Psychology essay 25

Outline and evaluate the biological approach to treating obsessive-compulsive disorder

The Biological Approach to treating OCD

Biological Approach

Focuses on physical processes in the body, such as genetic inheritance and neural function.

Drug Therapy

Treatment involving chemicals that affect the functioning of some aspect of our bodies, often at neurotransmitter levels.

Antidepressants: SSRIs (A01)

The standard medical treatment used to tackle the symptoms of OCD involves a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI for short) Low levels of the neurotransmitter serotonin are associated with depression as well as OCD, so drugs that increase levels of serotonin are used with both mental disorders. This summarises how SSRI’s work:

• Serotonin is released into the synapse by the pre-synaptic neuron.

• Normally, after serotonin has crossed the synapse from the presynaptic neuron, it is reabsorbed by the presynaptic neuron (reuptake mechanism) ready to be re- used.

• SSRIs work by preventing (or ‘inhibiting’) this reabsorption. This results in more serotonin staying in the synapse for longer. This allows the serotonin to stimulate the postsynaptic neuron for longer, compensating for the deficiency in the serotonin system. SSRI’s help to reduce the anxiety associated with OCD and ‘normalise’ the worry circuit.

A typical daily dose of an SSRI, such as fluoxetine (Prozac) is 20mg. It takes three to four months of daily use for SSRIs to have much impact on symptoms.

Anti-anxiety drugs (A01)

Benzodiazepines (e.g., Valium) are commonly used to reduce anxiety. Benzodiazepines work by increasing the activity of the neurotransmitter GABA. GABA has a quietening effect on neurons in the brain and therefore, helps to slow down brain activity.

How GABA works:

• GABA is released into the synapse by the presynaptic neuron.

• It locks onto receptors on the postsynaptic neuron

• This opens a channel that increases the flow of chloride ions into the neuron.

• Chloride ions make it harder for the neuron to be stimulated by other neurotransmitters, thus slowing down its activity, reduces the anxiety experienced due to obsessions and makes the person with OCD feel more relaxed.

(Optional A01)

Other drugs used:

- SNRIs (Serotonin Noradrenaline Reuptake Inhibitors).

These drugs work by preventing the reuptake mechanism of both serotonin and noradrenaline, thus increasing the levels of both of these neurotransmitters and reducing anxiety.

- Tricyclics

These are an older drug which work in the same manner as SNRIs but have more severe side effects.

Evaluation (A03)

P: There is clear evidence for the effectiveness of drug therapy in reducing the symptoms of OCD.

E: For example, Soomro et al (2009) reviewed studies comparing SSRIs to placebos in the treatment of OCD. They found that SSRIs were significantly more effective than placebos in treating OCD.

E: Additionally, Kahn et al (1986) compared placebos and Benzodiazepine (BZs) in 250 patients. They found that BZs were significantly superior to placebos in treating anxiety.

L: This is a strength because drug therapy enables people with OCD to cope with their symptoms, such as anxiety, thereby improving the quality of their lives.

P: A further strength of drug therapy as a treatment for OCD is that they are cost-effective compared to psychological treatments.

E: For example, they do not require a trained therapist and are less disruptive to the patients’ lives.

E: Drugs allow patients to reduce their symptoms without having to engage with much of the hard work needed by psychological therapies such as CBT.

L: For these reasons, drug therapies are the preferred method of treatment for many doctors and patients. They enable people to control their symptoms with minimal effort, saving time and money.

Additionally, drug therapy combines well with CBT by reducing a patient’s anxiety, thereby enabling them to engage more successful with the techniques.

P: Although drug therapies are more commonly used to treat OCD, in a comprehensive review of treatments for the disorder, Koran (2007) argued that psychotherapies such as CBT should be tried first.

E: This is because drugs only treat the symptoms of OCD rather than the root cause. Whilst drug therapy is effective in the short-term by placing a ‘chemical mask’ on symptoms, they are not a lasting cure.

E: For example, patients normally relapse within a few weeks after medication is stopped.

L: This is an issue as alternative therapies such as CBT or a combined approach of drugs and CBT, may be seen as more appropriate in the long-term.

P: A major weakness of drug therapy are the side effects that most patients experience.

E: Common side effects of SSRIs include blurred vision, indigestion and loss of sex drive. These may not seem that terrible but often are enough to make a patient prefer not to take the drug. Some patients also experience more serious side effects like hallucinations, erection problems and raised blood pressure.

E: BZs are renowned for being highly addictive and can also cause increased aggression and long-term memory impairments. As a result, BZs are usually only prescribed for short- term treatment.

L: Consequently, these side effect diminish the effectiveness of drug treatments, as patients will often stop taking medication if they experience these side effects.

The biological approach to treating OCD include the use of antidepressants (SSRIs) and anti- anxiety drugs (benzodiazepines). Selective serotonin reuptake inhibitors (or SSRIs) work by preventing the re-absorption of serotonin, therefore increasing the levels of serotonin in the brain. Low levels of serotonin are associated with depression as well as OCD, and so the drugs are used to treat both conditions. It may take 3-4 months of daily use of SSRIs to se an improvement in OCD symptoms.

Benzodiazepines are commonly used to reduce anxiety, by increasing the activity of the neurotransmitter GABA. GABA works by locking on to receptors on the postsynaptic neuron, which increases the flow of chloride ions into the neuron. This makes it harder for the neuron to be stimulated by other neurotransmitters, thus slowing down its activity and reducing anxiety. This reduction of anxiety makes the person with OCD feel more relaxed.

One strength of drug therapies is that there is supporting evidence to suggest they are effective in the treatment of OCD. Somoro et al reviewed studies comparing SSRIs to placebos in the treatment of OCD, finding that SSRIs were significantly more effective. Additionally, Kahn et al compared placebos and benzodiazepine in 250 patients, finding benzodiazepines to be much more effective. This is a strength because drug therapy enables people with OCD to cope with their symptoms.

Another strength of drug treatments is that they are more cost effective than psychological treatments. For example, they do not require a trained therapist and are less disruptive to the patients lives. They allow patients to relieve their symptoms, without having to engage with as much of the work required by treatments such as CBT. Therefore, they are the preferred method of treatment for many doctors and patients, as they enable the treatment of symptoms with minimal effort, saving time and money.

However, one weakness of drug therapy is that it often has side effects. Common side effects of SSRIs include blurred vision and indigestion, which may be enough to make people prefer not to use them. Some patients also experience more extreme side effects such as hallucinations. Benzodiazepines are also known for being highly addictive, which means they are only prescribed for short-term treatment. Therefore, these side effects diminish the effectiveness of these treatments, as patients will often stop taking medication if they experience these side effects.