Stimulants make OCD better, or worse?

[~carol~]

I started Vyvanse about 2 months ago. Since then, my OCD has gotten gradually worse to where I am now back to checking things and performing some other OCD behaviors of mine too complicated to explain here. It seems this may be caused by the Vyvanse; the problem is that it is helping in other areas.

I did a check on Google and am seeing conflicting info- some sites say stims help OCD. My dad died right around the time the OCD worsened, and I've got other things causing anxiety which could have aggravated things. I am just not sure.

Is there a definitive answer about whether stims help or hurt OCD?

Thanks!

[elegy]

Stimulant use is generally contraindicated in the presence of OCD. They are well known to seriously worsen OCD symptoms, and can induce OCD symptoms in people without a history of obsessive and/or compulsive feelings and actions.

I've never read about stims relieving OCD symptoms...

The stims are helping a lot, but is it worth the OCD coming back with a vengeance? This doesn't mean you can't treat your ADD, or even that you can't take any stimulant ever. But, at the least, there probably needs to be a decrease in the dose and an addition of another med. I strongly recommend looking into a non-stimulant medication, like Strattera or Wellbutrin.

Good luck.

[Driver]

Stimulants generally make anxiety disorders worse, so you have to pair the stimulants with anti-anxiety medication too.

[~carol~]

Thank you for the help- I was confused at seeing the various sites where claims were being made that Vyvanse helps OCD, since as far as I've seen, stimulants will usually cause OCD.

I'm sort of walking a fine line here and trying to figure out if it's worth it to have some OCD here since that looks essentially like the only real problem. I've been through Strattera, Concerta, and Adderall XR as well as the Vyvanse; none of the first three appeared to be acceptable, but Strattera remains a possibility. I feel I may not have given it enough of a trial.

Wellbutrin is unfortunately out; a doctor combined it with Prozac years ago and it appears I may have had a seizure (I was alone at the time). Also, the combination gave me something that appeared to be Tourette's (it was a mess; I got pulled off of it before we could figure what was causing what).

Thanks again! I'll be talking to my nurse about this the next time I see her.

[Driver]

Stims can also make tics more pronounced, hence why you thought you had Tourette's. I'm surprised your tics didn't get worse on other stimulants (Wellbutron is a mild stimulant too).

[The ADHD Fan]

I agree with the above posts. Stimulant medications can definitely push neuro chemical levels towards an unfavorable balance resulting in OCD. In general (but including several exceptions), ADHD is characterized by below-normal levels of the brain chemicals dopamine and norepinephrine, while OCD and depression are often the result of low free levels of serotonin. In some ways, these two disorders are almost in a push-pull state (this is oversimplifying a bit, but is often a good depiction). Stimulants are often prescribed for the ADHD end and antidepressants are prescribed for the OCD/depression end in an attempt to correct these imbalances.

Unfortunately, overprescribing can result in overshooting this balance and causing an imbalance in the other direction. As a result, ADHD stimulant treatments can aggravate an OCD or depression like imbalance and corresponding symptoms.

Interestingly, Tourette's often falls in between these two sides and shares a high degree of overlap with both ADHD and OCD. These symptoms can be aggravated by medications on both ends of the spectrum, although it appears that amphetamines and other stimulant medications are often more of a culprit.

Strattera does offer some advantages, as it is a non-stimulant treatment option for ADHD. Another drug which is similar to Strattera is Reboxetine. Reboxetine has shown to be effective for treating ADHD in cases where stimulant medications have failed. Unfortunately, this drug, while available in Europe, is yet to hit the US market (the FDA rejected it in 2007 for reasons that aren't entirely clear yet). Unlike many stimulants, Reboxetine (like Strattera) targets norepinephrine instead of dopamine as its primary target, so its effects on OCD are less pronounced (it is often used as an antidepressant itself).

Finally, it might be worth having another go at a different dosage for one of the "failed" ADHD medications above. Sometimes an overdose actually causes one to exhibit a similar array of effects and symptoms as that of an underdose. There is a certain "sweet spot" that must be hit, and missing it on either side can actually have similar effects. For more info on this medication dosage "therapeutic window", take a look at Dr. Charles Parker's blog here.

[The ADHD Fan]

Just one more quick thing I forgot to mention. Although medications work wonders, there are a few vitamin/mineral balancing factors that are also worth addressing. Deficiencies in magnesium as well as vitamin B6 can actually exacerbate symptoms of OCD, ADHD and Tourette's, all at the same time. This might be a good auxiliary or supplementary measure to use alongside medication treatment strategies for ADHD while potentially dampening the OCD-related effects.

[Driver]

Originally Posted by The ADHD Fan

Just one more quick thing I forgot to mention. Although medications work wonders, there are a few vitamin/mineral balancing factors that are also worth addressing. Deficiencies in magnesium as well as vitamin B6 can actually exacerbate symptoms of OCD, ADHD and Tourette's, all at the same time. This might be a good auxiliary or supplementary measure to use alongside medication treatment strategies for ADHD while potentially dampening the OCD-related effects.

That hasn't been tested by clinical studies yet, that said, a good multivitamin never hurt anyone.

[~carol~]

Thanks all for the info.

I'm writing in a hurry; just wanted to clarify that I'd taken Wellbutrin with relatively little trouble in the past. It was in combination with Prozac that I apparently had a seizure and Tourette's. Wellbutrin DOES NOT play well with SSRIs and this combination was a terrible error on my (ex) doctor's part.

[Driver]

Originally Posted by ~carol~

Thanks all for the info.

I'm writing in a hurry; just wanted to clarify that I'd taken Wellbutrin with relatively little trouble in the past. It was in combination with Prozac that I apparently had a seizure and Tourette's. Wellbutrin DOES NOT play well with SSRIs and this combination was a terrible error on my (ex) doctor's part.

Wellbutrin + SSRI is a common prescription combination. In fact, Wellbutrin is prescribed to overcome the sexual side effects of the SSRI. That said, it's only a small dose of Wellbutrin that is needed.

[kk1015]

adderall makes my OCD worse. i do not have OCD bad, but i compulsivley wash my hands when i don't need to, to the point they are dry and cracking- in summer! about 10 times just doing my make-up and that only takes me about ten minutes, you do the math! lol- but when i'm not taking my adderall i'm able to better control my need to constantly wash my hands.

[RecruitDir]

Wellbutrin is a stimulant - but marketed as being an antidepressant; it has CNS energizing effects and tends to raise anxiety, which causes OCD. If there is enough/excess dopamine, it can be sedative - which the WB may help to some degree/just like Adderall makes some users sleepy. An SSRI would be a better option.

[_Kevin_]

I know this is an older post, but wanted to add my 2 cents.

I have OCD and ADHD. I was diagnosed, finally at age 51, about 6 months ago. The first medicines prescribed for me were 30 mg dose of Vyvanse, and 100 mg Luvox CR. The first medication I took, that mid-morning, was Vyvanse. I was waiting for the evening to start the Luvox CR.

My OCD symptomsdisappeared (not to mention the positive effect on my ADHD) within 30 minutes of taking the first dose! (Remember, this was prior to taking the Luvox.) This lasted for approximately 5 or 6 hours after the first dose, after which I got extremely tired.

I talked to the therapist (actually the Nurse Practitioner with whom I was working) about this approximately a week later and questioned the need to take the Luvox CR (which I had started the evening I took the first Vyvanse dose). She said that it's a matter of getting the correct balance of brain chemicals, and that it was possible for me that the Vyvanse may be all I needed. However, I continued to take the Luvox after further discussing it with her because I felt it gave me a "lift" at that time and seemed to help with other aches and pains I had. Note I haven't been diagnosed with depression.

Anyway, since that time I've researched stimulant therapy for OCD online and found where there are many cases where it helped when nothing else did. I remember one case in particular where a 55 year-old male who had rather severe OCD since the age of 3, that was non-responsive to anything tried over the years, took an Adderall tablet (5 mg or 10... can't remember) prescribed for his young son because he wanted to "check the side-effects on himself prior to giving the drug to his son, to make sure it was safe, at least in his mind. Within 30 minutes, his symptoms improved dramatically, almost to the point of not having any, and lasted for 3 or 4 hours.

He shared this information with his doc who subsequently prescribed it in order to treat his symptoms. And this guy had a case that brain-stimulation therapy (kind of an "end-of-the-line" approach) didn't help.

Moral of the story: There are cases where stimulants, in particular of the dextroamphetamine variety, CAN alleviate OCD symptoms, even when nothing else can. While it might be only a small percentage of cases (although some studies show upwards of 50% can be helped, but it must be of the dextro variety), and conventional wisdom says stimulants can cause OCD symptoms, it can be beneficial for many of us struggling with OCD.

I wonder if in somebody who has OCD it improves the symptoms, whereas in somebody who doesn't, too much of it causes the symptoms? Sort of like an ADHD person who takes stimulants is calmed by the drugs whereas someone who truly isn't is revved up by the drugs?

Thanks,
Kevin
PS- I'm working my way off the Luvox and going to try the Vyvanse-Adderall approach only and see if it's all I really need. SSRI's don't play well with a good love life. Although I'll probably keep taking the Wellbutrin that was prescribed to offset the side-effects of the SSRI; it's also been show to help OCD in some cases.