Saturday, June 16, 2012

OCD and Medication

When I suffered a debilitating OCD/anxiety/depression attack in 2010, I didn't know what was happening. I knew I had a less than proud history of being a highly anxious cat who had suffered from social anxiety and health anxiety periods ever since I went to college in 1974. This latest vicious relapse was different and much more extreme ass-kicker (although I also had a bad trip in 1996).

Part of the distress of OCD is caused by the cognitive dissonance of having "an objective bystander" as part of your conciousness that knows you are blowing things out of proportion, that you should move on from your reccurring obsessive thoughts, and that there is no apparent reason to be jacked-up from wave after crashing wave of electrifying  "fight or flight" alarms. One night, as I tried to mellow out and slip into slumberland, I could feel the different "systems" of my brain duking it out with each other. I suppose my cerebral cortex was trying to overide my limbic system or some such -- the old Brain Lock circuit. There was "no consensus of mind systems," only rank dissent and fragmentation. I cried aloud in deperation , "I've got to get outside of my own head." Then just to make it more fun, a freaky, momentary, out-of-body experience known in psychology circles as dissociation kicked in.

From ye Wiki, "Dissociation is a term in psychology describing a wide array of experiences from mild detachment from one's immediate surroundings to more severe detachment from one's physical and emotional reality. It is commonly displayed on a continuum. The major characteristic of all dissociative phenomena involves a detachment from reality -- but not a loss of reality as in psychosis.

At one end of the continuum, dissociation describes common events such as daydreaming while driving a vehicle. Further along the continuum are non-pathological altered states of consciousness. Near the end of the continuum are post-traumatic stress disorder, complex post-traumatic stress disorder and the dissociative disorders, including dissociative fugue and depersonalization disorder. Dissociative disorders are sometimes triggered by trauma, but may be preceded only by stress, psychoactive substances, or no identifiable trigger at all, The ICD-10, but not the DSM-IV, classifies conversion disorder as a dissociative disorder.

In mild cases, dissociation can be regarded as a coping mechanism or defense mechanism in seeking to master, minimize or tolerate stressincluding boredom or conflict."

Anyhoo, this was the precise moment I declared, "Something is very wrong. I'm going to seek professional help, and I'm going get to the bottom of this once and for all." I coined my own snappy smooth Johnny Cochran-like meme, "First you deal -- then you heal" (patent pending).

After eighteen months of solid support from friends and family, successful talk and medical therapy, improved sleep, and much reading in psychology, I finally had my anwers. Of course, I still have to live with this crummy chronic condition, but I do believe that "knowledge is power," and at least now my cortical brain system has more logical juice for any potential neuroplastic rewiring. A diagnosis is more than a label, less than a panacea.

I'm writing these OCD/anxiety posts in the hopes of helping others who suffer from anxiety and OCD, and travel along along the same moon-crater-sized, pothole-festooned road I went down. I'm certainly no know-it-all, but I enjoy writing these blog posts, sharing what I've learned and felt. The blogings are therapeutic because they engage the "flow state" of creativity.

Now, on to the topic at hand: OCD and Medication. As a sufferer of health anxiety I was, and am, quite wary of any and all potential iatrogenic artifacts from perscription drugs.

Wikiquote, "Iatrogenesis, or an iatrogenic artifact; originating from a physician") is an inadvertent adverse effect or complication resulting from medical treatment or advice, including that of psychologists, therapists, pharmacists, nurses, physicians and dentists. Iatrogenesis is not restricted to conventional medicine: It can also result from complementary and alternative medicine treatments.

Some iatrogenic artifacts are clearly defined and easily recognized, such as a complication following a surgical procedure. Some less obvious ones can require significant investigation to identify, such as complex drug interactions. Furthermore, some conditions have been described for which it is unknown, unproven, or even controversial whether they are iatrogenic or not; this has been encountered in particular with regard to various psychological and chronic-pain conditions. Research in these areas continues.

Causes of iatrogenesis include chance, medical error, negligence, social control, unexamined instrument design, anxiety or annoyance related to medical procedures, and the adverse effects or interactions of medications."

Naturally, such concerns serve as a hair-trigger for the OCD person's avoidance of uncertainty and risk. Even so, with a reasonable amout of caution, medication will very likely be a help to those with OCD. In my reading, I came across Jonathan Grayson's clearly stated thoughts on the thorny topic, which I now present in my own "Cliff Notes" fashion. Buy his book for more in-depth information -- it's a first-rate self-help book.


For OCD sufferers, medication is not a crutch. When medication is needed, it is because something is biologically wrong that no amount of strength or fortitude will change. Medication alone, on the average leads to a 30-50% reduction in symptoms -- better than nothing, but leaving most with symptoms that would interfere with life. You can think of medication doing three things: 1) reducing your sensitivity to uncertainty, 2) increasing your feelings of completion, and 3) making it easier to "let go" of thoughts. Without medication your sensitivity to obsessive triggers is greater. When medication is working, your responses to obsessive trigers are purely the result of learning, not biology.

Must you go on medication if you have OCD? No. The biological component of OCD may not be active at all times. When it is inactive, medication isn't necessary. There are no medical tests for OCD, so medication is prescribed as an educated guess. The presence of depression is a major indicator that a patient needs medication. If there is improvement in depression, then it is probable that the medication is also helping with OCD.

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