PATH 13 - OCD treatments 2 Flashcards
(14 cards)
1
Q
What is drug therapy?
A
- Treatments involving drugs i.e. chemicals that have a particular effect on the functioning of the brain or some other body system
- In the case of psychological disorders such drugs usually affect neurotransmitter levels
2
Q
How does drug therapy work?
A
- Psychoactive drugs increase or decrease the levels of neurotransmitters in the brain
- If the levels of these neurotransmitters are associated with the illness, then changing the levels should help to reduce symptoms
3
Q
What are SSRIs?
A
- Stands for selective serotonin reuptake inhibitors
- Most common drug treatment for OCD
- SSRIs increase levels of serotonin in the synapse
- The most commonly used SSRI is fluoxetine
4
Q
What are the prescription details for SSRIs?
A
- Typical dosage of fluoxetine is 20mg per day, increasing to 60mg if necessary, if the current dosage is not benefitting the patient or it can be combined with other drugs
- Delivered by capsule or liquid
- Response (i.e. impact on symptoms) is slow (up to 3-4 months of daily use)
- Other antidepressant are used when SSRIs don’t work
5
Q
What are some alternatives to SSRIs?
A
- Tricyclics (an older type of antidepressant)
- SNRIs (serotonin-noradrenaline reuptake inhibitors)
6
Q
How do tricyclics work?
A
- These are sometimes used, such as clomipramine
- This 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 respond to SSRIs
7
Q
How do SRNIs work?
A
- They have 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
- SNRIs increase levels of serotonin as well as another different neurotransmitter called noradrenaline
8
Q
How do SSRIs work?
A
- SSRIs work on the serotonin system in the brain
- Serotonin is released by certain neurons in the brain
- It is released by the presynaptic neurons and travels across a synapse
- The neurotransmitter chemically conveys the signal from the presynaptic neuron the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron where it is broken down and reused
- SSRIs stop the reuptake and breakdown of serotonin in the presynaptic neuron and therefore increase levels of serotonin in the synapse and thus continue to stimulate the postsynaptic neuron
- This alleviates the symptoms of depression, which is often caused by the anxiety resulting from OCD
- It also compensates for whatever is wrong with the serotonin system
9
Q
Why are SSRIs combined with other treatments such as CBT?
A
- Drugs are often used alongside cognitive behaviour therapy (CBT) to treat OCD
- The drugs reduce a person’s emotional symptoms, such as feeling anxious or depressed
- This means that 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 using drugs like fluoxetine
- Occasionally other drugs are prescribed alongside SSRIs
10
Q
What are the strengths of drug treatment for OCD?
A
- Evidence for effectivenes
- Cost-effective and non-disruptive
11
Q
What evidence is there for the effectiveness of drug treatment for OCD?
A
- One strength of drug treatment for OCD is good evidence for its effectiveness.
- There is clear evidence to show that SSRIs reduce symptom severity and improve the quality of life for people with OCD
- For example, G. Mustafa Soomro et al. (2009) reviewed 17 studies that compared SSRIs to placebos in the treatment of OCD. All 17 studies showed significantly better outcomes for SSRIs than for the placebo conditions
- Typically, symptoms reduce for around 70% of people taking SSRIs. For the remaining 30%, most can be helped by either alternative drugs or combinations of drugs and psychological therapies
- This means that drugs appear to be helpful for most people with OCD
12
Q
How is drug treatment for OCD cost-effective and non-disruptive?
A
- One strength of drugs is that they are 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
- This means that drugs are popular with many people with OCD and their doctors
13
Q
What are the limitations of drug treatments for OCD?
A
Serious side-effects
14
Q
What are the serious side effects of drug treatments for OCD?
A
- One limitation of drug treatments for OCD is that drugs can have potentially serious 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
- This means that some people have a reduced quality of life as a result of taking drugs and may stop taking them altogether, meaning the drugs cease to be effective
