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Friday, November 6, 2015

Medications that may Exacerbate OCD Symptoms or Unveil OCD Behavior

There's a significant overlap in Pharmaceutical drug use and applications which may make it difficult to predict  the entirety of a given medications effects; including psychoactive effects. What this means, is a medication used for pain may end up having adverse psychological effects and there is a such thing as a 'paradoxical reaction' to meds typically used for Anxiety disorders.

Below, we will list the medications along with references (studies and reports respectively) that can exacerbate Obsessive & Compulsive behavior. 

  • Gabapentin (Neurontin) a calcium channel blocker used for Neuropathic Pain, Epilepsy and off-label for Anxiety; may worsen OCD-symptoms. (1) (2)
  • Triptan's used for Migraines (they activate certain serotonin heteroreceptors which then worsen OCD-symptoms) (3) (4)
  • PCP, Ketamine and many other dissociative 'street drugs' can worsen OCD symptoms and cause psychotic symptoms. (5) (6) (7) (8)
  • Clozapine and some other anti-psychotic medications used for Schizophrenia, including Risperidone and Seroquel (9) (10) (11) (12) (13) (14)
  • Anti-Nicotonic Medications used for Smoking Cessation (Varenicline; Chantix)* (15) (16) (17)
  • SSRI's (Prozac, Luvox etc) though commonly prescribed for OCD may paradoxically worsen OCD symptoms in a fair handful of individuals. (18) (19) (20) (21) 
  1. Serotonin receptor downregulation seems to benefit OCD patients and so the partial anti-serotonin effect in terms of genetic expression is , along with neuropeptide changes; the benefit in OCD patients treated with SSRI's - in other words, SSRI's don't help OCD patients in all cases - and in the one's that do - it is because of adaptive changes in the brain which includes reduced serotonin receptor concentration that benefits OCD patients...also the increased oxytocin may play a role in alleviating symptoms.
2. It may also be that alterations in certain proteins caused by genetic polymorphisms may contribute to the pathogenesis of OCD and SERT (serotonin transporter) is a key target which can be manipulated by SSRI's. This proteins affects the rate of clearance of serotonin in the brain but it also affects how serotonin is distributed - it's thus possible that serotonin is simply firing at 'abnormal rates' in OCD patients rather than high or low levels...though it seems that excessive serotonin is associated with more obsessive and psychotic characteristics. Whereas lower serotonin is associated with more 'regular' behaviors such as cleaning and organization. 

                   ~!~   OF THE CORE SCIENCE ~!~
Generally with obsessive-compulsive disorder; you do not want to antagonize or 'block' the following receptors.

  • NMDA-glutamate receptors (rather, you should 'activate' them)
  • Muscarinic acetylcholine receptors (blocking them can cause dissociation and psychotic states)
  • Nicotinic acetylcholine receptors (antagonizing them long-term may have benefit, but in the short term will worsen symptoms)
  • Dopamine D(2) Receptors; blocking these dopamine receptors will likely worsen OCD symptoms as it is reported; probably due to a functional striatal interaction in which firing rates become further distorted.

Receptors that may be 'blocked' or antagonized to IMPROVE OCD-symptoms include.

  • 5-HT1A, 1D and 1B receptors of the serotonin class. (only if you antagonize 5-HT1D as a {PRE}recquisite.


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