5- biological treatments for OCD

What is the main biological treatment for OCD?

Drug therapy

What does drug therapy involve changing the levels of?

Neurotransmitters in the brain

What is the purpose of changing neurotransmitter levels?

To either increase or decrease their activity and restore chemical imbalances.

How many types of drugs are used?

Two

What are the two types of drugs that can be used?

Anti-depressant and anti-anxiety drugs

Which neurotransmitter is said to be low in OCD patients?

Serotonin

What drug increases the levels of serotonin in the brain?

SSRIs

What do the letters SSRI stand for?

Selective serotonin reuptake inhibitors

What is the most commonly prescribed SSRI?

Fluoxetine (Prozac)

What two actions do SSRIs do with regards serotonin?

Reduce the re-absorption and breakdown of serotonin at a synapse during synaptic transmission.

In what location do we want to increase serotonin levels in a patient?

Synapse

What is the effect of increasing serotonin levels in the synapse?

It increases the amount of serotonin being received by the post-synaptic neuron which means that post-synaptic neuron is stimulated.

What is the change in mood that serotonin causes?

Increases mood

Which part of the brain linked to OCD has also been found to operate at normal levels when SSRIs are used?

The OFC (orbital frontal cortex)

What happens to the individual when their OFC is able to operate at more normal levels?

Reduces the anxiety which is associated with the obsessions and compulsions of the patient.

In some cases, SSRIs may not work.

What alternatives to SSRIs could be provided in a situation that they do not work?

Tricyclics such as Clomipramine (an older type of antidepressant) or SNRIs

Which neurotransmitters do SNRIs work on?

Serotonin and noradrenaline

What is the name given to the anti-anxiety drugs that may be prescribed to OCD patients?

Benzodiazepines (BZs)

What is an example of a BZ?

Valium

What neurotransmitter do BZs work on?

GABA

What do BZs aim to do?

Increase the action of GABA which has the effect of telling the brain to “slow down” and “stop firing”.

Around what percentage of neurotransmitters in the brain respond to GABA?

40%

How can BZs help OCD patients?

They have a quietening influence on the brain, reducing anxiety which is experienced as a result of the obsessive thoughts.

SSRIs reduce the symptoms of OCD by around what percentage?

70%

Studies using SSRIs and what have showed that SSRIs have significantly better results?

Placebo

Who found that SSRIs were successful in treating OCD compared to placebos?

Soomro et al.

How many trials did Soomro use?

17

Did Soomro find SSRIs useful in the short term or long term?

Short term

What technique did Leonard use to look at the effectiveness of SSRIs?

A 10-week double blind study with children and adults

What percentage of people in Leonard’s study had a relapse when SSRIs were changed to a different anti-depressant?

64%

What are 2 advantages of drug therapy over CBT?

More cost-effective method and less time-consuming method to implement

How is drug therapy beneficial for the economy?

It doesn’t depend on trained professionals and reduces strain on the NHS.

What potential side effects can drugs have?

Mild to serious side effects such as headaches, nausea, indigestion, blurred vision, hallucinations and loss of sex-drive.

Which drug has more serious side effects?

Clomipramine

What proportion of people taking Clomipramine will suffer erection problems, tremors and weight gain?

1 in 10

What might 1 in 100 people taking Clomipramine suffer from?

Disruption to blood pressure and heart rhythm.

What is a significant issue with BZs?

Highly addictive and can cause increased aggression and memory impairments.

What might happen to those people who suffer side effects that might impact the effectiveness of drug therapy?

Stop taking the drugs

How long is it before SSRIs might have much impact on the symptoms of their OCD?

3-4 months

True or false, the obsessions and compulsions fully disappear with drug therapy.

False

What percentage of people did Maltby find had improvements in their OCD by taking SSRIs?

30-60%

What percentage of people did Maltby find had a relapse in their obsessions and compulsions once drug therapy was stopped?

65-90%

How long should OCD patients continue taking drugs for, even after the symptoms have stopped?

1 year

True or false, drug therapy treats the underlying cause of OCD.

False – it only reduces anxiety and alleviates the symptoms of OCD

What should drug therapy ideally be paired with for treating OCD to better tackle the cause?

CBT

What do drugs and CBT each tackle?

Drugs tackle the emotional symptoms, but CBT tackles the cognitive elements.