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Does intake of Topamax help in controlling impulsive thoughts?

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Posted on Mon, 9 May 2016
Question: hello-
i have had harm ocd for a long time with no improvement with medications. I have harm thoughts of shooting and stabbing people. it started after the birth of my first child 8 yeras ago. I get violent imgaes and urges too. i have tried multiple ssris that dont work im currrently taken off of prozac and going to start either topamax or namenda. What are the success rates for these meds. Are there any other testing i should get done i am unable to get rid of symptoms
doctor
Answered by Dr. Alexander H. Sheppe (1 hour later)
Brief Answer:
Consultation

Detailed Answer:
Hello, and thanks for your question.

First, before we discuss medications, if you are having active thoughts of hurting yourself or others, you need to visit an emergency room for an immediate evaluation by a trained professional.

I typically do not use Topamax, Namenda, or SSRIs in these cases, as they are not good medications at controlling impulsive thoughts. I would use a combination of a mood stabilizer and an atypical neuroleptic. Both of these classes of medications can treat OCD and impulsive urges.

The specific mood stabilizer I would use is Lamictal. It has an excellent side effect profile, and is effective at decreasing unpleasant thoughts and urges.

The specific atypical neuroleptic I would use is Abilify (or continue your current atypical neuroleptic, Risperdal). Again, it has an excellent side effect profile, can treat OCD, and is good at controlling uncomfortable thoughts and urges.

If you are interested in an antidepressant that is not an SSRI but is still useful in treating OCD, I would suggest clomipramine, a tricyclic antidepressant.

These three medications, clomipramine, Lamictal, and Abilify (or Risperdal) would be my suggestions in your situation. Topamax and Namenda have limited efficacy. And again, if you are having active thoughts of hurting yourself or others, you need to visit an emergency room for an immediate evaluation by a trained professional.

Please remember to rate and close this answer thread when you are finished and satisfied.

In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Alexander H. Sheppe (15 hours later)
What does my diagnosis sound like with these symproms
doctor
Answered by Dr. Alexander H. Sheppe (7 hours later)
Brief Answer:
Followup

Detailed Answer:
I would agree with a diagnosis of OCD, or perhaps bipolar disorder.

Please remember to rate and close this answer thread when you are finished and satisfied.

In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Alexander H. Sheppe (14 hours later)
does ocd have impulsive urges that goes with the thoughts thats what i have all day
doctor
Answered by Dr. Alexander H. Sheppe (10 hours later)
Brief Answer:
Followup

Detailed Answer:
Hello, Welcome back to HCM.

Yes, OCD does include "compulsions" which are urges. These compulsions would be improved with the medications I suggested.


In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
Answered by
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Dr. Alexander H. Sheppe

Psychiatrist

Practicing since :2014

Answered : 2240 Questions

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Does intake of Topamax help in controlling impulsive thoughts?

Brief Answer: Consultation Detailed Answer: Hello, and thanks for your question. First, before we discuss medications, if you are having active thoughts of hurting yourself or others, you need to visit an emergency room for an immediate evaluation by a trained professional. I typically do not use Topamax, Namenda, or SSRIs in these cases, as they are not good medications at controlling impulsive thoughts. I would use a combination of a mood stabilizer and an atypical neuroleptic. Both of these classes of medications can treat OCD and impulsive urges. The specific mood stabilizer I would use is Lamictal. It has an excellent side effect profile, and is effective at decreasing unpleasant thoughts and urges. The specific atypical neuroleptic I would use is Abilify (or continue your current atypical neuroleptic, Risperdal). Again, it has an excellent side effect profile, can treat OCD, and is good at controlling uncomfortable thoughts and urges. If you are interested in an antidepressant that is not an SSRI but is still useful in treating OCD, I would suggest clomipramine, a tricyclic antidepressant. These three medications, clomipramine, Lamictal, and Abilify (or Risperdal) would be my suggestions in your situation. Topamax and Namenda have limited efficacy. And again, if you are having active thoughts of hurting yourself or others, you need to visit an emergency room for an immediate evaluation by a trained professional. Please remember to rate and close this answer thread when you are finished and satisfied. In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers