(OCD) Obsessive Compulsive Disorder Treatment in NYC

Dr. Saidi OCD Obsessive Compulsive Disorder

Obsessive Compulsive Disorder Treament

Family and genetic studies have shown significant associations between obsessive-compulsive disorder (OCD) and other psychiatric disorders such as generalized anxiety disorder, panic disorder, depression, hypochondriasis, body dysmorphic disorder, trichotillomania, obsessive-compulsive personality disorder, and avoidant personality disorder. Therefore if you are seeking treatment for OCD it is important for your psychiatrist to screen for these other disorders as they may affect the treatment efficacy. This is even more true since OCD per se can be challenging to treat and remission rates are low despite the introduction of several new evidenced-based treatments over the past two decades.

The current state of art for OCD treatment includes one or more of the following: psychotherapy, behavioral therapy, medications, and neurosurgery. In this section I will focus on the pharmacotherapy of OCD. First-line treatments are serotonin reuptake inhibitors such as clomipramine (Anafranil), venlafaxine (Effexor), duloxetine (Cymbalta), escitalopram (Lexapro), and others in the same class. Several medications from other classes have also shown some efficacy as stand-alone or add-on treatments: Monoamine oxidase inhibitors (MAOI) such as phenelzine (Nardil) seem particularly helpful for OCD patients who also have panic attacks. Newer antipsychotic agents may be of help when combined with SRIs, including Risperdal, Seroquel, Geodon, Abilify – especially for OCD patients who also suffer from tic disorder. Finally, more recent research has provided evidence of excess glutamate in certain regions of the OCD brain. This had led to some promising trials with medications such as memantine (Namenda), riluzole (Rilutek), and N-acetyl cysteine (NAC). In summary, understanding the etiology, pathophysiology, and treatment of OCD and related disorders is an area of intense research, and we are fortunate that several treatment modalities have shown good results. If you are seeking help with OCD discuss these evolving treatments with your psychiatrist.

For more information about OCD and its treatment visit The OCD Foundation: www.ocfoundation.org

Smoking and Cessation

Dr. Saidi Smoking Treatment

Smoking and Cessation: Non-nicotine Treatments

smoking-and-cessation
A recent scientific research looked at why smokers find it so hard to quit despite knowing the benefits of quitting and the dangers of continuing. It found that nicotine distorts the type of reward smokers seek; i.e., they become less concerned with the value of a non-drug reward or punishment (e.g. gaining or losing money) and more driven to assess the magnitude of the reward (i.e. the immediate relaxation and good feelings brought on by smoking). This may, in part, explain why using nicotine-based treatments such as gum or patch are not very successful.

Over the past few years several non-nicotine treatments have become available for treating nicotine dependence. Some of the more successful ones are listed below:

  1. Bupropion (Zyban): An antidepressant medication that has shown some efficacy in treating nicotine use whether there is any depression present or not. About 40% achieve abstinence at the end of treatment (about 12 weeks), but about 50% relapse in a year
  2. Nortriptyline: Another antidepressant that doubles the odds of long-term abstinence from nicotine.
  3. Varenicline (Chantix): It reduces withdrawal symptoms and doubles or triples the odds of quitting and staying abstinent.

References:

Rose EJ et al. Acute nicotine differentially impacts anticipatory valence- and magnitude-related striatal activity. Biol Psychiatry 2013 Feb 1; 73:280

Addy NA and Picciotto MR. Nicotine, striatum, and reward. Biol Psychiatry 2013 Feb 1; 73:205

Depression and Illness

Dr. Saidi Depression

Consider this statement: “Of course he’s depressed – so would I if I had just had a heart attack and gone through all that surgery and hospitalization.” I have heard many variations on that theme in the office and outside. It sucks to have a medical illness, and the sicker you are the more it probably sucks. But the ‘suckiness’ of a medical illness does not automatically equate with the patient being clinically depressed. And depression does not inevitably lead to poor physical health. The relationship between the different processes is more complicated, and it is the job of the psychiatrist to establish cause and effect when possible. The short article below summarizes this concept:

Harvard Medical School – HEALTHBeat, March 23, 2013

Depression and Illness

 

 

 

 

Depression and illness: Chicken or egg?

Depression is more than a passing bout of sadness or dejection, or feeling down in the dumps. It can leave you feeling continuously burdened and can sap the joy out of once-pleasurable activities. Effective treatment can lighten your mood, strengthen your connections with loved ones, allow you to find satisfaction in interests and hobbies, and make you feel more like yourself again.

When depression strikes, doctors usually probe what’s going on in the mind and brain first. But it’s also important to check what’s going on in the body, since certain medical problems are linked to mood disturbances. In fact, medical illnesses — and medication side effects — may be behind nearly 10% to 15% of all cases of depression.

It’s not uncommon for a physical illness to trigger depression. Up to half of heart attack survivors and those with cancer report feeling blue, and many are diagnosed with depression. Many people who have diabetes, Parkinson’s and other chronic conditions become depressed.

It works in the other direction, too. Depression can affect the course of a physical disease. Take heart disease — depression has been linked with slower recovery from a heart attack and an increased risk for future heart trouble.

Read more…