Can weed prevent Clomipramine to start working, or delay it's therapeutic onset?

[dordort]

Hi everyone! I'm a 24 years old male, which had a very severe OCD (intrusive thoughts) in the past, controlled very well recently by self-medicating with weed (indica, sativa did the opposite). Iv'e smoked socially every night for like 2 months, and felt awsome! like all of my childhood tics and OCD tendencies was cured and under control. Iv'e became more active and light-headed, laughed more and was less inside my head.

Unfortounately, I started using amphetamines (adderall, vyvanse) to study in my new university. I felt too lazy and unmotivated without it. Sometimes it helped, but eventually I felt that it triggered back my OCD gradually. Especially when I was alone, and stressed (about homework etc..) it made me think too much and self-observe, and I felt my symptoms coming back hard-time. Also I reduced the weed recently (because of the study) so I guess it's also a trigger.

In conclusion, Iv'e had my obsessions under control using weed for awhile, and stress + amphetamines triggered all back to me.

Anyway, I decided to go see a psychiatrist, as I felt too stressed out and unfunctional. He started me with Clomipramine 25mg for 4 days, then 75mg SR.

I'm 1 week on (75mg) and except very noticable side-effects (eye wiggles like on MDMA, yawnings, insomnia and sexual dysfunction) I still don't feel any good results, actually I think I feel more anxious during this time.

Iv'e heard it's common that the medication will start having good effects only after several weeks, so I'm still optimistic.

However, as i'm ADHD and cannot focus without amphetamines, and also still in a high-anxiety state, I was wondering if I can help myself until the Clomipramine starts working.

I know that both weed and amphetamines is safe to combine with TCA's, but my actual questions are:

*Is smoking weed now to ease the initial medication anxiety, can interfere with it's onset? I mean, can smoking weed before Clomipramine kicked-in, is able to make it uneffective, or delay the onset? Because I'm really trying to prevent myself from smoking now, but it's so difficult. Maybe I'm preventing myself for no reason?... :)

*Same question about amphetamines: can I try using them already for studying? or they can mess with the medication onset? I really need them to study and right now i'm struggling to study without them, which is almost impossible (too lazy, brain fogged etc...).

(I know the risk of becoming again more obsessive from amphetamines, actually that's the main reason I wanted to start a long-term medication. I hoped that Clomipramine will prevent amphetamines from making me more obsessed and will work well together. But I still hurry to start using amphetamines again as I cannot function in the study now without them..)

Thanks a lot for everyone, I hope that someone have the right answers for me. =]

[Paxiled]

There are no "right" answers.  This is trial and error stuff.  For most anxiety sufferers, pot makes it worse or triggers it in the first place because it tends to bring out of us what's inside us.  However, some do find it helps, especially PTSD sufferers. You're missing the weed because, unlike an antidepressant, it gets you stoned, and when that's pleasurable you obviously feel it's loss when you stop, especially when, like you, you smoke all the time.  It's not an addictive drug, but it is hard to stop at first because you just don't feel things as intensely sober as you do stoned.  As for having OCD, I know "intrusive thoughts" are now labeled OCD by many practitioners, but it's not the same as true OCD, which involves ritual behaviors that, if not performed, leave you with an anxiety attack.  All mental illness is marked by obsessive thinking, otherwise none of us would have it.  We'd be thinking other more pleasant things.  What this means for you is, clomipriamine was chosen because of the OCD diagnosis, but know that it is one of the most difficult meds to take -- loaded with side effects.  Other meds are far easier to take.  So some of your problems might be the particular drug you've been told to take -- you might do better on others.  And if you're going to take an antidepressant, you don't want to use pot too if only because it will only increase the sedation that is a side effect of the med you're taking and of many others as well.  As for the ADHD, make sure you really have it -- it's one of the most over-diagnosed ailments out there (as is OCD) and is done more to sell drugs than because so many people truly have it.  But assuming you really do have it, well, you're going to need a really good psychiatrist because speed obviously makes anxiety worse but when you have ADHD it might not.  But it doesn't help.  It does help with depression, though.  Many times our anxiety is caused by depression, and so can symptoms that might be called ADHD be depression.  Nobody here can really know what's truly going on with you, and your docs are trying to do the best they can by you, but the labels you use will greatly influence the drugs they give you so make sure they're the right labels.  I'm not one to tell anyone with ADHD what to do, but I can tell you again, if you're going to move from pot to antidepressants to treat your problem, it's probably time to stop the pot at least as a regular thing.  And do some homework on antidepressants and then talk to your doc about a range of options rather than him choosing one of the few that was specifically approved by the FDA to treat OCD, which is why you were put on that one.  Good luck.  

[dordort]

Thanks for your answer. I didn't mention, that I have tried Lexapro in the past, 10mg for 2 weeks, then 20mg for 1 month with no positive effects, except apathy. So I stopped it, That's why he put me on TCA.

And about the OCD, I actually do have some rituals, my main issue is the obsessive thoughts, but I do have rituals (that was really minor recently) as looking at myself in the mirror at a specific angle for example... And the amphetamine tends to exacarbate those actions once it wears off, and especially when i'm alone (when with friends it keeps me from going OCD).

So starting Clomipramine was for preventing this issue in the long-term, so I can take my amphetamines without having OCD execarbated.

Anyway, you think it's ok to have some weed until the medication will start to work? because I don't feel in the first week positive effects instead of the side-effects.

Thanks again.

[Paxiled]

No, didn't say that.  Said if you're on medication I wouldn't use pot at all especially at first, because you don't know what the combination will do.  TCAs can be really really sedating.  Personally, I'd try a different ssri, and if I was going to do a TCA there are others that are much easier on the side effects.  But it's your choice, and since you've made it, give it time to see if it works.  I know, I know, pot is fun.  It's hard to move on from it.  If the drug works, you might find it okay to have some once in awhile, but at some point most people find taking a drug regularly becomes a process of maintaining, not getting high.  You've arranged your life around drugs.  For the long term, as you're doing this, try to see if you can't find a more permanent solution that doesn't involve getting high so if you do get high it's for fun, not because you don't think you can survive without it.  Peace.

[dordort]

Is it possible that the side-effects will go away soon? or it's unlikely?
I had a choice to try another ssri but as Clomipramine found the most effective for OCD I prefered this choice.
Thanks.

[Paxiled]

No way to know -- it's a very individual thing.  The ones you're reporting aren't common for this drug -- the most common ones for TCAs are dry mouth, constipation, sedation, headaches, and you usually have to watch your liver, but clomipramine has a lot that other TCAs don't have.  Sexual dysfunction is more common with ssris and snris than it is for TCAs, and you don't specify what it is -- for all we know it's you having trouble getting excited without being stoned.  Who knows?  It's not true that clomipramine is the most effective for OCD and I'm personally not sure you have OCD, or at least not true OCD.  You do mention some rituals, but you don't mention that if you don't do them you panic.  You mention obsessive thoughts, which everyone with mental disorders have, and this is not the same as true OCD.  But here's how it works in the wonderful field of American medicine:  a drug is invented by someone.  It gets licensed to a large pharmaceutical company because they control the marketing of drugs.  They try for a patent for something that isn't already full of patented drugs, so they make an antidepressant but because there's a lot of them around they get the FDA to approve it for OCD.  But all antidepressants potentially treat OCD, they just didn't get a patent that mentioned that because they didn't need to.  Also, when a patent expires, companies extend the patent by getting it approved for a different use than the original approval, in this case OCD.  Cymbalta got itself approved for pain treatment.  Most doctors aren't that aware of this or care about it -- most of them are paid by pharmaceutical companies in some way so they don't want to rock the boat that lays the golden egg.  Any drug that treats anxiety will potentially treat OCD, and potentially might not treat it as it depends on the individual taking the drug and how well it's absorbed.  My feeling is, you've already started this drug, so see if it will work and if the side effects go away.  Nobody can predict what will happen, so hope for the best, which is that it works well, the side effects are tolerable, and in the meantime, get to therapy over and over until you find a healer who can get you out of this part of your mess.  If you can't, you stay on the meds.  Be easy on yourself and know you're doing the best you can and your doctor is doing the best he or she knows, which might be not very much or might be a ton.  If the side effects outweigh the benefits, you try something else, and the one benefit of TCAs is that for most people they are much easier to stop taking than those that target serotonin more strongly.