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Copyright Ó Blackwell Munksgaard 2004 Ephedra alkaloids and brief relapse inEMDR-treated obsessive compulsivedisorder Fluvoxamine with no compulsive hand washing and no mooddisturbance.
In his review of the adverse effects of some herbal medicines, While there is still debate about the mechanism of action of Ernst (1) draws attention to reports that ma-huang, a herbal EMDR in post-traumatic stress disorder, the use of eye preparation containing ephedra alkaloids, has been associated movements or alternating bilateral auditory stimulation deliv- with psychiatric and neurological complications. We here ered through headphones may enhance attentional focus (6) in report the case of a patient who was effectively treated for a way which allows accelerated information processing (2). In severe obsessive compulsive disorder but relapsed briefly this case, the key component appeared to be a fast processing following ingestion of herbal products containing ephedra of anxiety provoked by imaginal exposure to the usual triggers alkaloids that she bought to facilitate weight loss. The patient while resisting the urge to obtain relief through compulsive was a 29-year-old woman with a 10-year history of obsessive compulsive disorder who was referred for Eye Movement That reprocessing of the childhood trauma in this case had Desensitisation and Reprocessing (EMDR) (2) when her not occurred (an attempt to target it specifically had not condition had not responded to CBT nor to various medica- elicited any significant emotional memories) is also suggested tions including Fluoxetine, Paroxetine, Clomipramine and by the re-emergence of the presenting clinical picture when the Amitriptyline. At the time of referral she was taking Fluvox- patient had a sudden and unexpected increase in anxiety.
Perhaps treatment would have been more conclusive if the Most distress was occasioned by hand washing: up to 50 memories of the childhood events had been more emotionally times a day in multiples of 5. There were various triggers, some charged and therefore more responsive to reprocessing. Nev- of which related to thoughts about an incident of non- ertheless, it is of interest that this longstanding treatment- penetrative sexual molestation when she was a child. Her resistant obsessive–compulsive disorder responded well to score on the Dissociative Experiences Scale (3) was low and EMDR but relapsed briefly with ephedra alkaloids, which there was nothing in the clinical history to suggest major are known to stimulate catecholamine release.
dissociative disorder, so after preparation with mindfulness,relaxation and safe place imagery she proceeded to treatment Unfortunately she felt so much better after two sessions that she stopped Fluvoxamine completely without a titrated withdrawal, became depressed, and treatment was delayed until she was re-established on 100 mg nocte and brighter in mood. After a further five sessions she was completelysymptom-free despite reduction of Fluvoxamine to 50 mg Nine months later she reported a relapse into increased 1. Ernst E. Serious psychiatric and neurological adverse effects anxiety with a partial return to compulsive thoughts and of herbal medicines – a systematic review. Acta Psychiatr behaviours after she had obtained a herbal health product sold 2. Shapiro F. Eye movement desensitization and reprocessing.
to promote weight loss. Each capsule contained 200 mg caffeine, 50 mg capsicum and 3 mg ephedra alkaloids obtained 3. Carlson EB, Putnam FW. An update on the dissociative from Sida Cordifolia (Therma Pro; Pro Lab Nutrition, experiences scale. Dissociation 1993;6:16–27.
Bloomfield, CT, USA). According to the manufacturer, Sida 4. Haller CA, Benowitz NL. Adverse cardiovascular and Cordifolia is essentially similar to but weaker than ma-huang, a central nervous system events associated with dietary sup- herbal remedy that has been associated with adverse events plements containing ephedra alkaloids. N Engl J Med including death (4) and psychosis (5).
In this patient one capsule had been sufficient to trigger a 5. Doyle H, Kargin M. Herbal stimulant containing ephedrine partial relapse into hand washing. This cleared with immediate has also caused psychosis. BMJ 1996;313:756.
cessation of the herbal health product, a temporary increase in 6. Corrigan FM. Mindfulness, dissociation, EMDR and the Fluvoxamine and a session of hypnosis to reduce baseline anterior cingulate cortex – a hypothesis. Contemp Hypn anxiety. Six months later the patient was again well on 50 mg

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