“These Thoughts are Driving Me Crazy!” OCD and ADHD

Reader’s Question

I keep having intrusive thoughts about having sexual intercourse with my mother and younger sister. I also have the intrusive thought that I might urinate uncontrollably at any given moment. These thoughts are driving me crazy! These thoughts make me feel like a horrible perverted person. I am a 27-year-old male who was diagnosed with ADHD at a very young age. Since then I have been diagnosed with chronic depression. Some moments I am really excited and happy, and others I feel completely down in the dumps. I’m not sure if I should tack on Bipolar Disorder or OCD to my laundry list of problems. When am I going to feel like everybody else again? Am I just plain crazy? This has got to stop!

Currently taking: Remeron 30 mg, Vistaril 25 mg as needed for anxiety (though I’m not sure why such a low dosage) and Neurontin 300 mg twice daily.

Psychologist’s Reply

Intrusive thoughts are typically associated with Obsessive-Compulsive Disorder (OCD). In clinical practice there is a strong link between ADHD and OCD and an even stronger link between Depression and OCD.

The intrusive and obsessive thoughts you are experiencing are not associated with a Bipolar Disorder. Depression and OCD are related to low levels of the neurotransmitter Serotonin, and it’s very common for depressed individuals to develop obsessive thoughts. As you describe, obsessive thoughts are always very uncomfortable and typically involve repulsive, immoral, or humiliating thoughts. These obsessive thoughts usually have a content/subject that is offensive to the specific individual. In post-partum depression, good mothers report obsessive thoughts to harm their new baby. Religous individuals are tormented by obscene thoughts. People who curse like a sailor don’t receive cursing obsessive thoughts…they get something else.

In your specific situation, Depression is the problem. Your Depression is producing the obsessive thoughts and fears of humiliation (sudden urinating). When we review your medications, your antidepressant, Remeron, is a low dose and is probably being used as a sleeping pill. Treatment for OCD obsessive thoughts typically involves a medication that increases the availability of Serotonin such as a Selective Serotonin Reuptake Inhibitor (SSRI).

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Treatment for your obsessive thoughts will involve a change in your medications. I strongly recommend that you bring these symptoms to the attention of your physician or psychiatrist. Don’t be embarrassed about the nature of the thoughts as from a clinical standpoint, those thoughts are a symptom of low Serotonin and not some strange relationship with your family members. Those are obsessive thoughts — not sexual concerns. You are not a horribly perverted person — you’re a person with commonly-encountered obsessive thoughts. Additional information can be found by clicking on the ‘OCD’ link in the sidebar, which will take you to other Ask the Psychologist questions tagged as related to OCD.