Lesson 13: Biological Treatments For OCD

Question 1

Biological approach to treating OCD

Answer 1

• medically retained psychiatrists and doctors are responsible for treating most people with psychotic al disorders and the vast majority will on the first instance treat psychological disorders either drugs. If you are diagnosed with a psychological disorder, then you are most likely to be treated with drugs.

Question 2

Drug therapy

Answer 2

• drug therapy for mental disorders aims to increase or decrease levels of neurotransmitters in the brain or to increase/decrease their activity. With regards to OCD, drugs work in various ways to increase the level of serotonin in the brain.

Question 3

SSRIs (Selective serotonin reuptake inhibitors)

Answer 3

• standard drug treatment of OCD is through an anti-depressant drug called a selective serotonin reuptake inhibitor. SSRIs work on the serotonin system in the brain. Serotonin is released by certain neurons on the brain (presynaptic neurons) and travels across the synapse. The neurotransmitter chemically coneys the signal from the preynaptic neuron to the post synaptic neuron and then it is reabsorbed by the presynaptic neuron where it is broken down and reused. By preventing the reabsorption and breakdown of serotonin, SSRIs effectively increase its levels in the synapse thus continue to stimulate the post synaptic neuron. This compensates for whatever is wrong with the serotonin system in OCD. The drug (fluxoetine) is available as liquid or capsules and generally takes three to four months of daily doses to have an impact on symptoms.

Question 4

Anti-anxiety drugs

Answer 4

Benzodiazepines (BZs) are a range of anti anxiety drugs including Valium and Diazepam. BZs work by increasing activity of the neurotransmitter GABA. GABA is an inhibitory neurotransmitter which reduces neurone activity. Effectively GABA tells neurons in the brain to ‘slow down’ and ‘stop firing’ and around 40% of the neurons in the brain respond to GABA. This means that BZs have a general quietening influence on the brain and consequently reduce anxiety, which is experienced as a result of the obsessive thoughts.

Question 5

Combining SSRIs with other treatments

Answer 5

• drugs are often used alongside CBT to treat OCD. The drugs reduce the patient’s emotional symptoms (feeling anxious or depressed; which allows the patient to engage more effectively with CBT. Occasionally other drugs are prescribed alongside SSRIs.

Question 6

Alternatives to SSRIs

Answer 6

• when SSRIs are not effective three to four months, the dose can be increased or it can be combined with other drugs. Sometimes different anti-depressant drugs can be tried such as;
• tricyclics - an older type of anti-depressant, have the same effect on serotonin as SSRIs but they have more severe side effects, so are generally kept in reserve for people who do not respond to SSRIs
• SNRIs (serotonin-noradrenaline reuptake inhibitors) are also a second line of defence for people who do not respond well to SSRIs. SNRIs increase levels of serotonin and noradrenaline.

Question 7

Strengths of drug therapy

Answer 7

• the effectiveness of SSRIs is supported by studies which uses randomised drug trials. These trials compare the effectiveness of SSRIS and placebos. Soomro et al (2008) conducted a review of the research examining the effectiveness of SSRIs and found that SSRIs were more effective than placebos in the treatment of OCD in 17 different trials. This supports the use of biological treatments, especially SSRIs for OCD.
• anti depressants and anti-anxiety drugs, are relatively cost effective in comparison to psychological treatments like cognitive behavioural therapy. Consequently, many doctors prefer the use of drugs over psychological treatments, as they are more cost-effective for the NHS.
• drugs are also non-disruptive to patient’s lives - patients can just take them until their symptoms improve. In contrast, psychological treatments take time and effort often requiring the patient to complete homework in their own time. Drugs are more likely to be more successful for patients who lack motivation to complete intense psychological treatments.

Question 8

Weaknesses of drug therapy

Answer 8

• SSRIs and BZs both have side effects. Possible side-effects of SSRIs: indigestion, blurred vision, reduced sex drive, however these are usually temporary.
• Possible side effects of BZs: drowsiness, dizziness and lack of coordination. BZs are also known for their withdrawal effects - this makes them very addictive. In the long term BZ can have quite serious negative effects including cognitive impairments. As a result, BZs are usually only prescribed for short-term treatment. In some instance, side effects will cause patients to stop taking the drug, preventing it from being effective.
• drug treatments are criticised for treating the symptoms of the disorder and not the cause. Although SSRIs work by increasing the levels of serotonin in the brain, which reduces anxiety and alleviates the symptoms of OCD, it does not treat the underlying cause of OCD. This means that once a patient stops taking the drug, they are prone to relapse, suggesting that psychological treatments may be more effective, as a long-term solution.