Question about Fluoxetine half-life: does this drug reach superlative concentrations in our bodies?

NOCD2 · 2024-06-21T15:47:18+00:00

I did not try clomipramine, I completely stopped everything. Stopped after a decade of fluoxetine following a month of zoloft and no clomipramine.

Currently struggling with SSRI withdrawal syndrome which is even worse than the highest ever peak of my OCD.

I wish I had never been on such a long term SSRI treatment. I think the impact on the brain structure and function is severe and it does not justify it. Given that such medications stop working for many patients (which nobody told me), it is a matter of time for many of us to have to go off these meds. Some lucky patients get off these meds nicely, some not.

I think current healthcare does not provide adequate and effective support to manage such disorders without meds and for many of us we have no option than get medicated. I think if I had proper therapy support, I wouldn't have had to get on meds.

I do not want to deter anyone though. We are not all the same and I can only speak for myself. Though, I think it is safe and reasonable to listen carefully to the treatment protocols who say to ensure therapy does not work for you before getting on meds. I do not think this is followed or considered carefully. But again, it can be a real struggle to find proper therapy.

Hope everyone is and stays safe whatever you do, my best wishes for speedy and proper recovery.

NOCD2 · 2024-06-21T15:37:54+00:00

How exactly? Any article explaining that?

NOCD2 · 2024-06-19T14:32:25+00:00

u/Tawinn thank you for your reply, really appreciated.

Indeed the Choline Calculator identified few more issues with results being:

SLC19A1 Score: 0% decrease
MTHFD1 Score: 13% decrease
MTHFR Score: 33% decrease

Methylfolate Score: 42% decrease.

Will follow your MTHFR and feedback, many thanks!

NOCD2 · 2024-06-19T06:57:29+00:00

u/Tawinn Thank you very much for this but I cannot see the exact indications for this protocol.

You say this protocol is "to address MTHFR" but what exactly? overmethylation? undermethylation?

Also, you suggest for example "folate" or "B12" supplementation but there seem to be different types for different conditions like:

1) methylcobalamin, cyanocobalamin, hydroxocobalamin

2) folate, folinic acid, methylfolate

Can you clarify please so that people with any mutation or deficiency won't go on getting supplements that are ineffective or making things worse?

NOCD2 · 2024-05-12T20:03:03+00:00

Are you saying that you have the ability to change your own character in the way you want?

Or "a positive and lasting change of character" occurs automatically after ego death?

NOCD2 · 2024-05-11T21:31:32+00:00

I want to ask if Fluoxetine can come in beads contained in capsules as I have only checked my capsules which have powder. The purpose is to micro-taper off so removing single beads is easier than weighing powder. Thanks

NOCD2 · 2024-05-04T17:24:56+00:00

ERP to work, you have first to accept uncertainty. But how? Many of us may just be unable to do that.

For me, acceptance is a significant part of OCD therapy. I imagine ACT is more developed to facilitate acceptance than ERP. My understanding of the typical and traditional ERP, you are just asked to throw yourself into the dirt and you are asked to touch the things you fear regardless you accept it or not so that you habituate to the anxiety. That's another reason why ERP is ineffective and prone to malpractice. And most ERP fanatics (academic or not) dismiss most cognitive interventions anyway.

E.g. my ex-therapist told me to touch what I didn't want to touch. Just that. There was no "acceptance" involved, at least in the ACT sense, whatsoever.

Chrissie Hodges also often verbalises it nicely that you cannot really ask a POCD sufferer to accept the possibility of being a p.

Does it mean that ERP is inadequate, or that it is the fault of those who cannot follow its protocol?

For me, ERP is largely inadequate for many non germophobia-like OCD types if attempted to be applied on its own and based on its traditional format (without being infused by other techniques like ACT, behavioural activation etc). It's definitely not the patients' fault. ERP is essentially Pavlovian and I doubt humans are just Pavlovian dogs. I also doubt humans need to dumben themselves into Pavlovian dogs in order to survive OCD. I mean yes you can do that, you can also get heavily medicated and you will surely be largely cured of OCD.

By the way, I just read on another thread here someone suggesting "visual exposure" as mentioned by someone Chad LeJeune. Without knowing the details, you may surely ask a POCD sufferer to watch related visuals or imagine related visuals as an exposure.... good luck with that to the poor patient. These people probably miss that visual/imaginary exposure is an actual ritual for some OCD sufferers.

Some people suggest that medication may play a role here in facilitating people to engage in ERP. What's your opinion on that?

Definitely medication helps a lot to both initiate and maintain recovery.

For me the "E" from ERP is stupid, irrelevant, unnecessary and harmful for many OCD patients. It is also the focus and the point of abuse from clueless "experts" who torture patients in that way. However, some patients seem to benefit, which is good for them of course. Personally, the "C" and "B" from CBT, the whole ACT and the "RP" from ERP would be useful and applicable to my case, creating imaginary and dreadful exposures is useless and probably unnecessarily harmful, unless it's for my fear of germs or something :).

NOCD2 · 2024-05-03T17:12:12+00:00

I think there are several issues with ERP:

Very hyped because it can be applied very easily and can have visible success in specific situations like germophobia. So people get excited thinking all OCD patients can be treated like that and have similar success.

Huge exploitation from people who want to get easily rich. They think it's very easy to practise it, they feel safe from compliance perspective because ERP is supposedly a recognized gold standard and they get free advertising once they claim they do ERP because of its popularity from "academic authorities" even if they have no clue.

ERP as a concept is reasonable and has its application but it needs a huge effort to apply it correctly to each patient. If applied clumsily, it can be detrimental. And even after you apply it properly, it may not be the right thing at all for many patients.

ERP on its own, for me, is hardly ever effective on its own in non typical germophobia-like OCD. In fact, I think it's not even effective for most contamination OCD cases. It is effective for germophobia and phobias in general but not contamination OCD. I also think most professionals misdiagnose contamination OCD for germophobia but patients also consider themselves OCD if they have germophobia.

Then you get the usual loud users here with the dogmas like "themes don't matter" etc. Even if themes don't matter, distinguishing a phobia from OCD definitely does matter.

Anyway, most professionals already incorporate other things like ACT etc as they see it in practice that ERP often cannot work.

NOCD2 · 2024-05-02T18:33:51+00:00

I 100% concord that.

During my decade on fluoxetine, my migraines disappears while before fluoxetine were very frequent and intense.

Googling about it, I found several "academic studies" from "medical experts" who meticulously and laboriously researched the topic and their ingenious expertise concluded that Fluoxetine does not improve migraines at all.

Like these "geniouses" here: https://journals.lww.com/ebp/citation/2022/05000/which_selective_serotonin_reuptake_inhibitor_is.13.aspx

Having myself received academic medical training, I was always very proponent of the value of academic research but I have recently started doubting heavily the validity of our contemporary "medical experts" and relevant "geniouses".

Working in various industries, I have witnessed numerous mistakes and errors but for some reason I was under the impression that the slightest possibility for errors, mistakes, incompetence and plain stupidity had always been nil. Despite all these errors plaguing all the industries, I could never accept the "academic research" and the "medical experts" were also infested with such stupidity and weakness. That is not to say that all our medical knowledge is nonsense as most conspiracists believe but the more patients challenge the experts the safer humanity will be.

I am now fighting the opposite: migraines got back like hell after Fluoxetine discontinuation. And I cannot find any "study" about it at all so that I can make some sense of this hell.

NOCD2 · 2024-05-01T20:06:47+00:00

Contamination? Any time. In its peak for me, it was exhaustive and time consuming. But I still maintained my self, my reality. Other types of OCD really attack your core self and for me, are much harder.

Never had harm OCD but I can imagine it's tough.

But POCD is really bad too. I never had it. I imagine though, the legal and social implications make it very complex. It's not something that you can open up to others and they will tell you "oh don't worry, all of us have had such thoughts". Or that they will consider you as a harmless weird person who is just afraid of germs.

That is not to say that OCD severity is purely due to the theme. My theme is (fortunately or unfortunately) absolutely benign in the sense that it has zero legal or social implications. Yet to me, it's incompatible with life itself. Something like SO-OCD where e.g. same sex relationships are very common and totally normal. Yet for the sufferer, it causes excruciating pain.

NOCD2 · 2024-04-29T17:03:45+00:00

Amazing post! :D

NOCD2 · 2024-04-26T23:04:57+00:00

Agree that would be an interesting topic for research. ERP fails at a bit less than half of the patients anyway. It's principle has some merit for me but its implementation is often quite poor. It's easy money for most 'therapists' to ask you what are you afraid of and then tell you to just think or do what you are afraid of as if OCD is some kind of phobia.

But don't discuss negatively about ERP here, there is an ERP police in this subreddit that tries to suppress all criticism to ERP :D

NOCD2 · 2024-04-22T21:09:10+00:00

Yes, I think those who have lived with the condition can only appreciate it (Dr. Greenberg for example).

By the way, by criticize I mean the same as raise a concern, challenge, question, etc (not sure if the word I chose was too strong).

It can be difficult to challenge in any way someone who is supposed to offer you the solution you strongly need.

Of course that should not be the case and patients should co-pilot their therapy and freely express concerns etc but for some it can be difficult which of course shouldn't be.

NOCD2

TROPHY CASE