Treating OCD Flashcards
(12 cards)
Drug Therapy
- Biological treatments for OCD aim to restore biological imbalances, such as too little serotonin.
- Drug treatments are based on the assumption that chemical imbalances are the main cause of the problem.
What are the two types of drugs used for the treatment of OCD?
- Anti-depressants (SSRIs)
- Anti-anxiety drugs
- Anti-depressants (SSRIs)
- The biological explanation suggests that OCD is the result of low levels of serotonin in the brain.
- Selective Serotonin Re-uptake Inhibitors (SSRIs) are one type of anti-depressant drug, which include drugs like Prozac.
- When serotonin is released from the pre-synaptic neuron into the synapse, it travels to the receptor sites on the post-synaptic neuron. Serotonin which is not absorbed into the post-synaptic neuron is reabsorbed into the pre-synaptic neuron. SSRIs increase the level of serotonin available in the synapse by preventing it from being broken down and reabsorbed into the pre-synaptic neuron.
- This increases the level of serotonin in the synapse and results in more serotonin being received by the post-synaptic neuron.
- Anti-depressants (like anti-anxiety drugs) improve mood and reduce anxiety which is experienced by patients with OCD by normalising the activity of the worry circuit.
- The dosage varies, for example, a daily dose of fluoxetine is 20mg but takes 3-4 months to have an impact.
What are some more examples of anti-depressants?
a) Tricyclics
b) SNRIs
a) Tricyclics
- Tricyclics block the reuptake of both serotonin and noradrenaline, increasing levels of these neurotransmitters in the brain. Therefore, they have the same effect on the serotonin system as SSRIs.
- An example is clomipramine, one of the first drugs used to treat OCD.
- Clomiparine has more side-effects than SSRIs (e.g., dry mouth, drowsiness, weight gain) so it is generally kept in reserve for patients who do not respond to SSRIs.
b) SNRIs
- SNRIs also increase serotonin and noradrenaline levels by preventing their reabsorption into the pre-synaptic neuron.
- They are not typically the first-line treatment for OCD but may be prescribed if SSRIs are ineffective.
- Examples include venlafaxine and duloxetine.
Side-effects
Because tricyclics and SNRIs work on multiple neurotransmitters, such as serotonin and noradrenaline, i.e. they are non-selective, they tend to have more intense side effects.
- Anti-anxiety drugs
- Benzodiazepines (BZs) are a range of anti-anxiety drugs, which include trade names like Valium and Diazepam.
- BZs work by enhancing the action of the neurotransmitter GABA (gamma-aminobutyric acid) which is an inhibitory neurotransmitter.
- 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 effect on the brain and consequently reduce anxiety, which is experienced as a result of the obsessive thoughts.
Strength
Point: A strength of drug treatments for OCD is that there is strong evidence supporting their effectiveness.
Evidence: Soomro et al. (2009) conducted a review of 17 studies with a sample of 3097 participants, comparing SSRIs to placebos in the treatment of OCD. All 17 studies found significantly better outcomes 6-17 weeks post-treatment for participants who had taken SSRIs compared to those given placebos.
Justification: This suggests that SSRIs are effective in reducing the severity of OCD symptoms. Around 70% of patients typically experience improvement, and many of the remaining 30% can benefit from alternative medications or combined treatments, such as drug therapy with CBT. This highlights the reliability and utility of drug treatment.
Implication: These findings support the practical application of biological treatments for OCD, demonstrating that SSRIs can significantly improve quality of life for a majority of sufferers and are therefore a valuable component of treatment plans.
Counterargument: However, a limitation of drug treatments for OCD is that they may not be the most effective option available.
Evidence: Skapinakis et al. (2016) conducted a systematic review of outcome studies and concluded that cognitive and behavioural therapies, particularly exposure-based treatments, were more effective than SSRIs in reducing OCD symptoms.
Justification: This suggests that while SSRIs can be beneficial for many, psychological therapies may address the root causes of OCD more directly and lead to longer-lasting improvement, especially by targeting the cognitive and behavioural patterns that maintain the disorder.
Implication: Therefore, drug treatments may not always be the optimal first-line approach, and greater emphasis should be placed on psychological interventions, either as standalone treatments or in combination with medication for best results.
Strength
Point: A further strength of drug treatments for OCD is that they are cost-effective and mainly non-disruptive to people’s lives.
Evidence: Drug therapies, such as SSRIs, are relatively cheap to produce compared to psychological therapies. Thousands of doses can be manufactured quickly and inexpensively, whereas psychological therapies require multiple, time-consuming sessions with trained professionals.
Justification: This makes drug treatment a practical and economical option, especially for public health systems like the NHS, which must allocate limited resources efficiently. Furthermore, taking medication is far less disruptive to daily life than attending regular therapy sessions, which can be time-intensive and emotionally demanding.
Implication: As a result, drug treatments are often preferred by both patients and doctors due to their affordability, ease of use, and convenience, supporting their value in managing OCD symptoms effectively.
Counterargument: On the other hand, despite their time and cost-effective merits, drug treatments for OCD have the potential for unpleasant and sometimes severe side-effects.
Evidence: While SSRIs are generally effective, some patients experience side-effects such as indigestion, blurred vision, and loss of sex drive. These effects may be temporary, but for some individuals they can be long-lasting and distressing. Tricyclics like clomipramine are associated with even more severe side-effects with 1 in 100 people becoming more aggressive and experiencing heart-related problems.
Justification: These side-effects can negatively impact a patient’s quality of life and may discourage continued use of the medication. For a small but significant proportion of individuals, the discomfort or health risks associated with drug treatments outweigh the benefits, leading to non-compliance and reduced effectiveness.
Implication: This limits the overall usefulness of drug therapies, suggesting that they may not be suitable for all individuals with OCD and highlighting the need to consider alternative or complementary treatments, such as psychological therapies.
Weakness
Point: A limitation of drug therapies for OCD is potential bias in research.
Evidence: Goldacre highlights that most studies on drug effectiveness are carried out by the pharmaceutical companies that manufacture them.
Justification: These companies have a financial incentive to produce positive results, which raises concerns about the objectivity of the findings. Furthermore, the file drawer problem—where studies with negative or inconclusive results often go unpublished—can skew the overall evidence base, making drugs appear more effective than they truly are.
Implication: This undermines the reliability but also validity of the evidence supporting drug treatments, suggesting that their true effectiveness may be overstated and inaccurate, calling into question how much we can trust the current data in treating patients with OCD.
Weakness
Point: A limitation of drug therapy for OCD is that it may only treat the symptoms, not the root cause of the disorder.
Evidence: It has been argued that low serotonin levels may be a consequence of OCD rather than a cause. Supporting this, Kiara Cromer et al. found that 54% of 265 people with OCD had experienced at least one traumatic life event, and those who had experienced trauma reported more severe symptoms.
Justification: This suggests that in many cases, OCD may have psychological or environmental origins, such as trauma, rather than purely biological ones. Drug treatments like SSRIs may reduce symptoms but fail to address the underlying causes.
Implication: Therefore, while drugs can offer a temporary solution, psychological therapies that target trauma and distorted thinking patterns—such as CBT—may offer a more effective, long-term treatment for OCD.
