Obsessions and Compulsions
Some Approaches for OCD
Many people can suffer from obsessions and compulsions without technically having OCD “Obsessive Compulsive Disorder”. These individuals may be considered to have Obsessive Compulsive Personality or obsessive and compulsive tendencies.
Either way, OCD tendencies can drastically affect someone’s quality of life and it can be very difficult to stop the OCD behaviour. Classic OCD-type behaviour would generally be a situation where an individual has a terrible thought of impending doom or they have a horrific or undesirable possible scenario they imagine where they feel a strong urge to prevent this scenario from happening by doing some irrational activity. This irrational activity could be something like touching the wall of a building three times, or by going down a certain street as opposed to another. For example, if the person who feels they need to touch a wall three times leaves the area and then later questions whether they in fact touched the wall three times or not may feel a strong urge to return to the wall and touch it three times, just to be safe. Not “stepping on a crack (on the sidewalk) to avoid breaking your mother’s back”, as it were.
Typically people with these thoughts know very well that rationally their actions and rituals have no bearing on causing or preventing these scenarios they have thought up, but they do it anyway. Most of the time, they do it without much choice, they feel a strong sense of obligation to do the ritual or activity all while knowing it is not reasonable, rational and overall makes no sense.
However, OCD is a broad category of mental illness and many actions and activities are considered to be OCD or OCD-like. Hair-pulling, skin-picking, and nail-biting can all be considered OCD, in certain situations. Further, there can be more benign actions as a result of some mild OCD, such as knocking on wood.
Fun fact, the whole “knocking on wood” practice is said to be from ancient Greek mythology, where people believed tree trunks (especially oak trees) contained forest dryads or nymphs and knocking on the trees (the wood) would be a way to get help from the nymphs. Over time this turned into knocking on wood.
It may seem benign, and many people do it, but some with OCD truly feel they need to knock on the wood. If they feel obligated to knock on the wood and they don’t, they will fear that something bad will happen and this thought can consume them, until they knock on the wood. Knocking on the wood immediately gives relief, but this can over time lead to a worse OCD mental state and the actions that one feels obligated to take can transform and get more cumbersome.
OCD activities can be quite severe, where, for example, some people feel they cannot enter a doorway unless the hand on their watch is on an odd number. If the hand is on 4 they can’t enter, if it’s on 5 they can. Some people must touch everything they touch with their right hand, with their left hand as well. So if they open a door with the right hand, they have to grab the door knob with the left hand after as well. All while fully understanding that this is totally irrational, and they may even think of themselves as crazy for acting like this, but again - they feel they have to do it anyway. Many irrational fears can also be considered to be related to OCD, such as extreme germaphobia. OCD can also come with excessive rumination.
OCD is a disorder that seems to, sometimes, be considered almost charming. This is likely a result of how OCD is displayed in many books, tv-shows and movies. For example, it could be argued that the genius detective Hercule Poirot deals with some type of OCD. Monk is a detective on a show that bears the same name and also deals with many OCD tendencies. A lot of the time OCD is depicted as quirky and harmless in TV shows and movies.
Even though many obsessions and compulsions are at most annoying to the individuals who experience them and are overall fairly benign, it is still a problem and can indicate that there is something wrong. Many want to be able to be free of their OCD or OCD tendencies and would ideally like to avoid potentially harmful medications. For example, a lot of the time OCD is “treated” with SSRIs which have a slew of negative effects and often do not really help that much. Sometimes OCD is treated with antipsychotics/neuroleptics which are notoriously harmful drugs.
One type of drug that seems to be helpful for OCD is the NMDA antagonists. For example, amantadine and memantine are NMDA antagonists and have been shown, off-label, to be useful for OCD. Many non-prescription substances can help block NMDA such as agmatine, magnesium, zinc and potentially lithium orotate. Blocking NMDA can be very beneficial for a variety of conditions such as anxiety. One thing that can increase NMDA activation, and thus potentially worsen OCD, is quinolinic acid. Vitamin B6 helps to lower quinolinic acid and this is likely one of the ways that vitamin B6 helps with OCD and related issues.
Part of what seems to be happening in OCD is an imbalance of glutamate (an excitatory neurotransmitter) and GABA (a calming inhibitory neurotransmitter). In theory, people with OCD likely have too much glutamate in relation to GABA. Vitamin B6 can be very useful in this situation as this vitamin is required for the conversion of glutamate into GABA. This helps in three ways, 1. you are lowering glutamate, 2. you are increasing GABA, and 3. you are helping to bring a better balance between the two.
There are many other things one can do to optimize GABA, for example, lemon balm (as a tea or tincture) can help prevent the excessive degradation of GABA - this means that you hold on to your GABA longer. Many other herbs and teas can increase GABA levels such as chamomile and valerian root. Many amino acids can be beneficial in this regard, most notably agmatine, taurine and theanine. All three of these amino acids seem to be able to help with OCD, especially agmatine. There is also quite a bit of evidence that the amino acid supplement NAC can help with OCD. Learn more about the “Dance of Glutamate and GABA” in my article on the topic.
When it comes to NAC, I think it makes the most sense to take it 2-3x a day (similar to myo-inositol). In terms of dosage, I think 900mg 3x a day is a good idea (for a total of 2700mg). I wouldn’t go higher than 3g a day.
Furthermore, the fact that the blood pressure medication clonidine helps reduce OCD symptoms is an important point to consider. Simply put, clonidine works by lowering the release of certain stress hormones and catecholamines. What we can glean from this is that high output of certain stress hormones like cortisol, adrenaline and norepinephrine can certainly worsen OCD symptoms. A major cause of high-stress hormones would be that the stress hormones are elevated to compensate for low energy production as a result of low thyroid function/metabolism. I’ve written about this topic in many of my articles, such as my articles on ADHD, Insomnia and PCOS.
There also seems to be a hormonal aspect to OCD, where it appears that in males lower testosterone levels are correlated with OCD. Testosterone is a steroid hormone, and thus it is very important to optimize steroid hormone production. Steroid hormones are made from cholesterol. The body takes cholesterol and converts it into pregnenolone which is the first steroid hormone. For this conversion, many things need to be available, most notably vitamin A (retinol) and active thyroid hormone, T3. There are many other things that can help with this conversion, such as B vitamins, eating enough, and eating enough carbohydrates, in general.
Find out about which nutrients are high in certain foods in my Reference List of Highly Nutritious Foods
Other steroid hormones that seem to be very important in keeping OCD at bay are progesterone and its neurosteroid metabolite allopregnanolone. The same general advice applies to increasing the conversion of cholesterol into steroid hormones in order to increase the levels of progesterone and allopregnanolone in the body. Be that as it may, people can supplement pregnenolone and progesterone in order to help increase these beneficial hormones in the body when their OCD is particularly bothersome. Pregnenolone is the first hormone to be produced via the conversion of cholesterol, so taking pregnenolone can increase many of the downstream hormones.
As mentioned, allopregnanolone and other neurosteroids seem to have the potential to help a lot with OCD. Allopregnenolone comes from progesterone, so theoretically taking progesterone, especially as a woman, should be able to help with OCD. Progesterone itself can probably help with OCD through its various calming effects, but the conversion of progesterone into allopregnanolone is likely a huge reason why progesterone supplementation would help. Many SSRIs also have the effect of increasing allopregnanolone, and this may explain why some people benefit from such a medication - however, I’m strongly against the use of SSRIs but that is a topic to be discussed for another time.
Allopregnanolone is a 5-alpha-reduced hormone, so if someone is taking a 5-alpha-reductase inhibitor (5a-R), such as common hair loss drugs (Propecia, finasteride etc), then this may be contributing to low allopregnanolone symptoms such as OCD-like symptoms. Natural things can inhibit 5a-R as well, such as lions’ main mushroom and saw palmetto.
OCD is common in people who have a chronic tic disorder, such as Tourette’s Syndrome. You can find out more about Tics and TS in my article on the topic. Both of these seem to potentially be able to be caused by an autoimmune reaction in children, and this is termed PANDAS. Find out more about autoimmune conditions and what to do about them here.
Some orthomolecular doctors and PhDs have explained that undermethylation, which will typically involve high levels of histamine, can result in OCD-like symptoms. For instance, Dr. Carl Pfeiffer suggested the use of calcium, manganese, zinc and methyl donors for someone with symptoms of high histamine such as allergies, headaches, nausea and compulsions. As such, I think things like creatine, TMG and phosphatidylcholine can help reduce OCD symptoms as these substances all help people who are undermethylating.
Lithium Orotate, a nutritional lithium supplement, appears to have the potential to help reduce OCD symptoms. There are likely many reasons for this, and in general, lithium seems to help reduce irritability reliably. I suggest reading the book “Nutritional Lithium, A Cinderella Story” for more info on this topic. Having said that, in general, it seems people do well with 5mg of lithium orotate, potentially increasing the dosage over time. There is not a set range but one range I’ve seen is anywhere between 1-40mg of lithium orotate as a typical dosage.
I believe the combination of lithium and agmatine would be a particularly beneficial combination for OCD, but either alone should be able to help.
It seems that vitamin D can really help with OCD. If someone is low in vitamin D on a blood test then its use would be indicated even more. Vitamin D has broad protective effects and seems to be useful in many related disorders such as tic disorders. Sunlight is the best way to increase vitamin D levels in the body but some may greatly benefit from supplementing.
Myo-inositol is another supplement that seems to be able to help with OCD, 18g a day seems to be the general recommendation. As is selenium. Selenium is high in eggs, organ meats and shellfish like shrimp, but some may benefit from supplementation.
Dr. James Greenblatt suggests using myo-inositol powder dissolved in water (or other liquids) taken 3x a day. The effective dose in his opinion seems to be anywhere from 2-12g a day. Having said that, he noted that even in serious instances of OCD he found that 6-8 total grams a day was typically sufficient. Thus, I think taking 2g of myo-inositol 3x a day (for a total of 6g a day) will be a good idea for those with OCD. Perhaps some will need less, and some may need more, but 6g a day seems like a good and effective dose.
Interestingly enough, as with other disorders like tic disorders and ADHD, nicotine seems to be able to help with OCD. Another surprising substance that seems to help with OCD is caffeine. So perhaps regular consumption of coffee is a reasonable approach to lessen OCD symptoms.
Cognitive behavioural therapy seems to be very useful for OCD, so this may be worth a try for individuals with particularly severe OCD. This approach seems to be more effective than most medications used for OCD.
If someone felt that they needed to be medicated for their OCD, I think talking to your physician about non-SSRI and non-neuroleptic medications would be a good idea. Some safer medications that can help with OCD seem to be clonidine, amantadine and memantine. Those three medications can also be helpful in ADHD, and many other mental health-related problems.
An interesting Haidut blog post about the potential negative role of serotonin in OCD:
Some supplements that can potentially help with OCD
Vitamin B6 (P5P)
Magnesium
Agmatine
Lithium Orotate
Progesterone
Pregnenolone
NAC
Vitamin D
Taurine, Theanine, Glycine
Herbs like Valerian Root, Lemond Balm, Chamomile etc
Myo-Inositol
Selenium
Caffeine/Coffee
*None of this is medical advice. I am not a medical professional, always talk to your doctor*
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Excellent article. Love the “Hercule Poirot” reference!
And your list of supplement recommendations at the end of your articles is incredibly helpful.