biological approach to OCD Flashcards
drug therapy definition
treatment involving drugs, chemicals in the brain that have a particular effect of the functioning of the brain or some other body system. in the case of psychological disorder such drugs usually affect neurotransmitter levels
what are drug therapies for
for mental disorders aiming to increase or decrease levels of neurotransmitters in the brain or to increase or decrease their activity
what neurotransmitter is associated with OCD
low levels of serotonin are associated with OCD. therefore drugs to treat OCD work in various ways to increase the level of serotonin in the brain
what does SSRI stand for
selective serotonin reuptake inhibitor
what is a common drug treatment for OCD
SSRIs as involve a particular type of antidepressant
what do SSRIs work on
work on serotonin system in the brain.
what normally happens with serotonin
released by certain neurons in the brain. in particular is it released by the presynaptic neurons and travel across the synapse. the neurotransmitter is chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then is reabsorbed by the presynaptic neuron where it is broken down and reused
how do SSRIs work
preventing the reabsorption and breakdown, SSRIs effectively increase levels of serotonin in the synapse and thus continue to stimulate the postsynaptic neuron. this compensated for whatever is wrong with serotonin system in OCD
dosage of SSRIs
vary according to which SSRI is prescribed
typical does of fluoxetine
20mg but can be increased if it is not benefitting the person
how can drugs be taken
capsules or liquid
how long does it take for SSRIs to work
3-4 months of daily use for the SSRIs to have much impact on symptoms
how can SSRIs be used alongside other treatments
drugs are often used alongside cognitive behvaiour therapy to treat OCD. the drugs can be used to reduce a person’s emotional symptoms, such as feeling anxious or distressed. this means the people with OCD can engage more effectively with the CBT. in practice some people respond best to CBT alone whilst others benefit more when additionally prescribed drugs like fluoxetine. sometimes other drugs are prescribed alongside SSRIs
what happens if an SSRI is not effective
where an SSRIs not effective after 3-4 months the dose can be increased such as up to 60mg a day for fluoxetine or can be combined with other drugs. sometimes different antidepressants can be tried
how can other people respond differently to different drugs
-people can respond very differently to different drugs and alternatives work well for some people and not all for others
what are 2 alternatives to SSRIs
-tricyclics
-SNRIs
what are tricyclics
an older type of antidepressant such as clomipramine
how do tricyclics work
acts on various systems including the serotonin system where it has the same effect as SSRIs. clomipramine has more severe side-effects than SSRIs so it is generally kept in reserve for people who do not response to SSRIs
what does SNRI stand for
serotonin-noradrenaline reuptake inhibitors
what do SNRIs do
more recently been used to treat OCD. these are a different class of antidepressant drugs and, like clomipramine, are a second line of defence for people who don’t respond to SSRIs increase levels of serotonin as well as another different neurotransmitter noradrenaline
strength of biological approach to treating OCD - evidence for effectiveness
-evidence for effectiveness
-clear evidence to show SSRIs reduce symptom severity and improve the quality of life for those with OCD. for example Soomro et al 2009 reviewed 17 studies of SSRIs and compared to placebos in the treatment of placebo conditions. all 17 studies showed significantly better outcomes for SSRIs than placebo conditions. typically symptoms reduce around 70% for people taking SSRIs. for the remaining 30% most can be helped by either alternative drugs or combinations of drugs and psychological therapies –> drugs appear to be helpful for most people with OCD
limitation of biological approach to treating OCD- counterpoint to evidence for effectiveness
-there is some evidence to suggest that even if drug treatments are helpful for most people with OCD they may not be the most effective treatments available. Skapinakis at al 2016 carried out a systematic review of the outcome studies and concluded that both cognitive and behavioural exposure therapies were more effective than SSRIs in the treatment of OCD
strength of biological approach to treating OCD- cost-effective and non-disruptive
-cost-effective and non-disruptive to people’s lives
-a strength of drug treatments for psychological disorders in general is that they are cheap compared to psychological treatments because many thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one session of a psychological therapy. using drugs to treat OCD is therefore good value for public health systems like the NHS and represents a good use of limited funds. as compared to psychological therapies, SSRIs are also non-disruptive to people’s lives, if you wish you can simply take drugs until your symptoms decline. this is quite different from psychological therapy which involves time spent attending therapy sessions –> means that drugs are popular with many people with OCD and their doctors
limitation of biological approach to treating OCD - serious side-effects
-potentially serous side-effects
-although drugs such as SSRIs help most people, a small minority will get no benefit. some people also experience side-effects such as indigestion, blurred vision, and loss of sex drive. these side effects are usually temporary, however, they can be quite distressing for people and for a minority they are long-lasting. for those taking the tricyclic clomipramine, side-effects are more common and can be more serious. for example more than 1 in 10 people experience erection problems and weight gain, 1 in 100 become aggressive and experience heart-related problems –> means that some people have reduced quality of life as a result of taking drugs and may stop taking them altogether, meaning the drugs cease to be effective
evaluation of biological approach to treating OCD - biased evidence
-there is always some controversy over the evidence for the effectiveness of drugs, some psychologists believe that the evidence for drug effectiveness is biased because researchers are sponsored by drug companies and may selectively publish positive outcomes for the drugs on their sponsors are selling (Goldacre 2013)
-on the other hand, there is a lack of independent studies of drug effectiveness and also research on psychological therapies may be biased. the best evidence available is supportive of the usefulness of drugs for OCD
