(OCD) Obsessive Compulsive Disorder Treatment in NYC

Dr. Saidi OCD Obsessive Compulsive Disorder

Obsessive Compulsive Disorder Treament

Family and genetic studies have shown significant associations between obsessive-compulsive disorder (OCD) and other psychiatric disorders such as generalized anxiety disorder, panic disorder, depression, hypochondriasis, body dysmorphic disorder, trichotillomania, obsessive-compulsive personality disorder, and avoidant personality disorder. Therefore if you are seeking treatment for OCD it is important for your psychiatrist to screen for these other disorders as they may affect the treatment efficacy. This is even more true since OCD per se can be challenging to treat and remission rates are low despite the introduction of several new evidenced-based treatments over the past two decades.

The current state of art for OCD treatment includes one or more of the following: psychotherapy, behavioral therapy, medications, and neurosurgery. In this section I will focus on the pharmacotherapy of OCD. First-line treatments are serotonin reuptake inhibitors such as clomipramine (Anafranil), venlafaxine (Effexor), duloxetine (Cymbalta), escitalopram (Lexapro), and others in the same class. Several medications from other classes have also shown some efficacy as stand-alone or add-on treatments: Monoamine oxidase inhibitors (MAOI) such as phenelzine (Nardil) seem particularly helpful for OCD patients who also have panic attacks. Newer antipsychotic agents may be of help when combined with SRIs, including Risperdal, Seroquel, Geodon, Abilify

Smoking and Cessation

Dr. Saidi Smoking Treatment

Smoking and Cessation: Non-nicotine Treatments

smoking-and-cessation
A recent scientific research looked at why smokers find it so hard to quit despite knowing the benefits of quitting and the dangers of continuing. It found that nicotine distorts the type of reward smokers seek; i.e., they become less concerned with the value of a non-drug reward or punishment (e.g. gaining or losing money) and more driven to assess the magnitude of the reward (i.e. the immediate relaxation and good feelings brought on by smoking). This may, in part, explain why using nicotine-based treatments such as gum or patch are not very successful.

Over the past few years several non-nicotine treatments have become available for treating nicotine dependence. Some of the more successful ones are listed below:

  1. Bupropion (Zyban): An antidepressant medication that has shown some efficacy in treating nicotine use whether there is any depression present or not. About 40% achieve abstinence at the end of treatment (about 12 weeks), but about 50% relapse in a year
  2. Nortriptyline: Another antidepressant that doubles the odds of long-term abstinence from nicotine.
  3. Varenicline (Chantix): It reduces withdrawal symptoms and doubles or triples the odds of quitting and staying abstinent.

References:

Rose EJ et al. Acute nicotine differentially impacts anticipatory valence- and magnitude-related striatal activity. Biol Psychiatry 2013 Feb 1; 73:280

Addy NA and Picciotto MR. Nicotine, striatum, and reward. Biol Psychiatry 2013 Feb 1; 73:205