Treating OCD

• Drug therapy

  Aims to increase or decrease levels of neurotransmitters in the brain or to increase/decrease their activity. Low levels of serotonin are implicit in OCD, so drugs used to treat the disorder often aim to increase serotonin levels in the brain.
• Selective Serotonin Reuptake Inhibitors - SSRIs

  Serotonin is released by presynaptic neurons and travels across a synapse. The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then is it reabsorbed by the presynaptic neuron where it is broken down and reused.
• SSRIs prevent re-absorption


  By preventing the re-absorption and breakdown of serotonin, SSRIs effectively increase its levels in the synapse and thus continue to stimulate the postsynaptic neuron. This compensates for whatever is wrong with the serotonin system in OCD.
• Dosage of SSRIs

  Typical dosage pf fluoxetine is 20 mg daily, this can be increased or decreased depending on the patient's needs. The drugs is available as capsuals or liquid, and it usually takes 3-4 months to have an impact on symptoms.
• Alternatives to SSRIs.

  When an SSRI is not effective after 3-4 months the dose can be increased or combined with other drugs, sometimes different antidepressants are tried.

  • Tricyclics are sometimes used (such as Clomipramine). These have the same effect on the serotonin system as SSRIs. Clomipramine often has more side-effects than SSRIs so it is generally kept in reserve for patients who do not respond to SSRIs.
  • SNRIs (appeared in last 5 years). Used as a second line of defense for patients who don't responds to SSRIs. These drugs also increase serotonin, as well as noradrenaline.
• Combining SSRIs with other treatments.


  Drugs are often used alongside CBT to treat OCD. The drugs reduce a patient's emotional symptoms, such as feeling anxious or depressed. This means patients can engage more effectively with the CBT.

  In practise some people respond best to CBT alone whilst others benefit more from drugs.
• Limitation of using drugs to treat OCD is that they can have side-effects. 


  Although the drugs are helpful in treating OCD, a significant majority get no benefit. Some patients also suffer side-effects such as indigestion, blurred vision, and loss of sex drive (usually temporary).
• A further limitation is the evidence for drug treatments is unreliable.


  Although SSRIs are fairly effective and any side-effects will probably be short term, like all drug treatments, SSRIs have some controversy attached. For example some believe the evidence favouring drug treatments is biased because it is sponsored by drug companies who do not report all evidence. Such companies may try to suppress evidence that doesn't go in their favour, thus only supporting such research to further their economic gain
• A strength of drug therapy for OCD is that it is effective at tackling symptoms. 


  For example. Soomro reviewed 17 studies comparing SSRIs to placebos in the treatment of OCD. All 17 studies showed significantly better results for SSRIs than the placebo. Effectiveness is greatest when drugs are paired with CBT. Typically symptoms reduce for around 70% of people; the rest are helped with alternative drugs or combinations of drugs and therapy.