Biological Treatment for OCD

What does the SERT gene do?​

Lowers levels of serotonin in the brain

What have low levels of serotonin been linked to?

experiencing obsessive thoughts

What happens in the process of re-uptake: when does it occur?

after synaptic transmission

What happens in the process of re-uptake: what is it?

the process of neurotransmitters being taken back in to the presynaptic neuron (after synaptic transmission)

What happens in the process of re-uptake: What are then ready to be used again?

the neurotransmitters

SSRIs?

Selective Serotonin Reuptake Inhibitors

SSRIs: what are they?

the standard medical treatment used to tackle the symptoms of OCD are SSRIs​

SSRIs: what do they do?

increase certain neurotransmitters in the brain

SSRIs: how do they increase certain neurotransmitters in the brain?

by preventing the re-absorption of serotonin

SSRIs: by preventing the re-absorption of serotonin, what do SSRIs effectively do?

effectively increase serotonin levels in the synapse

SSRIs: what do they continue to stimulate by effectively increasing serotonin levels in the synapse?

continue to stimulate the post-synaptic neuron

SSRIs: the process of re-uptake?

 …

SSRIs: what is medication usually used alongside?

cognitive-behavioural therapy(CBT)

SSRIs: why is medication and CBT used alongside each other - what do the drugs reduce?

the sufferer’s symptoms - such as anxiety or depression

SSRIs: why is medication and CBT used alongside each other - what does this mean the patient can do?

can then engage more effectively with CBT ​

SSRIs: why is medication and CBT used alongside each other - what may some sufferers respond best to?

CBT alone without the ​need for medication

SSRIs: what size dose are they usually given in to begin with?

20mg doses

SSRIs: what can be done when the SSRIs are not effective after three to four months (2)?

dose can be increased or it can be combined with other drugs

SSRIs: What can the does for Fluoxetine be increased up to?

up to 60mg a day

What do patients respond differently to?

to different drugs - and sometimes alternatives work well for some people and not at all for others

Older type of medication?

Tricyclics

Tricyclics: what are they?

A type of anti-depressant (e.g. Clomipramine)

Tricyclics: their effect?

same effect as SSRIs, but more severe side effects

Tricyclics: when are they used?

Only used if SSRIs are not working

Newer type of medication?

SNRIs

SNRIs: what does it stand for?

Serotonin – Noradrenaline Reuptake Inhibitors​

SNRIs: what does it increase levels of (2)?

levels of serotonin AND noradrenaline

SNRIs: who are they reserved for?

patients who do not respond to SSRIs​

SNRIs: diagram?

…

Strength - P: what is there a lot of research to show?

the effectiveness of SSRIs

Strength - Ev1: what was Soomro et al?

a meta-analysis which reviewed 17studies comparing SSRIs to placebos in the treatment of OCD

Strength - Ev2: when did Soomro et al take place?

2009

Strength - Ev3: what did all 17 studies researched in Soomro et al (2009) show?

significantly better results for SSRIs than for the placebo conditions

Strength - Ex1: how many participants is Soomro et al (2009) based on in total?

3097

Strength - Ex2: what does this large number of participants mean the research is?

more applicable to a wider range of people than a single research study

Strength - L: therefore, what is good about the supportive research?

has a good population validity

Weakness - P: what may evidence for drug treatments be?

biased

Weakness - Ev1: What has Ben Goldacre suggested?

that the evidence favouring drug treatments is biased because much of the research into them is sponsored by drug companies who have a vested interest in not reporting all the evidence

Weakness - Ev2: when did Ben Goldacre suggest this?

2013

Weakness - Ex: what may these companies not publish?

research that argues against the effectiveness of their drug to maximise their own economic gain

Weakness - L: therefore, what may not be as effective as the research suggests?

SSRIs

Strength - P: what is medication much less disruptive than?

psychological treatments

Strength - Ev1: what does taking SSRIs require?

very little effort - patients can simply take them until their symptoms decline

Strength - Ev2: what don’t patients have to engage with?

the hard work of psychological therapy

Strength - Ex what has this led to most patients doing?

finishing their medication treatment - whereas with therapy there is a much higher dropout rate

Strength - L: therefore, regardless of effectiveness, what patients much more likely to do?

much more likely to finish a course of medication than a course of therapy

Weakness - P: what can medication have?

side effects

Weakness - Ev1: while SSRIs will help most people, who experience relatively serious side effects?

Weakness - Ev2: how many patients who take tricyclics will experience weight gain?

1 in 10

Weakness - Ev3: how many patients who take tricyclics will become aggressive and suffer blood pressure problems?

1 in 100

Weakness - Ex: what do these side effects often result in?

patients not wanting to continue their drug treatment

Weakness - L: therefore, what is there a chance people will not do?

that people will not finish their drug treatment, again meaning that how effective the medication is will not actually matter