#i will return to this idea to collect more seratonin

[iamthepulta]

Having so much fun fucking with this tournament bracket lmfao. Elijah Fry vs Relia Faire is incredible. So is Morgan Faire vs Mr. Ivory.

Jamison Black vs Admiral Ashford has me in stitches.

(In canon, Ashford adopted Lizzie. He's like Brian Blessed. But in a suit.)

[moldybits]

Hello, I had a question about medication! I have ocd and me and my therapist have toyed with the idea of starting SSRIs, so my question is how does the medication actually work? For depression I understand it makes serotonin last longer, but would that actually help me with ocd obsessions? I don't understand how it would help me not want to wash my hands anymore!

disclaimer that i am not a doctor or pharmacist or any other type of licensed medical professional. i’m a certified pharmacy technician, and please do not take anything i say as medical advice. always talk your doctor or pharmacist before making any medical decisions!

Alright this a long one so here we go!

So SSRIs work by increasing the the balance of serotonin in the brain. I’ll try to the explain this process simply here:

Your brain sends messages through neurons. But when the message gets to the end of a neuron, it needs to jump the gap (synapse) to the next neuron(s). So in order to get through, very small amounts of neurotransmitters are released into these gaps. Serotonin being one of these neurotransmitters. Once the message has made it across the gap to the next neuron, the neurotransmitter serotonin is supposed to be absorbed by the nerve cell (this is what is called “reuptake”, the R is SSRI).

The gene that is in charge for the process of making the serotonin transporters is called hSERT. So the transporter is supposed to absorb the extra serotonin after it goes from one neuron to the other. What is believe could be happening is that some people’s hSERT gene is working TOO fast and is absorbing ALL the serotonin before the next neuron has received the message. So the job of an SSRI is to slow down the collection of serotonin by transporters such as the gene hSERT and slow down the process of the serotonin being returned back to the end of the neuron the serotonin was originally from- this is to increase the chance of the neurons being able to receive messages from each other.

So how does this connect to OCD?

We just simply do not know if OCD is caused by low serotonin levels (and the concept of low serotonin being the main reason for things like depression is likely way more complicated than initially thought, but I digress). For OCD, it is likely way more complicated than that. However studies have shown that an increase in seratonin can improve symptoms in some people and/or make them more responsive to therapy.

Why? Unfortunately, like almost all psychiatric medications, we truly do not know yet. So many medications seem to help with many different disorders, and for all we know about how a drug works chemically and why a disorder may be happening… why a specific drug helps a specific disorder or symptom is unknown. It really seems to be “it works and we have no true idea why, but we have possible theories”.

Alright so basic things to know about the drugs!

The specific SSRIs used are:

-Citalopram (Celexa)

-Fluoxetine (Prozac)

-Sertraline (Zoloft)

-Paroxetine (Paxil)

-Fluvoxamine (Luvox)

(You may also see clomipramine (Anafranil) used, it’s a tricyclic antidepressant (TCA). It is not first line of use due to side effects compared to SSRIs, but is an option. This was used before SSRIs were an option)

Studies say that about 40-60% of patients with OCD respond to an SSRI or TCA, but unfortunately it does not predict which drug that’ll be. Some people respond to Prozac but not Celexa, and vise versa. If one drug does not work for you, or you have side effects, do not be afraid to tell your prescriber and consider switching to another drug. It does usually take 10-12 weeks to truly know if it is working (but typically some response is seen between 6-8 weeks). Not all symptoms will disappear, but it seems to be about 40-50% of symptoms decrease in 60% of patients.

It is possible to augment SSRIs with another drug of a different class such as second generation antipsychotics (SGAs). Personally I’ve also heard things about the antiepileptic drug toprimate (Topamax) and interestingly, an OTC drug called Nac that is used in Tylenol overdoses. Nac seems to help some people with compulsive behaviors, including things such as hair pulling and skin picking.

So TLDR: SSRIs are a common treatment for OCD in conjunction with therapy and even other meds, because one of the possible causes of OCD is unbalanced/low seratonin in the brain. Why that would be the case is still being researched, but it seems to be a successful treatment option for a good deal of people.

Hope this answers your question and thank you for asking!!! Please feel free to follow up with anything other questions. And of course, talk with your pharmacist with any true questions or concerns about your medication, its side effects, and interactions!! That’s what they are there for!

This was very fun for me :3c