Treating

• Drug therapy for mental disorders aims to increase or decrease levels of neurotransmitters in the brain or to increase/decrease their activity
• Low levels of serotonin are associated with OCD

  • So drugs work in various ways to increase the level of serotonin in the brain
• What are SSRIs?

  Selective serotonin reuptake inhibitors.

  Prvent the reabsorption and breakdown of serotonin in the brain which increases serotonin levels in the synapse and so the serotonin continues to stimulate the postsynaptic neuron and so has an inhibitory effect. This compensates for whatever is wrong with the serotonin system in OCD.
• What is a typical daily dose of fluoxetine?

  20 mg
• It takes 3 to 4 months of daily use for SSRIs to impact upon symptoms
• Dose can be increased if appropriate
• Combining SSRIs with CBT

  Drugs are often used alongside CBT to treat OCD.

  • The drugs reduce emotional symptoms like feeling anxious or depressed so they can engage more effectively with CBT
• What are alternatives to SSRIs?

  Tricyclics and SNRIs
• What are tricyclics?

  An older type of antidepressant

  • e.g. clomipramine

  have the same effect on the serotonin system as SSRIs but the side effects can be more severe
• What are SNRIs?

  Serotonin noradrenaline reuptake inhibitors

  used on people who don’t respond to SSRIs

  Increase levels of serotonin and noradrenaline
• Effectiveness of drug therapy- A03

  Soomro et al. (2009)

  • reviewed 17 studies of SSRIs for the treatment of OCD
  • all 17 studies showed better outcomes following SSRIs than placebos

  typically OCD symptoms reduce for around 70% of people taking SSRIs.

  mean that drugs can be helpful to most people with OCD
• Not the most effective treatment- A03

  Cognitive and behavioural therapies may be more effective than SSRIs in the treatment of OCD

  Means that drugs may not be the optimum treatment for OCD
• Economic- A03

  drug treatments are cheaper compared to other psychological treatments

  • so using drugs to treat OCD is good vale for the NHS

  SSRIs are less disruptive to people’s lives than psychological therapies.

  • people can simply take the drugs until symptoms decline rather than spending time going to therapy sessions

  Means that many doctors and people with OCD prefer drug treatments
• Serious side effects- A03

  A minority of people taking SSRIs get no benefit.

  Some people experience side effects

  • like indigestion, blurred vision and lowered libido

  for people taking clomipramine side effects are mire common and more serious

  • more than 1 in 10 people experience erection problems and weight gain
  • 1 in 100 become aggressive

  means that people’s quality of life is poor and the outcome is they may stop taking the drugs altogether

  • reducing the effectiveness of the treatment
• Biased evidence- A03

  Some psychologist believe that the evidence for effectiveness is biased due to sponsorship of research by drug companies.

  But teh best available evidence supports the usefulness of drugs in treatment of OCD and evidence for psychological therapies is likely biased too.

  This means that as far as we know frugs are helpful for treating OCD

  • so it may be preferable to continue using them