Hi Questioner237,
It is certainly good for a patient to educate themselves when it
comes to medications, and for that I commend you! However, the final
decision will be up to the physician and/or psychologist. The decision
about which drug to prescribe depends on many factors, including age,
sex, and the overall health of your relative and what other drugs s/he
may be taking. Both drugs have side effects (as do all medications),
but the physician can monitor your relative for these with frequent
check ups and blood tests.
However, the two drugs you mention are not typically prescribed for OCD.
I have gathered numerous sites for you about both medications, plus
medications that are generally prescribed for OCD. Please check each
site for complete information.
Abilify (Generic name Aripiprazole):
=======================================
My research concludes that Abilify is not the drug of choice for
OCD. Indeed I rarely saw OCD as a condition for which Abilify is
prescribed, and few studies have been performed on it?s therapeutic
properties.
?The antipsychotic medication Abilify (aripiprazole) is now
available as a 2 mg tablet strength and a nonrefrigerated oral
solution. These new doses will give doctors more flexibility in
treating patients with schizophrenia or bipolar disorder.?
http://www.ocd-world.org.uk/
?Abilify is an atypical antipsychotic with proported fewer side
effects than the other current anti psychotics on the market. Abilify
is less likely to cause weight gain, heart disturbances, blood
pressure problems etc. For some of us bipolar II individuals, Abilify
appears to help big time in eliminating depression and anxiety that
antidepressants could not eliminate. For some it is definitely a
miracle drug. It appears to be well tolerated for bipolar youths and
helps with mania.
For this individual Risperdal works better for obsessive thought and
irritation, but I would rather trade getting rid of the underlying
depression.(There was one small open study for OCD and Abilify)?
?While no changes were noted in vital signs, a mean weight gain of 1.8
kg was observed. CONCLUSION: Although from a small, open-label study,
these results suggest that aripiprazole holds promise for treating
OCD. Larger, controlled studies of aripiprazole as monotherapy and as
augmentation in partial responders to selective serotonin reuptake
inhibitors are needed.?
Ablify is used with caution on patients with a history of heart
disease, and may cause orthostatic hypotension in some patients.
Orthostatic hypotension manifests as a dizzy or light headedness
feeling when rising from a lying or sitting position.
?FDA ALERT [04/2005] Abilify is a type of medicine called an
atypical antipsychotic. FDA has found that older patients treated with
atypical antipsychotics for dementia had a higher chance for death
than patients who did not take the medicine. This is not an approved
use.?
http://www.nami.org/Template.cfm?Section=About_Medications&template=/ContentManagement/ContentDisplay.cfm&ContentID=8133
?Abilify is one of a group of medicines called antipsychotics. It
is also known as Aripiprazole, and is used to schizophrenia, and the
manic phase of bipolar disorder.
Be sure to tell your doctor of any allergies you have whether it is to
medication or food, preservatives, or dyes. Tell your doctor
immediately if you are, or become pregnant, or are breastfeeding, as
it is unknown how Abilify may affect your baby. Also, tell your doctor
of any other medications you are taking, including vitamins and
supplements, and any medical conditions you may have.
Avoid alcohol when taking this medicine.?
?Aripiprazole may cause drowsiness, difficulty thinking, or
controlling movements, it may make it more difficult for your body to
cool itself down, or it may affect your blood sugar.
Contact your doctor immediately if you notice any of the following:
difficulty speaking; drooling; loss of balance control; muscle
trembling, spasms, or stiffness; restlessness; shuffling; stiffness or
twisting movements of body; uncontrolled movements; blurred vision;
dizziness; nervousness; pounding in the ears; slow or fast heartbeat;
or convulsions. Get immediate medical help if you notice signs of
allergic reaction such as: difficulty swallowing; hives or welts;
itching, puffiness or swelling of the eyelids or around the eyes,
face, lips, or tongue; itching skin; large, hive-like swelling on
face, eyelids, lips, tongue, throat, hands, legs, feet, sex organs;
redness of skin; shortness of breath; skin rash; tightness in chest;
trouble in breathing; unusual tiredness or weakness; or wheezing.?
http://www.pharmacy-and-drugs.com/reviews/Abilify.html
?General Precautions with Abilify:
? Abilify may impair judgement, thinking, or motor skills. You should
be careful in operating machinery, including automobiles, until you
know how Abilify affects you.
? Abilify may cause trouble swallowing (esophageal dysmotility). This
can cause choking and lead to a type of pneumonia called aspiration
pneumonia in some patients.
? Avoid drinking alcohol while taking Abilify.
? It is important to avoid overheating and dehydration while taking
Abilify. Abilify may make it harder to lower your body temperature.
Especially tell your health care provider if you take:
? Ketoconazole
? Quinidine
? Tegretol (carbamazepine)
? Medicines to treat high blood pressure
Some of these medicines may cause serious side effects if used while
you also take Abilify. Some of these medicines may affect how Abilify
works, or Abilify may affect how these medicines work.
?Disruption of the body's ability to reduce core body temperature
has been attributed to antipsychotic agents. Appropriate care is
advised when prescribing aripiprazole for patients who will be
experiencing conditions which may contribute to an elevation in core
body temperature, eg, exercising strenuously, exposure to extreme
heat??
?Patients should be advised regarding appropriate care in avoiding
overheating and dehydration.?
Page 18 of this document lists side effects and the percentage of
patients that experience them.
http://www.fda.gov/cder/consumerinfo/druginfo/abilify.HTM
?A potentially fatal symptom complex sometimes referred to as
Neuroleptic Malignant Syndrome (NMS) has been reported in association
with administration of antipsychotic drugs, including aripiprazole.
Two possible cases of NMS occurred during aripiprazole treatment in
the premarketing worldwide clinical database. Clinical manifestations
of NMS are hyperpyrexia, muscle rigidity, altered mental status, and
evidence of autonomic instability (irregular pulse or blood pressure,
tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs
may include elevated creatine phosphokinase myoglobinuria
(rhabdomyolysis), and acute renal failure.?
http://www.fda.gov/cder/foi/label/2002/21436_Abilify_lbl.pdf
?SIDE EFFECTS: Vomiting, fever, lightheadedness, dizziness, change
in weight, blurred vision or drowsiness may occur. If any of these
effects persist or worsen, notify your doctor or pharmacist promptly.
Tell your doctor immediately if any of these highly unlikely but very
serious side effects occur: irregular or unusually fast heartbeat
(especially with fever and increased sweating), severe muscle
stiffness, uncontrolled muscle movements (especially of the face or
tongue), unusual increase in thirst or urination, vision changes. A
serious allergic reaction to this drug is unlikely, but seek immediate
medical attention if it occurs. Symptoms of a serious allergic
reaction include: rash, itching, swelling, severe dizziness, trouble
breathing. If you notice other effects not listed above, contact your
doctor or pharmacist.?
http://www.medicinenet.com/aripiprazole-oral/article.htm
More on Abilify
?The prescriber should be aware that the figures in the tables and
tabulations cannot be used to predict the incidence of side effects in
the course of usual medical practice where patient characteristics and
other factors differ from those that prevailed in the clinical trials.
Similarly, the cited frequencies cannot be compared with figures
obtained from other clinical investigations involving different
treatment, uses, and investigators. The cited figures, however, do
provide the prescribing physician with some basis for estimating the
relative contribution of drug and nondrug factors to the adverse event
incidence in the population studied.?
http://realmentalhealth.com/medications/abilify.asp
Zyprexa (Generic name Olanzapine):
==================================
I don?t find any evidence that this drug is used fir OCD. In fact,
there are report sin the literature that this drug may worsen OCD.
?Olanzapine is a new atypical antipsychotic drug with
antidopaminergic and antiserotonergic properties. Two other atypical
neuroleptic agents, clozapine and risperidone, also have
antiserotonergic activity and may worsen obsessive-compulsive disorder
(OCD) symptoms or precipitate de novo OCD in patients being treated
for schizophrenia.?
http://ajp.psychiatryonline.org/cgi/content/full/156/5/799
?Secondly, although OCD has been treated successfully by augmenting
with olanzapine (Koran, Bogetto), there are reports of OCD symptoms
emerging with olanzapine treatment (e.g. Lykouras, Mottard). I think
I've seen the exacerbation of OCD by olanzapine myself, though not
emergence de novo, as some of the patients described in these articles
manifested.
On the whole, I still use olanzapine with much less hesitation than
risperidone, as far as inducing symptoms goes (in bipolar disorder);
however, the weight gain risk is so severe, I try to avoid it as a
long term solution (though have had a few "saves" through topiramate
as appetite suppressor!).
Dr. Phelps?
http://www.bipolarworld.net/Phelps/ph_2001/ph188.htm
Other studies show that adding Zyprexa (Olanzapine) to another SSRI
may help OCD. Your relative?s doctor will know how to handle this.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10937610&dopt=Abstract
?Be sure to tell your doctor of any allergies you have whether it
is to medication or food, preservatives, or dyes. Tell your doctor
immediately if you are, or become pregnant, or are breastfeeding, as
Zyprexa may seriously affect your baby. Also, tell your doctor of any
other medications you are taking, including vitamins and supplements,
and any medical conditions you may have.
Avoid alcohol when taking this medicine.?
?Tell your doctor as soon as possible if any of the following side
effects occur: agitation; behavior problems; difficulty in speaking or
swallowing; restlessness or need to keep moving; stiffness of arms or
legs; trembling or shaking of hands and fingers; blurred vision; chest
pain; fever; flu-like symptoms; headache; inability to move eyes;
itching of the vagina or genital area; lip smacking or puckering; mood
or mental changes, such as anger, anxiety, giddiness, loss of memory,
or nervousness; muscle spasms of face, neck, and back; muscle
twitching or jerking; nervousness; pain during sexual intercourse;
pounding in the ears; puffing of cheeks; rapid or worm-like movements
of tongue; rhythmic movement of muscles; slow or fast heartbeat;
swelling of feet or ankles; thick, white vaginal discharge with no
odor or with a mild odor; twitching movements; twitching, twisting,
uncontrolled repetitive movements of tongue, lips, face, arms, or
legs; uncontrolled chewing movements; uncontrolled jerking or twisting
movements of hands, arms and legs; uncontrolled movements of lips,
tongue, or cheeks; unusual or incomplete body or facial movements.?
http://www.pharmacy-and-drugs.com/reviews/Zyprexa.html
?Olanzapine may cause you to have high blood sugar (hyperglycemia).
Talk to your doctor if you have any signs of hyperglycemia such as
increased thirst or urination, excessive hunger, or weakness. If you
are diabetic, check your blood sugar levels on a regular basis while
you are taking olanzapine.
? Do not take olanzapine for longer than 8 weeks unless your doctor
has told you to.
? Olanzapine can cause side effects that may impair your thinking or
reactions. Be careful if you drive or do anything that requires you to
be awake and alert.
? Dizziness may be more likely to occur when you rise from a sitting
or lying position. Rise slowly to prevent dizziness and a possible
fall.
? Avoid becoming overheated or dehydrated. Drink plenty of fluids,
especially in hot weather and during exercise. It is easier to become
dangerously overheated and dehydrated while you are taking olanzapine.
Olanzapine has caused fatal heart attack and stroke in older adults
with dementia-related conditions.
? Before taking olanzapine, tell your doctor if you have:
? liver disease;
? kidney disease;
? heart disease, high blood pressure, heart rhythm problems;
? a history of heart attack or stroke;
? a history of breast cancer;
? seizures or epilepsy;
? a personal or family history of diabetes;
? an enlarged prostate or difficulty urinating;
? glaucoma; or
? trouble swallowing.
http://www.drugs.com/Zyprexa/index.html
Zyprexa (olanzapine) may cause some patients to gain weight:
?In patients who have not responded to an anti-OCD medication or
whose response has been inadequate (about 40% of any large series of
patients), the clinician can consider adding one of the following
drugs: risperidone 0.5-6.0 mg/day; buspirone 60-90 mg/day; olanzapine
2.5-20 mg/day (weight gain is a problem); trazodone 150-600 mg/day;
or, L-tryptophan 2 gm twice daily, plus pindolol 2.5 mg three times
daily, plus niacinamide 500 mg daily. One starts with a small dose and
increases the dose weekly to the likely therapeutic range, as
necessary and as tolerated. Response should be evident within two
weeks at a given dose, except for trazodone and the L-tryptophan
combination, which may take four to six weeks to produce a substantial
effect.?
http://ocd.stanford.edu/treatment/pharma.html
Patient comments on Zyprexa:
http://www.remedyfind.com/treatments/62/846/
Medications Commonly used for OCD:
===================================
SSRIs or clomipramine ( A tricyclic antidepressant) are the drugs
of choice for OCD:
?What is the treatment for obsessive compulsive disorder?
Treatment options are an antidepressant medicine, behaviour therapy,
or a combination of the two.
Antidepressant medicines
Although these are often used to treat depression, they can also
reduce the symptoms of OCD even if you are not depressed. They work by
interfering with brain chemicals (neurotransmitters) such as serotonin
which may be involved in causing symptoms of OCD.
? Antidepressants do not work straight away. It takes 2-4 weeks before
their effect builds up and start to work. They may take up to 10 weeks
to work fully. A common problem is that some people stop the medicine
after a week or so as they feel that it is doing no good. You need to
give them time to work.
? Antidepressants are not tranquillisers, and are not usually addictive.
? There are several types of antidepressants, each with various 'pros
and cons'. For example, they differ in their possible side-effects.
However, SSRI antidepressants (selective serotonin reuptake
inhibitors) are the ones most commonly used to treat OCD.
? The doses needed to treat OCD are sometimes higher than those needed
for depression.
? If it works, it is usual to take an antidepressant for at least a
year to treat OCD.
Symptoms can improve by up to 70% if you take an antidepressant. So,
although symptoms may not go completely, they usually greatly improve
so the obsessions and compulsions are much less of a problem. This can
make a big difference to your quality of life.?
http://www.patient.co.uk/showdoc/23069002/
General OCD Treatment Information
=======================================
Effective treatments for each person with OCD varies just as the
symptoms of OCD vary from person to person. The individual affected by
OCD and their family members and friends can benefit from learning all
they can about the disorder. Treatments can include one or more of the
following:
Medications
Finding the most effective medication is important and useful. A
series of trials on different medications is not uncommon.
Psychiatrists can prescribe medications for OCD. It is important to
discuss your symptoms honestly and openly and report any side effects
you experience when taking medications. Although medications may have
side effects, they can be very effective in reducing the symptoms of
OCD with minimal adverse side effects. It is important to learn as
much about the medication as possible, given that some medications do
adversely interact with alcohol, other medications, sunlight, certain
foods, etc. Medications commonly prescribed for OCD include Anafranil,
Luvox, Paxil, Prozac, Zoloft, and Effexor.?
http://www.hopkinsmedicine.org/ocd/treatment.html
?OCD is treated using medications and psychotherapy.
The first medication considered is usually a type of antidepressant
called a selective serotonin reuptake inhibitors (SSRI). These drugs
include fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft),
paroxetine (Paxil), and citalopram (Celexa).
If an SSRI does not work, an older antidepressant called clomipramine
may be prescribed. Clomipramine is the oldest medication treatment for
OCD. It works better than SSRI antidepressants in treating the
condition, but it has unpleasant side effects, including sleepiness,
difficulty starting urination, dry mouth, and a drop in blood pressure
when rising from a seated position.
In some cases, an SSRI and clomipramine may be combined. Other
medications such as benzodiazepines may offer some relief from
anxiety, but they are generally used only with the more reliable
treatments.
Psychotherapy is used to reduce anxiety, resolve inner conflicts, and
provide effective ways of reducing stress.
Behavioral therapies may include:
? Exposure/response prevention: The person is repeatedly exposed to a
situation that triggers anxiety symptoms, and learns to resist the
urge to perform the compulsion.
? Thought-stopping: The person learns to stop unwanted thoughts and
focus attention on relieving anxiety.?
http://www.nlm.nih.gov/medlineplus/ency/article/000929.htm
?When obsessions and compulsions cause marked distress, are time
consuming (for example, take more than one hour a day), or interfere
with functioning, treatment is recommended. Two treatments
significantly reduce the symptoms of OCD: cognitive-behavioral therapy
(CBT) using exposure and ritual prevention and pharmacotherapy with
serotonin reuptake inhibitors: clomipramine (Anafranil), fluoxetine
(Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline
(Zoloft), citalopram (Celexa), and escitalopram (Lexapro).?
http://www.columbia-ocd.org/
?Sertraline appeared, to me, to be the best at minimizing tics in
this feedback/elimination loop. Paroxetine appears to be the best at
handling panic and OCD.?
http://au.geocities.com/jones_kacm/med.htm
?Medical Care: The mainstays of treatment of OCD include
pharmacotherapy, behavior therapy, education and family interventions,
and neurosurgical treatment in refractory cases.
? Pharmacotherapy
o These treatments center on the use of potent 5-HT reuptake
inhibitors, such as the SSRIs and clomipramine (Anafranil).
o Doses above those needed for treatment of depression often are
necessary. A therapeutic dose for 6-10 weeks may be required to
observe a clinical response (see Medication).
o Other treatment studies also suggest a role for norepinephrine (NE)
in cases of OCD. A certain percentage of patients show greater
clinical improvement with a combination of 5-HT and NE reuptake
inhibition as compared to treatment with SSRIs alone. These have
included patients treated with clomipramine (a tricyclic
antidepressant [TCA] with both 5-HT and NE reuptake inhibition) and
those whose SSRI treatment was augmented with an NE reuptake inhibitor
such as desipramine.
http://www.emedicine.com/med/topic1654.htm
?Prozac is approved for use in pediatric patients with MDD and
obsessive compulsive disorder (OCD).?
?Adult ? The effectiveness of Prozac for the treatment of
obsessive-compulsive disorder (OCD) was demonstrated in two 13-week,
multicenter, parallel group studies (Studies 1 and 2) of adult
outpatients who received fixed Prozac doses of 20, 40, or 60 mg/day
(on a once-a-day schedule, in the morning) or placebo. Patients in
both studies had moderate to severe OCD (DSM-III-R), with mean
baseline ratings on the Yale-Brown Obsessive Compulsive Scale (YBOCS,
total score) ranging from 22 to 26.
In Study 1, patients receiving Prozac experienced mean reductions of
approximately 4 to 6 units on the YBOCS total score, compared with a
1-unit reduction for placebo patients. In Study 2, patients receiving
Prozac experienced mean reductions of approximately 4 to 9 units on
the YBOCS total score, compared with a 1-unit reduction for placebo
patients.?
http://www.healthyplace.com/medications/fluoxetine.asp
?Obsessive-compulsive disorder (OCD) is a chronic and often
incapacitating disorder that is frequently complicated by mood and
additional anxiety diagnoses. Although appropriate pharmacotherapy is
often of great benefit, full remission is rare. Separate multi-center,
placebo-controlled trials of clomipramine, paroxetine, fluoxetine,
sertraline and fluvoxamine, respectively, have established the
unparalleled efficacy and safety of the serotonin reuptake inhibitors
(SRIs) in the treatment of OCD. Direct comparisons of SRIs suggest
similar efficacy, but reduced tolerability for clomipramine in
comparison to fluoxetine, fluvoxamine, sertraline and paroxetine in
patients with OCD. Although 60-80% of OCD patients will respond to SRI
treatment, partial symptom reduction (mean improvement, 25-40% from
baseline) remains the rule. Controlled trials of adjuvant lithium,
buspirone, thyroid hormone or clonazepam added to ongoing SRI therapy
have failed to demonstrate substantial further antiobsessive effects.
The presence of comorbid conditions, specific OCD symptom content and
various other clinical features have been investigated as potential
predictors of medication response in patients with OCD, but consistent
factors have not yet been identified. Clinical experience and
preliminary data does suggest that a lack of response to one or more
SRIs does not preclude response to another SRI. An overview of the
pharmacotherapy of OCD, including first-line medication(s) and the
comparative efficacy and pharmacological features of the different
SRIs will be presented in this review, as well as potential strategies
for OCD patients who fail to respond to conventional
pharmacotherapeutic interventions.?
http://www.ingentaconnect.com/content/routledg/cirp/1997/00000009/00000001/art00012
Side effects of SSRIs
======================
?Selective serotonin reuptake inhibitors (SSRIs) are among the most
widely prescribed medications, and they are remarkably safe and
effective. But no medical treatment is without risk. The May issue of
the Harvard Mental Health Letter reviews the potential side effects of
these popular antidepressants and puts them into perspective.?
? Physical symptoms..
? Bleeding problems.
? Sexual effects.
? Suicide.
Please see the site for complete information.
http://www.health.harvard.edu/press_releases/ssri_side_effects.htm
?Currently, the serotonin reuptake inhibitors (SRIs) and the
serotonin selective reuptake inhibitors (SSRIs) are considered the
"first choice" agents for pharmacologic treatment of OCD, although few
head-to-head comparisons exist between any two specific agents.
Strategies for nonresponders and partial responders to the SRI/SSRIs
are reviewed. The only agents that have shown significant improvement
as augmenting agents to an SRI/SSRI in systematic trials have been
clonazepam and haloperidol. Predictors of response to pharmacotherapy
have been limited, but several reports have found that an early age at
onset of OCD has been associated with a poorer response to
medications.?
http://www.biopsychiatry.com/ocdtreat.htm
http://www.biopsychiatry.com/ocd.htm
?Clomipramine hydrochloride (Anafranil) is a tricyclic
antidepressant used to treat depression and obsessive-compulsive
disorder (OCD). It may also be used to treat other conditions as
determined by your doctor.?
Clomipramine is indicated for the treatment of obsessions and
compulsions in patients with Obsessive-Compulsive Disorder (OCD). The
obsessions or compulsions must cause marked distress, be
time-consuming, or significantly interfere with social or occupational
functioning, in order to meet the DSM-III-R (circa 1989) diagnosis of
OCD.
Contraindications
Clomipramine is contraindicated in patients with a history of
hypersensitivity to clomipramine or other tricyclic antidepressants.
?Seizure was identified as the most significant risk of clomipramine use.
Caution should be used in administering clomipramine to patients with
a history of seizures or other predisposing factors. e.g., brain
damage of varying etiology, alcoholism, and concomitant use with other
drugs that lower the seizure threshold.?
Please check this site for other contraindications and adverse affects.
http://www.healthyplace.com/medications/anafranil.asp
I sincerely hope this has helped you understand OCD and
medications. Please request an Answer Clarification, and allow me to
respond, before you rate.
My best to your friend!
Sincerely, Crabcakes
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=========================
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