Obsessive attachments to other people (it's killing me slowly)

[hopelessromantic]

I know what my problem is, but I don't know what can be done about it. I obsess over people. I get them in my head and that's all that spins around in my brain. It started last year with someone and to get past them I got involved with someone else, but now that is a problem. This is what is causing my insomnia. I have to take Ambien every night to sleep and even then I wake up at 4am and have to take another 1/2 to make it to 6:30. If I dream about this person I wake up immediately and then the brain spins and sleep is impossible without a pill. The anxiety that I already suffer from is now compounded with high blood pressure and adding the insomnia, well, you get the picture.

What prescriptions specifically target this? It's like my brain is "stuck" on this person and our involvement, and the rest of my life is just playing in the background......I don't want to go on like this forever, but I've been doing this with people for so long....it's just now really, really affecting my health. 

[AnxiouSteve]

I would say to try online dating and to find someone else, but that seems like it would just start the cycle anew.  I think I have a touch of this, perhaps, but this post isn't about me 

Are you on any meds, currently?  I hear OCD can be treated with meds and such...

Wikipedia Says:

http://en.wikipedia.org/wiki/Obsessive-compulsive_disorder

Medication

Medications as treatment include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Seroxat, Paxil, Xetanor, ParoMerck, Rexetin), sertraline (Zoloft, Stimuloton), fluoxetine (Prozac, Bioxetin), escitalopram (Lexapro), and fluvoxamine (Luvox) as well as the tricyclic antidepressants, in particular clomipramine (Anafranil). SSRIs prevent excess serotonin from being pumped back into the original neuron that released it. Instead, serotonin can then bind to the receptor sites of nearby neurons and send chemical messages or signals that can help regulate the excessive anxiety and obsessive thoughts. In some treatment-resistant cases, a combination of clomipramine and an SSRI has shown to be effective even when neither drug on its own has been efficacious.

Benzodiazepines are also used in treatment. It's not uncommon to administer this class of drugs during the "latency period" for SSRIs or as synergistic adjunct long-term. Although widely prescribed, benzodiazepines have not been demonstrated as an effective treatment for OCD and can be addictive.

Serotonergic antidepressants typically take longer to show benefit in OCD than with most other disorders which they are used to treat, as it is common for 2–3 months to elapse before any tangible improvement is noticed. In addition to this, the treatment usually requires high doses. Fluoxetine, for example, is usually prescribed in doses of 20 mg per day for clinical depression, whereas with OCD the dose will often range from 20 mg to 80 mg or higher, if necessary. In most cases antidepressant therapy alone will only provide a partial reduction in symptoms, even in cases that are not deemed treatment-resistant. Much current research is devoted to the therapeutic potential of the agents that effect the release of the neurotransmitter glutamate or the binding to its receptors. These include riluzole, memantine, gabapentin (Neurontin) and lamotrigine (Lamictal).

Low doses of the newer atypical antipsychotics olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone and risperidone (Risperdal) have also been found to be useful as adjuncts in the treatment of OCD. The use of antipsychotics in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their dopamine receptor antagonism), at high doses these same antipsychotics have proven to cause dramatic obsessive-compulsive symptoms even in those patients who do not normally have OCD. This is most likely due to the antagonism of 5-HT2A receptors becoming very prominent at these doses and outweighing the benefits of dopamine antagonism. Another point that must be noted with antipsychotic treatment is that SSRIs inhibit the chief enzyme that is responsible for metabolising antipsychotics — CYP2D6 — so the dose will be effectively higher than expected when these are combined with SSRIs. Also, it must be noted that antipsychotic treatment should be considered as augmentation treatment when SSRI treatment does not bring positive results.

Alternative Drug Treatments

The naturally occurring sugar inositol may be an effective treatment for OCD. Inositol appears to modulate the actions of serotonin and has been found to reverse desensitisation of the neurotransmitter's receptors.[34] St John's Wort has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities, and studies have emerged that have shown positive results. However, a double-blind study, using a flexible-dose schedule (600-1800 mg/day), found no difference between St John's Wort and the placebo. Studies have also been done that show nutrition deficiencies may also contribute to OCD and other mental disorders. Certain vitamin and mineral supplements may aid in such disorders and provide the nutrients necessary for proper mental functioning.

Recent research has found increasing evidence that opioids may significantly reduce OCD symptoms, though the use of them is not sanctioned for treatment and considered an "off-label" use, factors being physical dependence and long term drug tolerance. Anecdotal reports suggest that some OCD sufferers have successfully self-medicated with opioids such as tramadol (Ultram) and hydrocodone (Vicodin, Lortab), though the off-label use of such painkillers is not widely accepted, research on this has been limited. Tramadol is an atypical opioid that may be a viable option as it has a low potential for abuse and addiction, mild side effects, and shows signs of rapid efficacy in OCD. Tramadol not only provides the anti-OCD effects of an opiate, but also inhibits the re-uptake of serotonin (in addition to norepinephrine). This may provide additional benefits, but should not be taken in combination with antidepressant medication unless under careful medical supervision due to potential serotonin syndrome.

Recent studies at the University of Arizona using the tryptamine alkaloid psilocybin have shown promising results.[38] There are reports that other hallucinogens such as LSD and peyote have produced similar benefits. It has been hypothesised that this effect may be due to stimulation of 5-HT2A receptors and, less importantly, 5-HT2C receptors. This causes, among many other effects, an inhibitory effect on the orbitofrontal cortex, an area of the brain in which hyperactivity has been strongly associated with OCD.

Emerging evidence suggests that regular nicotine treatment may be helpful in improving symptoms of OCD, although the pharmacodynamical mechanism by which this improvement is achieved is not yet known, and more detailed studies are needed to fully confirm this hypothesis. Anecdotal reports suggest OCD can worsen when cigarettes are smoked as a way of obtaining nicotine.

Psycho surgery

For some, neither medication, support groups nor psychological treatments are helpful in alleviating obsessive-compulsive symptoms. These patients may choose to undergo psychosurgery as a last resort. In this procedure, a surgical lesion is made in an area of the brain (the cingulate bundle). In one study, 30% of participants benefited significantly from this procedure.[6] Deep-brain stimulation and vagus nerve stimulation are possible surgical options which do not require the destruction of brain tissue, although their efficacy has not been conclusively demonstrated.

In the US, psychosurgery for OCD is a treatment of last resort and will not be performed until the patient has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive cognitive-behavioral therapy with exposure and ritual/response prevention.  Likewise, in the UK, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive-behavioural therapist has been carried out.

Transcranial magnetic stimulation

Though in its early stages of research, Transcranial magnetic stimulation (TMS) has shown promising results. The magnetic pulses are focused on the brain's supplementary motor area (SMA), which plays a role in filtering out extraneous internal stimuli, such as ruminations, obsessions, and tics. The TMS treatment is an attempt to normalize the SMA's activity, so that it properly filters out thoughts and behaviors associated with OCD.

Neuropsychiatry

OCD primarily involves the brain regions of the striatum, the orbitofrontal cortex and the cingulate cortex. OCD involves several different receptors, mostly H2, M4, NK1, NMDA, and non-NMDA glutamate receptors.[citation needed] The receptors 5-HT1D, 5-HT2C, and the μ opioid receptor exert a secondary effect. The H2, M4, NK1, and non-NMDA glutamate receptors are active in the striatum, whereas the NMDA receptors are active in the cingulate cortex.

The activity of certain receptors is positively correlated to the severity of OCD, whereas the activity of certain other receptors is negatively correlated to the severity of OCD. Correlations where activity is positively correlated to severity include the histamine receptor (H2); the Muscarinic acetylcholine receptor(M4); the Tachykinin receptor (NK1); and non-NMDA glutamate receptors. Correlations where activity is negatively correlated to severity include the NMDA receptor (NMDA); the Mu opioid receptor (μ opioid); and two types of 5-HT receptors (5-HT1D and 5-HT2C) The central dysfunction of OCD may involve the receptors nk1, non-NMDA glutamate receptors, and NMDA, whereas the other receptors could simply exert secondary modulatory effects.

Pharmaceuticals that act directly on those core mechanisms are aprepitant (nk1 antagonist), riluzole (glutamate release inhibitor), and tautomycin (NMDA receptor sensitizer). Also, the anti-Alzheimer's drug memantine is being studied by the OC Foundation in its efficacy in reducing OCD symptoms due to it being an NMDA antagonist. One case study published in The American Journal of Psychiatry suggests that "memantine may be an option for treatment-resistant OCD, but controlled studies are needed to substantiate this observation."[44] The drugs that are popularly used to fight OCD lack full efficacy because they do not act upon what are believed to be the core mechanisms. Many trials are currently underway to investigate the efficacy of a variety of agents that affect these 'core' neurotransmitters, particularly glutamatergic agents.

Notable cases

    * David Beckham has been outspoken regarding his struggle with OCD, and has told media that he has to count all his clothes, and magazines have to lie in a straight line. He can not have more soda cans in the fridge than three, and if there are any more at home they have to be placed in a cupboard. He has explained that the reason he keeps getting more tattoos is that he feels addicted to the pain of the needle. In hotels, any books that are on a shelf must be placed in the drawer. He has expressed that he wants to get help for his problems.

    * Howard Hughes is known to have suffered from OCD and it is believed that his mother may have also been a sufferer. Friends of Hughes have mentioned his obsession with minor flaws in clothing and he is reported to have had a great fear of germs, common among OCD patients.

[Noahs Mom]

Have you tried talk therapy?  Sounds like something meds could help with, but perhaps being able to get help with controlling your thought patterns might be very beneficial as well...

[hopelessromantic]

At this point I think it's too big of a part of my life/mind to get beyond it by just talking to someone....I get that it has something to do with my head, call it chemical imbalance or just being "wired" wrong but it's something out of my physical control, I'm just so darn afraid of all these drug side effects, none of them sound remotely "decent" to try....but I'm resolved to the fact that I need to start one of them....my plan of action currently is to wait until I "crack" or when I absolutely cannot wait any longer, I know that's not the smart thing to do but here lately I haven't been doing too many smart things.....at the very least when that does happen I'll have no excuse at all.........

[Noahs Mom]

That's awfully defeatest and self centered, don't you think? 
I mean, you're impacting the lives of others with your obsessions... You're chosing to suffer because you're afraid to give it up.
What attachment do you have to this obsessiveness that prevent you from wanting to live a better life?
Is it fear?  What is it???  You know you have a problem, you know you want to get better, you know that there are avenues that can help you get there and yet you choose to stay in the comfort zone because doing anything about it is scary, and difficult so you'd rather wait until the decision is no longer yours.  At least, that's my understanding from what you said...

I know we all like to believe that it's a physical problem, that we're wired differently.  I'm starting to see that perhaps its because we learned wrong.  When you look at it that way, then it becomes possible to deal with.  We can un-learn the years of "scripts" that have been soldered into our minds over the years and re-learn how to really effectively deal with the "outside" world and have better relationships. 

We also have a tendency to think that our problems are too huge for therapy.  Maybe that's because we've never really been able to take a real look at ourselves because that DEFINITELY is frightening!  To look at our own faults and our own bad behaviors... to look for ways to improve lives...   It's about personal accountability.   By saying you'll wait until you crack is a way to take any control you might have in the situation away from yourself, so that it suddenly becomes something that you can't be held accountable for.

Things may be hard, but they are not impossible.  When we go through hard things, it helps us deal with the other hard and harder things down the road so we don't crumble under the pressure.   Go through this, really strive to get better, and the next hard thing will seem that much easier because you will learn from THIS experience... you'll learn how brave you can be and just how much you can perservere through.

[hopelessromantic]

I can't say that this problem is because I learned wrong, because no one taught me to be obsessed with other girls....I don't know how that "happens", if you're born that way or what....and no pill, therapy or doctor has a cure for that. Plus I went through a rollercoaster of bad side effects trying to find meds for my anxiety, including seizures from Wellbutrin, so I am a little gunshy of starting a new med and having to go through 3 or 4 to find the right one...

[c3m3t3rydr1ve]

Well, the problem with waiting to "Crack" is that when you do crack you'll probably end up doing something dangerous to yourself and the people you're obsessed with, such as stalking or hurting them or yourself. You really need to try some medicine and therapy, even if you feel you're too far along. And rather you wait or not, chances are you'll have to try different meds and therapy anyway, so it's better to do it before you end up doing something drastic.

[hopelessromantic]

To "crack" will probably be in the form of depression and weight loss, like after Mom died....either I will get caught, someone will leave, or the stress of this emotional ride will get to me...

[shoppingchickk]

Well now, if this is an OCD condition.. we all have some form of this!

Every single one of us has a problem with being attached to others. Its how much you let it affect you. I had this saaame problem with a guy (In fact, I just recently ended my obsession..for lack of better word). What you need is closure. I talked to the guy and asked him if he still had any feelings for me, since we had an on and off thing for awhile. He told me straight out to "move on" and "stop worrying.. stop asking... its unhealthy". It gave me a slap in the face, but you know what? I needed it! I feel so much bettter about myself now that I have closure... It has given me the opportunity to move on. If you feel like you can't handle the separation from the person by yourself, try talking to them.! It is OK to keep asking for answers until you are satisfied.