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Dr. Chris in Ohio
Dr. Chris in Ohio, Ohio Psychiatric Nurse Practitioner
Category: Mental Health
Satisfied Customers: 20
Experience:  24 years Psych experience. Expert: psych meds, depression, bipolar, anxiety disorders, schizophrenia
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For a PHYSICIAN please. I just took 100mg Dilantin. I have

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For a PHYSICIAN please. I just took 100mg Dilantin. I have ocd and hate taking zoloft...i have decreased my zoloft to 25 to 50mg and at that level it does little for ocd...I borrowed 100mg dilantin from my brother and within an hour my ocd symptoms decreased dramatically...i think i will asky my dr. to put me on dilantin instead of zoloft. because dilantin is tried and true and peopel have been on it their whole lives and been SMART still. SSRI"s I do not trust I have been on them 10 years and have seen deterioration in my memory. I am only 27 and am trying to finish a degree but am too impacted by zoloft...i think DILANTIn may be my saviour. There is some literature that it helps in ocd...and i am much more comfortable taking that than zoloft. We just don't know enough about the long term effects of SSRI's on the brain . I am not saying dilantin may not have side effects but epileptics take 300mg ...100mg worked dramatically for me. what do you think?
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Chris in Ohio replied 5 years ago.
Dear Customer,

Excellent question....

I am a NP with the same DEA license and prescribing privilidges as a MD, and I have 24 years experience in psychiatry, so I think I am qualified to answer your question for you.

First of all, there is very limited information on Dilantin being useful to treat OCD. Remember that Dilantin works to "slow down" the central nervous system, thus its effectiveness in treating seizure disorders. Also, remember that according to virtually all research, Serotonin (which is enhanced by Zoloft type drugs; SSRIs) is involved with biological processes such as mood, aggression, sleep, appetite, pain, and OCD behaviors.

It also seems that Serotonin is capable of connecting to nerve cells in the brain in many different ways and so can cause many different responses. A malfunction in one or more of the receptors in the brain that Seretonon attaches to is thought to cause OCD.

I work with a psychiatrist who has a subspecialty in treating OCD. Here are some things that we use to treatment resistant OCD. By the way, I have never seen any OCD patient on a SSRI loose their memory. Sometimes people on SSRIs have sluggish thought processes, which you may interpret as memory loss, but this is not permanent.

Our first choice of treating OCD is high doses of the SSRI Prozac. 60-80 mg. We NEVER use Zoloft, as it is not a drug of choice for OCD. Our second drug of choice is Luvox, with a higher dose of 200-300 mg per day.

Sometimes we will combine medium dosages of the above (40mg Prozac & 150 mg of Luvox) when one doesn't work alone.

Dilantin may work for you, but I honestly suspect that the positive effect you got is more of a "placebo" type effect. I would stick with the SSRI approach, and do not be afraid of the high dosages. These drugs are very safe, and although they may have some side effects, you will not lose your memory from any of them. Zoloft is a drug that should be best left in the arena of treatments for depression, not OCD.

Good luck.

Dr. CJH
Dr. Chris in Ohio, Ohio Psychiatric Nurse Practitioner
Category: Mental Health
Satisfied Customers: 20
Experience: 24 years Psych experience. Expert: psych meds, depression, bipolar, anxiety disorders, schizophrenia
Dr. Chris in Ohio and 2 other Mental Health Specialists are ready to help you
Customer: replied 5 years ago.
Thanks for your response but I am still very afraid of SSRI's despite many dr's saying they are safe even long term (I have been on 10 years). At the same time if dilantin at a low dose worked...i know you suspect placebo effect but IF it did work for me I would choose that over ANY SSRI because it has been around 70 years and people have been on it an entire lifetime from childhood and been succesful academically. We cannot say the same for SSRI's as their use is only 20 or so years old. I have what some refer to as Pure Obessional OCD and my thoughts are about getting brain damage from various things one of them medications. I am seeing Dr. Steven Phillipson in NYC . Have you heard of him he is a OCD guru. I am working with him employing Exposure prevention therapy . Not many people treat pure obsessional ocd where there are no outward compulsions he is one of hte leading experts and supposedly most people can get of medication with therapy alone as OCD is a thought/anxiety disorder that can be treated with CBT alone in something like 80% of people. So I am very hoepful that I can get off meds. How long does the therapy take to work though that is the thing? Dr. Phillipson says that the intrusive thoughts can be weakened over time through habituation and I can one day live without drugs most likely.
Expert:  Dr. Chris in Ohio replied 5 years ago.

Dear Customer,

 

If the Dilantin works for you, and we know it works directly in the brain by slowing brain activity, then I would say go forth, but please do so only under the supervision of Dr. Phillipson. Dilantin has one very nasty side effect.... over time your gums may overgrow, and begin to cover your teeth. To prevent this, brush your teeth VERY rigorously at least twice a day.

 

Good luck!

 

Dr CJH

Customer: replied 5 years ago.
well what is "safer" on the brain in terms of cognitive problems surfacing ? ssri's or dilantin or one of the other seizure meds like carbemazapine?
Expert:  Dr. Chris in Ohio replied 5 years ago.

Depakote, an anti-manic, anti-seizure medication which is much like Tegretol. There has been research that shows early promise that it may in fact even reverse some of the anatomical changes seen in early Alzheimer's Disease.

 

Depakote (also known as Valproic Acid) is a very safe medication, is very inexpensive, and has a very solid track record.

 

Good luck!

 

Dr. CJH



Edited by Dr. Chris in Ohio on 6/4/2009 at 12:17 AM
Customer: replied 5 years ago.
What about omega 3. I just started that in high doses it may increase serotonin enough for me to live a normal life without ssri's. that is what some literature says.
Customer: replied 5 years ago.
I also wanted to say my brother takes 300mg dilantin daily for 4 years. He had his first seizure at 18 and ended up intubated for a day because they were so severe and continous. He since then has been on 300mg dilantin and has a genius level iq. He has completed a computer engineering degree like it was nothing. I am however worried for his future...what is going to happen to his really smart brain from taking dilantin for many years...so far nothing has happened but what about in another 4 years?
Expert:  Dr. Chris in Ohio replied 5 years ago.

Glad to answer all your questions u2, but would appreciate whatever extra compensation you can offer....

 

Absolutely take Omega 3. I take 2 each day (a.m and p.m.). Not only will it help your memory, it reduces your cholesterol, helps keep you arteries clean, and serves as a natural anti-depressant.

 

The key is to buy "pharmaceutical grade" Omega 3, not the junk you can get at WalMart. I use Twin Labs brand. Most health food stores have it, and you can also buy it on line. Be sure to take them everyday.

 

Good luck!

 

Dr CJH

Customer: replied 5 years ago.
what about its efficacy for ocd (omega 3) it has shown to be effective for many and that is without taking ssri's too.
Expert:  Dr. Chris in Ohio replied 5 years ago.

u2..... Omega 3 makes the brain function better, but as far as it helping OCD, I have never seen any literature on it doing that, although it definitely would not hurt.

 

OCD is best treated by increasing Serotonin levels as high as possible. As indicated earlier, Prozac in large amounts, or Prozac and Luvox.

 

Earlier this year we had a young woman who could not stop washing her hands. She had been on everything by other Docs. We put her on Prozac 40 mg. and Luvox 100 mg, and her OCD symptoms diminished by 70%. She essentially got her life back.

 

Stick with what has been proven. Adding Omega 3 could only help.

 

Good luck!

 

Dr. CJH

 

 

Dr. Chris in Ohio, Ohio Psychiatric Nurse Practitioner
Category: Mental Health
Satisfied Customers: 20
Experience: 24 years Psych experience. Expert: psych meds, depression, bipolar, anxiety disorders, schizophrenia
Dr. Chris in Ohio and 2 other Mental Health Specialists are ready to help you
Customer: replied 5 years ago.
but you have to look at the long term effects of taking ssri's and the jury is still out. it is not worth the risk to me...even though it is hell without ssri's. CBT can reduce my sypmtoms 70% too.
Do you think i want to be a brain damaged fool from taking ssri's for 30 years. ? I am working on finishing a degree in school and need my brain for years to come
Expert:  Dr. Chris in Ohio replied 5 years ago.
u2.. nope, there is absolutely no evidence that longterm use of any antidepressants, whether they are SSRIs, or the older tricylics cause any long term harm to the brain. Remember, they do not anatomically change the brain.... all they do is block the re-update of neurotransmitters as to increase their levels.

The new antidepressants are very non-toxic. People have tried to OD on Prozac, and are fine several hours later. Some of the older antidepressants have now been around for over 50 years. There is absolutely no corelation between having taken them longterm, and then developing Alzheimers, or having a stroke, or any other form of damage to the brain.

The jury is not out u2. In a few years, there will probably be a new generation of even safer drugs out there. If the SSRIs help you, do yourself a favor, and take them, and "don't borrow trouble" by worrying about what may or may not happen years from now.

Good luck!

Dr. CJH

Edited by Dr. Chris in Ohio on 6/4/2009 at 2:39 AM
Customer: replied 5 years ago.
I know what you are saying but the INTERNET is inundated with forums where people claim that ssri's have damaged everything from their memory to their cognition and everything inbetween. How can we discount that?
Customer: replied 5 years ago.
and also what about my dilantin question..it's toxicity long term
Expert:  Dr. Chris in Ohio replied 5 years ago.
u2, the worst long term side effect from Dilantin/Phenytoin is the gum problem I told you about earlier. Many people have been on it for decades, and are doing just fine. There are tons of other anti-seizure meds now on the market, some of which we also use as mood stabilizers. Neurontin is another good one. The one I recommend, without a doubt is Depakote (Valproic Acid). Click this link to read for yourself about some new, exciting research: http://www.webmd.com/alzheimers/news/20081027/valproic-acid-may-treat-alzheimers u2..... chill my good man. Don't borrow trouble. Take what is available. Trust me, something better will be on the market sooner than later. Dr. CJH

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