Treating OCD:

• Background:

  • The biological approach to explaining OCD has been applied to the treatment of OCD. There is one main biological treatment for OCD = drug therapy
  • There is one main type of drug used to treat OCD = antidepressant drugs
• Antidepressant drugs:

  • Low levels of the neurotransmitter serotonin have been associated with both OCD and depression
  • As a result, drugs that increase levels of serotonin are used to treat both mental disorders
• What is the main type of antidepressant drug that is used to treat OCD?

  SSRIs- selective serotonin re-uptake inhibitors
• What do SSRIs do?

  They work by preventing the rate of reabsorption of serotonin by pre-synaptic neurons.
• More on SSRIs:

  • They have brand names such as Prozac and Fluoxetine
  • By preventing the reabsorption and breakdown of serotonin, SSRIs effectively increase the levels of serotonin in the synapse and thus continues to stimulate the postsynaptic neuron
• What happens to serotonin?

  • Serotonin is released by certain neurons in the brain. It is released by the pre-synaptic terminal and travels across the synapse.
  • The neurotransmitter chemically conveys the signal from the pre-synaptic neuron and then it is reabsorbed by the pre-synaptic neuron where it is broken down and reused
• What is the typical dosage of an SSRI?

  • A typical daily does of fluoxetine is 20mg although this may be increased if it is not benefitting the person
  • It takes 3-4 months of daily use for SSRIs to impact upon symptoms
  • Dose can be increased (e.g. 60mg a day) if this is appropriate
• Combining SSRIs with CBT:

  • Drugs are often used alongside cognitive behavioural therapy to treat OCD
  • The drugs reduce a person's emotional symptoms, such as feeling anxious or depressed. This means that they can engage more effectively with CBT.
• What are SNRIs?

  • An alternative to SSRIs
  • SNRI stands for serotonin noradrenaline re-uptake inhibitors
  • These are a second line of defence for people who don't respond to SSRIs
  • SNRIs increase levels of serotonin as well as noradrenaline
  • SNRIs have more serious side effects than SSRIs
• Strength of drug treatments:

  One strength is that there is evidence from placebo studies that drugs are effective at treating OCD. In a placebo study, a group of patients suffering from OCD are randomly split in half. Half are given a drug, while the other half are given a placebo. The patients do not know if they have been given the drug or the placebo. Soomro et al (2008) conducted a meta-analysis of 17 placebo studies and found that all the studies showed that SSRIs were more effective at reducing the symptoms of OCD than placebos. This supports the use of drugs as a biological treatment of OCD.
• Second strength of drug treatments:

  One strength is that drugs require little effort from the patient to be effective. The patient is only required to remember to take the pills. This is much easier than the time and effort that is required for psychological therapies such as CBT. Also, from the point of view of the health service, drugs are much cheaper than psychological therapies. Patients may also benefit simply from talking with a doctor during consultations. These benefits mean that drug therapies are more economical for the health service than psychological therapies.
• Limitation of drug treatments:

  One limitation is that many drugs used to treat OCD have unpleasant side effects. For example, nausea, headaches and insomnia are all common side effects of SSRIs. SNRIs have more serious side effects than SSRIs, such as hallucinations, which is why they are only used in cases when SSRIs are not effective. These side effects therefore limit the usefulness of drugs as a biological treatment for OCD.
• Second limitation of drug treatments:

  Another limitation is that, although drugs treat the symptoms of OCD, they do not provide a long-term cure. The effectiveness of the drugs used to treat OCD only lasts as long as the patient takes them. Maina et al (2001) illustrated this when they found that patients with OCD tend to relapse within a few weeks if they stop taking their medication. Therefore, it may be preferable to seek treatments that provide a long-term cure for OCD, such as psychological therapies. This suggests that drugs are not a lasting cure for people with OCD.
• Third limitation of drug treatments:

  A limitation of this research is that there is evidence of a publication bias towards studies that show positive outcomes of an antidepressant treatment, thus exaggerating the benefits of antidepressant drugs. Drug companies has a strong interest in the continuing success of psychotherapeutic drugs and much of the research is funded by these companies. Turner et al (2008) suggest that such selective publication can lead doctors to make inappropriate treatment decisions that may not be in the best interest of their patients.