Time for Medication?

[bluedog0317]

I, like many others on this forum, have an irrational fear of contracting HIV.  I came of age in the 1980's and early '90's when all the scare campaigns were going on and the media was in overdrive regarding the disease.  My mother also had an irrational fear of it.  I currently have no risk factors for this disease, yet there always seems to be a scenario where I could have contracted it.  My sister (a clinical psychologist) says it is OCD.  She recommended CBT.  I have been through 2 rounds with only minimal success.  I have so much trouble with the ruminating part.  I can't seem to turn the switch off and just stop thinking about possible exposures.  The latest one involved me convincing myself I sat on an HIV needle in the waiting area at the vet's office.  I never saw a needle, never felt a prick, just an uncomfortable sensation when I got up from the bench.  The benches are very hard, and  I put more weight into my left leg to get up.  The cartilage (not sure of correct anatomy here)behind my knee dug into the bench.  It wasn't until an hour or so later that I really started to worry--all the what ifs.  I went back to my CBT worksheets and tried to work the whole thing out, asking what is the evidence for and against, etc.  My mind won't let it go.  I keep replaying the scene in my head. When I got home that day, I checked the back of my leg with a mirror, which is bad, I know.  I found a tiny scab in the vicinity in question on my left leg, and decided to pick at it.  It began to bleed a little, and then a long, ingrown hair popped out.  I should have immediately attributed the scab to an irritation caused by the ingrown hair, but of course, it is still evidence of a needle prick from an HIV needle.  I have stayed away from medication in recent years due to side effects.  I used to take Prozac, but now it really upsets my stomach.  I have heard that some meds make you gain a lot of weight.  I don't know if I should discuss taking meds with my therapist because she can't prescribe them, as she is Master's level, although highly trained in CBT.  Any suggestions?

[meemoll]

I am currently ramping up on Luvox, after having tried Zoloft for several years.  WAnted to see if something different could help.  Like you I have battled HIV phobia worried that anything even the slightest poking sensation was an HIV needle.  I can throughly relate.

[JGF25]

It does help and I relied on it for years when I was off medication.  I think though that after you have been battling OCD for a while, you get tired of breathing, and self-coaching, and replacing those negative thoughts with positive ones and that is when we kind of fall off the CBT train.  

Do a bit of research into the SSRIs and look at the side effects.  That may help you pick one to try.  Your doctor may also know of one to try if they are used to prescribing the medication.  I would stay with therapy until you find a medication that is working for you though.  Even if it is talk therapy, that is useful in my book.  If the cost of the sessions is causing you more stress, then obviously you have to think about that as well.  

Have you tried a benzodiazepine?  Is your OCD always off the hook or are there times when you can manage?  I grew up in the late 70s/early 80s as a teenager and HIV was just coming on the scene so I understand full well what you are going through.  Part of my therapy was to sit in an AIDS clinic in the hospital across the street from my work on my lunch hour.  I did that for several weeks and now I don't give a darn about HIV.  I know that I'm not going to get it from door knobs or other surfaces or from blood draws or donating blood, and I know that nobody is going to poke me with a needle.  And if I did get poked with a needle I would know it because when they do draw my blood it hurts.  When I poke myself inadvertantly at work with a needle (not containing bodily fluids) but used to poke holes in tin foil, I sure know I did it becuase it hurts and it bleeds.  

I wish I had the magic answer for you.  But that self-coaching (CBT) does work for me.  I yell at myself in my head sometimes and that kind of zaps me out of the ruminating thought pattern.  

Anyway...I've rambled on.  So take care and let me know how you are doing.

[bluedog0317]

Yes, I have been more stressed.  My husband just got a job after 3 months of being unemployed.  My GP has prescribed Prozac in the past, so I'm sure she would again.  I will do some research so that I can ask for a specific medication, as opposed to leaving it up to her.  Unfortunately, I tried Wellbutin years ago and had an adverse reaction.  Same with Anafranil.  My system is very sensitive to medication in general which is why I've been so hesitant to go that route.  As for the CBT, I thought it would help so much more than it is.  This is distressing, as I am not aware of any other therapy that is effective in treating OCD.  My sister has confirmed that OCD/health anxiety are notoriously difficult to treat even for seasoned professionals.  In your experience, does CBT become more effective over time?  It is costing me $90 per session, and the commute is close to an hour.  Add in gas and tolls and the cost is about $100.  I would continue, though, if I really believed it would help.  This is where I am stuck.

[JGF25]

I think that CBT is helpful and that everyone with OCD should learn it but sometimes, as you are finding out, it isn't enough.  For my own OCD, stress makes it worse.  Are you stressed more at the present moment?  

As for the medication, since you have been through CBT and know that you need something it may be that you can get medication through your general practitioner.  The GPs have had to deal a lot with mental disorders and I think are getting much better at dealing with them.  At least mine is.  AND I knew exactly what I needed this last go around.  

So why not start there and continue with your CBT therapy?  You know Prozac upsets your stomach so perhaps try something else.  Do a bit of research.  I tried several before I settled on Wellburtrin.  It isn't the typical medication in that it is a SNRI rather than a SSRI but I didn't want to put up with the unwanted sexual side effects of the SSRIs.  So after Celexa, lexapro I went with wellbutrin and after about 4 weeks, it really started to work.  I still have to use my CBT because medication doesn't fix everything...just helps us let things go more easily.  We will still think the stupid stuff but we will be able to say "WHATEVER!"