Biological Treatments for OCD
All drugs, prescription and recreational have their effect at the synapse. They work by increasing or decreasing levels of neurotransmitters (e.g. serotonin, dopamine) available in the synapse.
We saw in the last section that lowered levels of serotonin have been suggested as a possible cause of OCD. It should come as no surprise therefore, that drugs that increase levels of serotonin are the ones most widely prescribed.
SSRIs (Selective Serotonin Reuptake Inhibitors)
How they work:
Serotonin is released from the pre-synaptic neuron and travels into the synapse. When it reaches the post-synaptic side it triggers receptors. If enough receptors are stimulated the message continues.
A fraction of a second after release, the serotonin is sucked back into the presynaptic neuron ready to be recycled. This reduces the levels of serotonin in the synapse. SSRIS such as fluoxetine (Proazac), block the suction pumps and prevent the reabsorption of serotonin. It has to stay in the synapse making future triggering of the receptors more likely.
All drugs, prescription and recreational have their effect at the synapse. They work by increasing or decreasing levels of neurotransmitters (e.g. serotonin, dopamine) available in the synapse.
We saw in the last section that lowered levels of serotonin have been suggested as a possible cause of OCD. It should come as no surprise therefore, that drugs that increase levels of serotonin are the ones most widely prescribed.
SSRIs (Selective Serotonin Reuptake Inhibitors)
How they work:
Serotonin is released from the pre-synaptic neuron and travels into the synapse. When it reaches the post-synaptic side it triggers receptors. If enough receptors are stimulated the message continues.
A fraction of a second after release, the serotonin is sucked back into the presynaptic neuron ready to be recycled. This reduces the levels of serotonin in the synapse. SSRIS such as fluoxetine (Proazac), block the suction pumps and prevent the reabsorption of serotonin. It has to stay in the synapse making future triggering of the receptors more likely.
SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors)
Work by the same process but this time block the reabsorption of both serotonin and noradrenaline. They are thought to be more effective, but because two neurotransmitters are affected there tend also to be more side effects.
Combining drug treatments and CBT
Ideally drug treatments should be combined with therapy such as CBT. Drugs reduce some of the anxiety and mood-related symptoms allowing CBT to be more effective.
Curative v Palliative
As we saw with Hollon’s study for depression, drugs are palliative. They reduce or remove the symptoms but don’t get to the root-cause of the problem. When we stop taking drugs the problems return. Therapy on the other hand does attempt to tackle the underlying causes and is therefore seen as curative. In the case of OCD, Maira et al (2001( found that symptoms return soon after medication is stopped.
Effectiveness
Soomro et al (2009) in a meta-analysis of 17 studies, found SSRIs to be more effective than placebo. They do reduce the symptoms of OCD. However, they don’t work for everyone. 30% of patients reported no improvement and in the 70% who did, sometimes the improvements were slight.
SSRIs do not work immediately. It may be many weeks before there are noticeable improvements. Often in the first few weeks there may be issues with increased anxiety and insomnia. Not ideal when you already have an anxiety disorder. Many people stop taking them during this period.
Costs
Drugs are cheap. They may not appear to be so when you pay for your prescription each month, but they are certainly cheaper than therapy.
Less time-consuming. It takes seconds to pop a few pills, therapy may take an hour a week for many weeks.
Less disruptive. People need to travel to hospitals or clinics for therapy. They may have to take time off work each week. Pills…
Side effects
All drugs have side effects. They don’t just affect the pathways in the brain that you want them to target. Other pathways carrying out other functions are also affected. Typically SSRIs bring dry mouth, constipation, blurred vision and erectile dysfunction (especially in men). The side effects of SNRIs tend to be more common and more serious. Weight gain, erectile dysfunction, aggressiveness and issues with the rhythm of the heart.
The ‘politics’ of psychopharmacology
Psychopharmacology is the branch of medicine that deals with the effects of drugs on thinking, behaviour, mood etc. It is big business and worth billions of pounds a year. There is a strong vested interest to show that unlike what The Verve say, the drugs do work! As a result it is thought that research showing success tends to be favoured for publication. Studies that suggest the drugs don’t work tend to be either glossed over or ‘published in a way that conveys a positive outcome.’
Work by the same process but this time block the reabsorption of both serotonin and noradrenaline. They are thought to be more effective, but because two neurotransmitters are affected there tend also to be more side effects.
Combining drug treatments and CBT
Ideally drug treatments should be combined with therapy such as CBT. Drugs reduce some of the anxiety and mood-related symptoms allowing CBT to be more effective.
Curative v Palliative
As we saw with Hollon’s study for depression, drugs are palliative. They reduce or remove the symptoms but don’t get to the root-cause of the problem. When we stop taking drugs the problems return. Therapy on the other hand does attempt to tackle the underlying causes and is therefore seen as curative. In the case of OCD, Maira et al (2001( found that symptoms return soon after medication is stopped.
Effectiveness
Soomro et al (2009) in a meta-analysis of 17 studies, found SSRIs to be more effective than placebo. They do reduce the symptoms of OCD. However, they don’t work for everyone. 30% of patients reported no improvement and in the 70% who did, sometimes the improvements were slight.
SSRIs do not work immediately. It may be many weeks before there are noticeable improvements. Often in the first few weeks there may be issues with increased anxiety and insomnia. Not ideal when you already have an anxiety disorder. Many people stop taking them during this period.
Costs
Drugs are cheap. They may not appear to be so when you pay for your prescription each month, but they are certainly cheaper than therapy.
Less time-consuming. It takes seconds to pop a few pills, therapy may take an hour a week for many weeks.
Less disruptive. People need to travel to hospitals or clinics for therapy. They may have to take time off work each week. Pills…
Side effects
All drugs have side effects. They don’t just affect the pathways in the brain that you want them to target. Other pathways carrying out other functions are also affected. Typically SSRIs bring dry mouth, constipation, blurred vision and erectile dysfunction (especially in men). The side effects of SNRIs tend to be more common and more serious. Weight gain, erectile dysfunction, aggressiveness and issues with the rhythm of the heart.
The ‘politics’ of psychopharmacology
Psychopharmacology is the branch of medicine that deals with the effects of drugs on thinking, behaviour, mood etc. It is big business and worth billions of pounds a year. There is a strong vested interest to show that unlike what The Verve say, the drugs do work! As a result it is thought that research showing success tends to be favoured for publication. Studies that suggest the drugs don’t work tend to be either glossed over or ‘published in a way that conveys a positive outcome.’
