Treating OCD biological approach

• DRUG THERAPY Drug therapy for mental disorders aim to increase or decrease levels of neurotransmitters in the brain to increase or decrease activity
• Drug therapy for OCD aims to increase or decrease the levels of neurotransmitters in the brain to regulate associated behaviours. Since low levels of serotonin are linked to OCD, drug treatments primarily work to increase serotonin levels in the brain. This can be achieved through medications like Selective Serotonin Reuptake Inhibitors (SSRIs), which prevent the reabsorption of serotonin into nerve cells, thereby increasing its availability in the synaptic cleft. By enhancing serotonin activity, these drugs help reduce OCD symptoms and improve overall mental health.
• The most commonly used antidepressants for treating OCD symptoms are Selective Serotonin Reuptake Inhibitors (SSRIs). These medications work by inhibiting the reuptake of serotonin into the presynaptic neuron after it has been released. By blocking this reabsorption process, SSRIs ensure that more serotonin remains available in the synaptic cleft, allowing it to continue transmitting messages between neurons.
• This increased serotonin activity helps regulate mood and reduce the anxiety and obsessive-compulsive symptoms associated with OCD, making SSRIs an effective treatment option for many patients.
• Break down example: transmission of Serotonin 1)When an electrical signal has reached the end of a neuron, it arrives at the terminal button. Here there are tiny sacs called vesicles which contains neurotransmitters. 2)The electrical signal arrival down the axon which causes the vesicles holding the neurotransmitters (serotonin) burst open, releasing the neurotransmitter into the synaptic cleft. 3)The neurotransmitters attaches to the postsynaptic receptors.
• The neurotransmitters (serotonin) left in the gap(Synaptic cleft) is broken down and reabsorbed into the sending cell (the pre-synaptic neuron). 4)The message is carried on to the next neuron
• SSRIs aim to compensate for whatever is wrong with the serotonergic system in OCD. Dosage and other advice vary according to which SSRI is prescribed. A typical daily dose of Fluoxetine is 20mg although this may be increased if it is not benefitting the patient. The drug is available as capsules or liquid. It takes three to four months of daily use for SSRIs to have much impact on symptoms.
• Drugs are often used alongside cognitive-behavioural therapy (CBT) to treat OCD. The medications, such as SSRIs, help reduce emotional symptoms like anxiety and depression, which can make it easier for patients to engage with CBT more effectively. By alleviating the emotional distress, patients may be in a better state to focus on and apply the cognitive and behavioural strategies taught in therapy.
• In practice, some individuals respond best to CBT alone, while others find a combination of CBT and medications like Fluoxetine more effective. In certain cases, additional medications may be prescribed alongside SSRIs to optimize treatment outcomes, depending on the patient's specific needs and response to therapy.
• If an SSRI is not effective after three to four months of treatment, the dosage can be increased (for example, up to 60mg a day for Fluoxetine). Alternatively, the SSRI can be combined with other drugs, such as: 1. Tricyclic antidepressants (TCAs): An older class of antidepressants, such as Clomipramine, may be used. These have a similar effect on the serotonin system as SSRIs, but they tend to cause more severe side effects. Therefore, TCAs are typically prescribed when a patient does not respond to SSRIs.
• 2. SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors): A newer class of drugs, SNRIs, such as Venlafaxine, are used when SSRIs are ineffective. These drugs increase the levels of both serotonin and noradrenaline, and can offer an alternative treatment for OCD in patients who have not responded well to SSRIs. These alternative treatments provide options for patients who do not see improvements with SSRIs alone, helping to address a broader range of symptoms. However, their use is generally considered only when SSRIs have proven ineffective.
• Evaluation One strength of drug treatment for OCD is the strong evidence supporting its effectiveness. Soomro et al. (2009) reviewed studies comparing SSRIs to placebos in the treatment of OCD. All 17 studies showed significantly better results for SSRIs, suggesting their efficacy in reducing OCD symptoms. The effects are even more pronounced when SSRIs are combined with other forms of treatment, such as CBT.
• Typically, 70% of patients experience significant symptom reduction with SSRIs, and for the remaining 30%, alternative drugs or psychological treatments are often effective.This evidence supports the idea that the biological processes underlying OCD, particularly those related to serotonin, play a significant role in the disorder's symptoms, and that targeting these processes with SSRIs can provide effective symptom relief.
• Drug treatments for OCD are often considered more cost-effective than other psychological treatments, such as CBT, making them a practical option for public health systems like the NHS. SSRIs are particularly advantageous as they are non-disruptive to patients’ lives, allowing them to take medication without significant lifestyle changes.For some patients, drug treatments offer a less demanding alternative, as they can take medication until they feel better, without the need to engage in the intensive work required in therapies like CBT.
• Support for this approach comes from both patients and doctors, as many prefer the convenience and relative ease of drug treatments compared to more time-consuming and effort-intensive psychological therapies.
• One limitation of drug treatment for OCD is that drugs can have potentially serious side effects. While SSRIs can be effective for many patients, a significant minority may not experience any benefit. Additionally, some patients may experience undesirable side effects. For example, Clomipramine, a tricyclic antidepressant, is associated with more common and severe side effects, such as erection problems, tremors, and weight gain in more than 1 in 10 patients.
• More seriously, 1 in 100 patients may experience aggression, blood pressure disruptions, and heart-related problems.Limitation – These side effects can reduce the effectiveness of the medication, as patients may discontinue treatment to avoid further health issues, ultimately lowering the overall quality of life and making the treatment less effective for managing OCD.
• Although SSRIs are generally effective and their side effects are typically short-term, like all drug treatments, they are not without controversy. One criticism is that the evidence supporting the effectiveness of drug treatments may be biased. Some psychologists argue that research into SSRIs is often sponsored by drug companies, which may influence the results
• For example, companies might withhold negative data or selectively report favourable outcomes, as highlighted by Goldacre (2012).Limitation – Such bias can undermine the reliability of the evidence supporting SSRIs, and the potential for biased research may contribute to patients feeling less confident in the treatment. This can lead to discontinuation of medication and ultimately reduce the overall effectiveness of the treatment.