P - The biological approach to treating OCD

Question 1

What approach do we look at for treating OCD?

Answer 1

The biological approach.

Question 2

What treatments are there for OCD?

Answer 2

Deep brain stimulation and drug therapy.

Question 3

What are SSRIs?

Answer 3

A type of drug therapy used to treat OCD and depression.

Question 4

What do SSRIs do to treat OCD?

Answer 4

Used to increase the levels of serotonin to normalise the worry circuit.

Question 5

What does SSRI stand for?

Answer 5

Selective serotonin re-uptake inhibitors.

Question 6

What is the order of drug preference in treating OCD with drug therapy from most prefered to least?

Answer 6

SSRIs
Tricyclics
Benzodiazepines

Question 7

What are some examples of SSRIs?

Answer 7

Fluoxetine (e.g. prozac)
Sertraline (e.g. zoloft)
Citalopram (e.g. celexa)

Question 8

How do SSRIs work?

Answer 8

Serotonin is released into a synapse from one nerve (neuron). It targets receptor cells on the receiving neuron at receptor sites and, afterwards, is re-absorbed by the initial neuron sending the message. In order to increase levels of serotonin at the synapse, and increase stimulation to the receiving neuron, this re-absorption (re-uptake is inhibited.

Question 9

What types of drug therapies can be used to treat OCD?

Answer 9

SSRIs
Tricyclics
Benzodiazepines

Question 10

What are tricyclics?

Answer 10

A type of drug therapy used to treat OCD and sometimes depression.

Question 11

How do tricyclics work to treat OCD?

Answer 11

They block the transporter mechanism that re-absorbs both serotonin and noradrenaline into the pre-synaptic cells after it has fired. As a result, more of these neurotransmitters are left in the synapse, prolonging their activity, and easing transmission of the next impulse.

Question 12

What are examples of tricyclics?

Answer 12

Amitriptyline (e.g. elavil)

Clomipramine (e.g. anafranil)

Question 13

What are the advantages of using tricyclics compared to SSRIs?

Answer 13

They target more than one neurotransmitter.

Question 14

What are the disadvantages of using tricyclics compared to SSRIs?

Answer 14

They have greater side effects.

Question 15

When are tricyclics used instead of SSRIs?

Answer 15

When SSRIs do not work - they are a second-line treatment.

Question 16

What are BZs?

Answer 16

Benzodiazepines - anti-anxiety drugs.

Question 17

What are some examples of benzodiazepines?

Answer 17

Alprazolam (e.g. xanax)
Diazepam (e.g. valium)
Lorazepam (e.g. ativan)

Question 18

How do benzodiazepines work to treat OCD?

Answer 18

They slow down the activity of the CNS by enhancing the activity of the neurotransmitter GABA, which when released has a general quietening effect on many of the neurons in the brain.

It does this by reacting with special sites (called GABA receptors) on the outside of receiving neurons. When GABA locks into these receptors it opens a channel that increases the flow of chloride ions into the neuron. Chloride ions make it harder for the neuron to be stimulated by other neurotransmitters, thus slowing down its activity and making the person feel more relaxed.

Question 19

Apart from SSRIs, tricyclics and BZs, what other drugs can be used to treat OCD?

Answer 19

D-Cycloserine.

Question 20

What does D-Cycloserine do and what can it be used to treat?

Answer 20

Reduces anxiety and thus may be an effective treatment for OCD, particularly when it is used in conjunction with psychotherapy.

Question 21

What is D-Cycloserine?

Answer 21

An antibiotic used in the treatment of tuberculosis but it also appears to enhance the transmission of GABA and thus reduce anxiety (Kushner et al., 2007).

Question 22

What does GABA stand for?

Answer 22

Gamma-aminobutyric acid.

Question 23

What is GABA?

Answer 23

A neurotransmitter that regulates excitement in the nervous system, thus acting as a natural form of anxiety reducer.

Question 24

What is noradrenaline?

Answer 24

A neurotransmitter found mainly in areas of the brain that are involved in governing autonomic nervous system activity, e.g. blood pressure or heart rate.

Question 25

What is serotonin?

Answer 25

A neurotransmitter implicated in many different behaviours and physiological processes, including aggression, eating behaviour, sleep and depression.