuitive but by constant exposure you get used to it. And doing this treatment while being fully aware it could pop up somewhere else…including the danger of becoming obsessive about OCD….no joke.

Mindfulness: If you hear me talk about OCD, in person, you’ll see me “spin up”. It puts the anxiety into overdrive and I start talking much faster and louder (because it’s not fun to discuss and as I said earlier, I’m pretty guarded and self-protecting). And the same could be said about just about anything that promotes anxiety (although sometimes my conflict avoidance causes me to shut down instead, since my anxiety and emotions will skyrocket, out-of-control and off to Mars, over personal, or heated, discussions). But what it entails is, basically, mellowing out. Just focusing on the here and now and the environment around you, at that moment in time, and throwing in relaxing things like Diaphragmatic Breathing.

Medicinal: I’ll have to take Selective Serotonin Reuptake Inhibitors (SSRIs) to assist in stabilizing my anxiety and compulsions until such time I can ween myself off. Think of anti-depressants like Zoloft, Lexapro, etc. People with OCD/Anxiety do commonly deal with depression from time to time (as do a lot of people) and occurs at a higher rate with OCD sufferers, so SSRIs help address those issues (remember – I originally sought out help for Situational Depression). But it also, coincidentally, helps with OCD symptoms, when taken in higher doses than you would normally take an SSRI. This is because of the aforementioned lower levels of seratonin that sufferers with OCD, typically, have. It’s not 100% deal. You can’t just treat it with a magic pill but it does add a little additional help. So, you can think about SSRIs, and their relation to OCD, sort of like Viagra. It covers more than one thing aside from it’s original intent. For instance – Viagra was originally supposed to be a cardiovascular pill, but “big surprise!” It just happens to allow the patient to…ummm…throw footballs through tires, work on lawnmowers or compels people to sit in separate tubs…in front of a lake…or something…

take-your-medicine

Sleep: My mind races at night, so for many years to quell my over-thinking and rumination I have relied on an average of 75 mg of Benadryl (which is a lot) at night to shut my mind down to get sleep. Well, once my anxiety/rumination is under control, there should be healthier methods I can employ to get proper shut eye. Good sleep does make a big difference on how I feel but I need to back off the self-medicating…then again…maybe all that Benadryl is why my allergies don’t bug me so much.

Group: I found a group here, locally, and that has been good in that seeing people who also have OCD (with differences in how their compulsions present themselves) I’m able to compare notes and not feel alone with this. I’ve learned a lot talking with people that have had years of working with this and has allowed me some important insights. I’ve only had a couple of months, so it’s a constant learning experience and that’s been great. When you’re telling someone what you’re going through and they nod their head in acknowledgment, you feel like you’re not the only one experiencing things and that’s been reassuring. These groups are all pretty informal. Conversations come and go naturally and it’s not odd feeling or anything. Let’s just say, it’s not the dark, weird and somber environment as it’s presented in a movie like Fight Club.

fight-club-quotes-6 — No, it’s not like this.

Support: Sharing it with friends and family that can offer a bit of support or understanding is extremely helpful. I don’t expect empathy, as most people I know likely don’t have it but hopefully some understanding. It’s a bit distressing because you’ll wonder how they’ll treat you. So far, it’s been fine and I’ve had a strong base of support. I’m thankful to have these people in my life, they haven’t treated me any differently, have been extremely supportive and many just shrug it off as “no big deal”. It’s been a nice thing to have.

Tag: Zoloft

La Folie du Doute