The medications that can have a positive effect on symptom reduction in OCD are some of the antidepressants called Selective Serotonin Re-uptake Inhibitors (SSRIs).
Some researchers believe that in OCD sufferers there may be low levels of a neurotransmitter (chemical) in the brain called serotonin, which might be related to the actual cause of OCD.
The brain is made up of millions of interconnected brain cells (neurons). Messages travel along these cells rather like electricity down a wire, but when the message reaches the end of the neuron, it has to jump the gap (synapse) to the next cell or group of cells. This is achieved by the neuron releasing tiny amounts of a neurotransmitter into the gap between the nerve cells.
The receiving neuron has many places on its surface which act rather like locks, for which the appropriate neurotransmitter is the key. These are called receptors. When enough of the neurotransmitter has locked on to these receptors, a nerve impulse is started in the new nerve, and thus the message gets from one nerve to the next.
In order to allow the nerve to recover and receive the next message, and in order to replenish stocks of the neurotransmitter in the original neuron, ready to send the next message, the body has a clever way of removing the neurotransmitter from the receptors, and allowing it to be taken back into the originating nerve (re-uptake).
The SSRIs slow down the process of returning the serotonin to the end of the neuron it comes from. Thus, the SSRIs work by allowing the body to make the best use of the reduced amounts of serotonin that it has at the time. In due course, the levels of natural serotonin will rise again, and the SSRI can be reduced and withdrawn.
The
typically prescribed SSRIs for treating OCD include:
Fluoxetine
(Prozac)
Fluvoxamine
(Faverin)
Citalopram
(Cipramil)
Sertraline
(Lustral)
Paroxetine
(Seroxat) *
N.B. The names of these medications (indicated in brackets) are those employed in the UK pharmacological industry and may vary in the USA.
* New research suggests Seroxat may have the side effect of making patients suicidal.
This is not a conclusive list, and sufferers may often be prescribed additional medications to enhance or augment the effects of these SSRIs.
Typically, the process of determining the most suited medication for an individual is achieved on a trial-and-error basis. However, in order to allow its maximum effects to be adequately observed each medication should be taken for a specified time period (approx 12 weeks) before seeking out an alternative.
You may be offered other types of antidepressant, but only one, Clomipramine (its trade name is Anafranil), is licensed for treating OCD. SSRI medications have fewer side effects than Clomipramine, so current opinion is that Clomipramine should only be prescribed after at least one SSRI has been tried, or if you have tried Clomipramine before and it has helped you.
Many sufferers are apprehensive about taking medications because of their suggested addictive qualities (commonly as purported by the media). Generally speaking, these medications are not addictive, but they may sometimes have withdrawal symptoms.
Along with their anxiety-reducing effects all medications can cause unwanted side effects, which usually diminish as the body adjusts to the new medication. Finding the medication that works best for you is a matter of trial-and-error. Often what works on one sufferer’s OCD will not work on someone else’s. Speak to your GP or pharmacist or mental health professional if any of the following side effects occur or become troublesome:
Being
easily excitable Blurred
vision Confusion Difficulty
urinating (passing water) Discharge
from the nipples Drowsiness Dry
mouth Enlargement
of the breasts Fast
or fluttering heartbeat Feeling
sick Increased
appetite Sexual
problems Shakiness Skin
rashes Sweating Weight
gain
What is particularly serious, especially in young people, is that medication may cause thoughts of self-harm or suicide. If this happens, talk to your GP or pharmacist or mental health professional immediately. Family members should be asked to keep a close eye on young people taking medication, for signs of depression or self-harm.
It is generally believed that medication is best taken in conjunction with Cognitive Behavioural Therapy (CBT). While medication is often deemed effective as a short-term means of alleviating some of the symptoms of OCD, optimal recovery results are often achieved through coupling medication with psychological treatments such as CBT.
Jeffrey Schwartz M.D., Neuropsychiatrist at the UCLA School of Medicine, applies a metaphor of the administering of drug treatment in his book Brain Lock. He defines their principal purpose as similar to that served by ‘water wings’ (armbands) in the initial stages of learning to swim. They offer a means of keeping the sufferer ‘afloat’ while he or she is developing and consolidating the new psychological skills necessary to combat OCD longer-term. Thus, they are incredibly useful at the outset of treatment as a means of ameliorating the effects of psychotherapeutic intervention strategies such as CBT.
It's important to remember that what works for one person may not work for another.
Although the patient may stop taking SSRIs whenever s/he wishes, it is
sensible to reduce them under supervision from your GP.
SNRI's (Serotonin and Noradrenaline Reuptake Inhibitors)
SNRIs are slightly different to SSRIs in that they work to balance the
levels of both serotonin and norepinephrine in your brain and are sometimes
also prescribed to treat OCD, although it should be noted they are not
licensed to treat OCD.
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