Best, Cutting Edge, OCD Treatment or Center
September 24, 2017 7:21 AM   Subscribe

I have had lifelong OCD/Depression/Anxiety. I have tried a bunch of different medications in the past (including SSRIs like Luvox) as well as therapy, homeopathy (B vitamins), meditation and ketamine infusions. I am considering taking another stab at medications, even though I have never had success with them. My current psychiatrist is recommended finding an OCD treatment center because they would be up on the latest treatments. I live in NY. Where do I go from here? Details inside

My obsessive thinking, depression and anxiety are ruining my life. I have been on meds in the past - SSRIs, benzos etc. I have tried working on methylation and all of the usual things. I went gluten free and eat healthy and exercise. My lifelong treatment resistant depression is still haunting me. Ketamine worked to knock out the depression and ease the thoughts, but it is not covered by insurance and costs $1000 a month. My insurance sucks. I have a $4000 deductible and no out of network benefits. My copays don't even kick in until my deductible is met.

I just have non stop obsessive ruminations and racing thoughts.

My current physician recommended trying to go to an OCD treatment center or hospital, as they would be on the cutting edge and know the best treatments. My other psychiatrist recommended psilocybin. I will admit that that makes me nervous. I also don't see any clinical trials going on now.

Where is the best place to get treatment in the tri state area? Is there a "gold standard" treatment center for OCD in this country?

I was considering anafranil as I haven't tried that one yet, but I am so scared of trying a medication again. It will also cost me $170 month for a generic or $1000 for the name brand. I felt awful after getting off meds years ago. It lasted for 6 months. I don't know if it was mostly due to benzos, but I had crying fits for 6 months. I haven't felt the same since. It has been 5 or so years. I also am afraid of the long term effects of these medications. When they rattle off the side effects and all the things that you have to avoid (foods, booze etc) in addition to having to have your liver checked etc, it makes me sooooooo nervous. I have also had so many crappy doctors over the last 20 years, that it makes me not trust them.

Thank you in advance
posted by kbbbo to Health & Fitness (7 answers total) 4 users marked this as a favorite
Have you looked into New York Psychiatric Institute? They're based in Manhattan at Columbia. If you are a participant in a clinical trial, their treatment is provided free of charge.

How bad is your insurance, and how much are you able to self-pay? If you can pay out of pocket, MacLean in Boston is very well-respected.
posted by quadrilaterals at 7:36 AM on September 24, 2017

Yes, to echo quadrilaterals, I have a friend with refractory OCD who has been to the OCDI at McLean at least twice. Once for an initial treatment, once for a tune-up. He has sort of a fatalistic attitude toward his illness, whatever will be, will be, but he found it helpful enough to go back!
posted by 8603 at 8:18 AM on September 24, 2017

Well, you just convinced me to make a sock puppet to say that an important person in my life has had reasonable success treating mild to moderate, obsessive rumination driven OCD with psilocybin for the past year. They didn't really expect it would work, but their OCD symptoms now reliably ratchet back up towards their former baseline about 5-6 weeks after their last mushroom session. It's kind of fascinating. This wasn't the first choice, due to some built in anxiety about hallucinogens, etc, but they also couldn't find any nearby trials and the mycology supply section of the internet was, by contrast, much more helpful. Your mileage may certainly vary, and mushroom possession carries significant legal risk. But from reading several trial results after my friend's experience and talking to them, if I were in your situation I'd seriously consider that psilocybin recommendation.
posted by socknonymous at 8:31 AM on September 24, 2017 [4 favorites]

I trained as a therapist in anxiety/OCD treatment at Alexian Brothers Behavioral Health outside of Chicago. Which I know is a haul, but I had patients come in from all over the country. McLean also has a very good program from my understanding.

Good on you for working to take control of your anxiety! I have some anxiety issues of my own that I'm better able to manage since my training and it's made a huge difference in my life. Feel free to send a MeMail if you have any questions.
posted by We'll all float on okay at 9:13 AM on September 24, 2017

The gold standard for treatment is at the OCD Institute at McLean Hospital . They saved and changed my son's life. All they do is OCD, 24/7/365. He was there for several months as an outpatient but they also have inpatient services. Two years after leaving the program, he no longer has any OCD issues AT ALL.

They're outside of Boston, affiliated with Harvard Medical School. Memail me if you want specific details; I know there's a waiting list. But it changed his life; it changes lives daily.
posted by yes I said yes I will Yes at 10:36 AM on September 24, 2017 [1 favorite]

I'm a researcher in psychology who's also trained as a therapist for anxiety and obsessive-compulsive disorders, so I feel like I can comment on best-practice/cutting-edge treatments given my familiarity with this literature.

Exposure with response/ritual prevention (ERP) is a manualized type of cognitive-behavioral therapy (CBT), which is a more general term for treatments that involve identifying and changing anxious thoughts and exposing oneself to feared stimuli. ERP and CBT more broadly are the gold standard of treatment. It's usually done on an outpatient basis. You will know that your therapist is doing CBT generally if (1) they explicitly give you a number of sessions that treatment will involve (often 12-16), (2) they are able to describe at the outset what different sessions will focus on, (3) they assign daily homework, and (4) they collaboratively set an agenda for each session with you. You will know that your therapist is doing ERP specifically if they help you set an agenda for gradually exposing yourself in a prolonged manner to specific fear-eliciting stimuli and develop a plan for abstaining from compulsions during exposure.

In a somewhat older meta-analysis comparing CBTs (including ERP) to psychological placebo (meaning relaxation training, a placebo pill, or talk therapy not involving exposure or cognitive restructuring), OCD was the most treatable condition, and treating OCD with CBTs also significantly reduced depression. The odds of recovery in CBT were 12 times higher than the odds of recovery with a psychological placebo. A newer, larger meta-analysis confirmed these findings. They found a 73% chance that a randomly selected person treated with CBT/ERP would do better than a randomly selected person who had done relaxation training/talk therapy. There is also evidence that the effects of these treatments endure for most people at 6- and 12-month follow up. I think that this is important because you may have success with outpatient CBT/ERP even if general talk therapy didn't work.

In terms of finding a provider, you can select exposure and response prevention in this search engine. I have a friend/colleague who's an OCD expert at Columbia's OCD center who I'd be happy to ask for referrals if you want to message me.

Best of luck!
posted by quiet coyote at 11:37 AM on September 24, 2017 [2 favorites]

Hello. Another psychologist here. Quiet Coyote's response was right on. ERP has the most research support of any treatment for OCD. If you can make it out there, you might also consider treatment at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania. It seems like you may even be able to get treatment for free by enrolling in one of their studies. Even if you don't meet criteria for one of their studies, they would discuss alternative providers in the area as part of the screening interview.
posted by MrBobinski at 4:26 PM on September 24, 2017 [2 favorites]

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