11. treating OCD

what is used to treat OCD

• drug therapy aims to increase or decrease levels of neurotransmitters in the brain to increase or decrease their activity

• drugs to treat OCD work in various ways to increase the level of serotonin in the brain

what is the standard drug

SSRIs, antidepressants

• they work in the serotonin system in the brain

  1. serotonin is released by presynaptic neurons and travel across a synapse

  2. the neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron

  3. then is reabsorbed by the presynaptic neuron where it is broken down and reused

what effect do they have and why

• by preventing the reabsorption and breakdown, they effectively increase levels of serotonin in the snyapse and thus continue to stimulate the postsynaptic neuron

• this compensates for whatever is wrong with the serotonin system in OCD

dosage

dosage or other advice vary according to which SSRI is prescribed

• a typical daily dose of fluoxetine is 20mg although this may be increased if its not benefitting the person

• drug is available as capsules or liquid

• takes three to four months of daily use for them to have much impact on symptoms

combining SSRIs with other treatments

• drugs are often used alongside CBT as the drugs reduce a persons emotional symptoms such as feeling anxious or depressed so they can engage more effectively with the CBT

• in practice some respond best to CBT alone whilst others benefit more when using drugs as well like fluoxetine

• occasionally other drugs are prescribed alongside SSRIs

alternatives to SSRIs

1. tricyclics eg clomipramine - older type of antidepressant. acts on various systems including the serotonin system where it has the same effect as SSRIs. it has more severe side effects so is generally kept as a reserve for those who do not respond to SSRIs

2. SNRIs - more recently been used. different class of antidepressants and are a second line of defence for those who do not respond to SSRIs. they increase level of serotonin as well as another different neurotransmitter known as noradrenaline

evaluation

• cost effective and non disruptive

• evidence of effectiveness (& counterpoint)

• serious side effects

• publication bias

cost effective and non disruptive

• drugs are cheap and convenient treatment

• they are cheap compared to psychological treatments as many thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one session of therapy - therefore good value for public health systems and represents a good use of limited funds

• also non disruptive to peoples lives as psychological therapy involves time spent attending therapy sessions whereas drugs can decline symptoms

• pracitcality makes them widely used for treatment

evidence of effectiveness

• drug treatments like SSRIs are effective for treatment and improve quality of life

• soomro et al reviewed 17 studies and found they significantly were more effective than placebos - typically symptoms reduced for 70%

• supports idea they help manage symptoms

counterpoint

• psychological therapies like CBT may be more effective in the long run

• a systematic review of outcome studies concluded both cognitive and behavioural (exposure) therapies were more effective

• so even though drug treatments are helpful, they are not necessarily the most effective treatments

drug therapy negatives

1. address symptoms rather than the underlying cause with CROMER ET AL finding 50% of patients had experiences past trauma, suggesting other factors may contribute to the disorder

2. side effects - SOOMORO ET AL found SSRIs often cause nausea, headaches and insomnia making CBT a potentially more favourable alternative 

publication bias

• positive results are more likely to be published than trials where the outcome was less successful (publication bias)

• goldacre found drug companies selectively publish positive outcomes for the drugs their sponsers are selling

• unethical and lessens validity of drug therapies