OCD Treatment

• What are SSRI’s?

  Increase serotonin levels by blocking reabsorption
• Example of an SSRI:

  Fluoxetine - daily dose, 3-4 months to impact symptoms
• How does low serotonin link to OCD?

  • involved in the worry circuit
  • More serotonin reduces anxiety
• How do SSRI’s work?

  1. Electrical impulse trigger serotonin release into the synapse
  2. This moves across the synapse to post-synaptic neuron, hits receptor sites which passes the electrical impulse to this neuron (releases more serotonin)
  3. Serotonin moves to be reabsorbed by pre-synaptic neuron to await further impulse. SSRI’s block the reabsorption site
  4. Serotonin waits briefly then returns to receptor sites, hits them again, passes impulse to release more serotonin again
  5. Cycle repeats causing serotonin to stay in synapse for longer, increasing levels
• What are Tricyclics?

  • antidepressants
  • Treat OCD not depression
  • E.g. Anafranil (clomipramine)
  • Block reabsorption of serotonin and noradrenaline
  • Prolongs their activity
• Advantages and disadvantages of tricyclics

  • + target more than one neurotransmitter
  • Weakness- greater side effects
• Anti-anxiety medicaction- Benzodiazepines (Bz)

  • e.g. Valium
  • Slow down the activity of the CNS by enhancing the activity of the neurotransmitter GABA (calming influence of brain)
  • Bz’s bind to GABA receptors in post synaptic neuron - chlorine ions flow
• D-cycloserine

  • reduces anxiety
  • Works best in conjunction with psychotherapy
  • Antibiotic
  • Enhances transmission of GABA
• Drug therapy and psychotherapies:

  • drug therapies are better combined with another treatment
  • Drug therapy reduces symptoms - person can get on with a normal life e.g. can now attend CBT sessions
  • OCD returns when drugs are stopped
• Strength - effectiveness

  • Soomro (2008) reviewed 17 studies of the use of SSRIs with OCDpatients
  • found them to be more effective than placebos in reducing symptoms of OCD, 3 months after treatment
  • only short term
• Strength - Drug therapies are preferred to other methods

  • generally requires less time and effort than
  • therapies such as CBT
  • Therefore - it is quick - only have to take a pill, rather than sit through 20 , 1 hour sessions with a therapist.
  • relatively cheap and requires less monitoring
  • so more convenient = more people take this help
• Weakness - side effects

  • SSRI - nausea, headaches, insomnia
  • BZ - increased aggressiveness, long term impairments of memory and possible addiction
  • Side effects may amount to costs that more than outweigh benefits
  • patient stops taking the drug- symptoms of OCD return
• Weakness - not a lasting cure

  • Koran (2007)- although drug therapy may be more commonly used -> psychotherapy such as CBT should be tried first.
  • Drug therapy must be efficient in the short term but it does not provide a lasting cure.
  • A lot of patients relapse within a few weeks if medication is stopped