What is exposure response treatment?

Write different types of antidepressant medication used

for body?

Obsessive compulsive disorder OCD is a disorder in which person has recurring

thoughts ,images ,sensations that compels them to perform certain actions or rituals

repetitively. Obsessions cause anxiety in the person in order to reduce that anxiety

person performs certain acts (compulsions)which make them rid of anxiety.Person

associates the two events the anxiety due to obsessions and the actions performed

which they link with improvement in the behaviour.After repeated associations they

think that action is bringing them the improvement and they perform them every time

they have obsessions. According to classical conditioning

Exposure Response Therapy:

Exposure response prevention technique is a behavioral therapy first developed by Psychiatrist

Victor Meyer in (1966).It is a technique that has been proven effective in treating Obsessive

compulsive disorder. It has been proven by the researches that between 55 and 85% of client

with obsessive compulsive disorder have been treated with exposure response prevention

technique. The Exposure in ERP refers to exposing yourself to the thoughts, images,

objects and situations that make you anxious and/or start your obsessions. While

the Response Prevention part of ERP, refers to making a choice not to do a

compulsive behavior once the anxiety or obsessions have been “triggered.” All of this
is done under the guidance of a therapist at the beginning — though you will

eventually learn to do your own ERP exercises to help manage your symptoms.

In exposure and response prevention therapy client is repeatedly exposed to siuations

or objects,images that produce anxiety and then they are instructed to resist the

response or action that they perform in order to eliminate the anxiety. The compulsive

behavior serves to "undo" or neutralize the anxiety that occurs when faced with an anxiety-

provoking situation. Since compulsive behaviors serve to reduce or eliminate anxiety they are

intrinsically rewarding. Therefore, they are repeated. Response prevention is based on a principle

of learning theory (specifically, operant conditioning). According to this principle, when a

behavior is no longer rewarded (reinforced) it becomes extinct. This means the behavior

gradually fades away. For instance, washing hands after contact with a doorknob serves to

"undo," or negate the anxiety that occurs after touching a doorknob. Response prevention

eliminates the rewarding effect of hand washing. As such, compulsive hand washing will

gradually become extinct.

The elimination (extinction) of rewarded behaviors (compulsive rituals, escape, and avoidance)

cannot be achieved unless these behaviors are prevented. Response prevention prevents these

behaviors from being rewarded. Once a behavior is no longer rewarded, it stops. Response

prevention is a necessary component of behavioral therapy in the treatment of obsessive-

compulsive disorder, body dysmorphic disorder, and hoarding. The combination of exposure to

anxiety-provoking stimuli, along with the prevention of rituals, escape, or avoidance leads to the

most effective treatment response. It should be evident that exposure and response prevention

therapies require the willingness to tolerate some discomfort until habituation develops.

Names of antidepressants and their actions in body?

Tetracyclic antidepressants (TeCAs):

Tetracyclic antidepressants (TeCAs) are a class of antidepressants that were first introduced in

the 1970s. They are named after their tetracyclic chemical structure, containing four rings of atoms,

and are closely related to the tricyclic antidepressants (TCAs), which contain three rings of atoms.

How tetracyclines work?

TeCAs do not inhibit the reuptake of serotonin[]. However, aside from mirtazapine, they do inhibit the

reuptake of norepinephrine[. TeCAs block the serotonin 5-HT2 receptors similarly to TCAs. Besides

mirtazapine, they also block the α1-adrenergic receptor[. Conversely, whereas TCAs have relatively

low affinity for the α2-adrenergic receptor, mianserin and mirtazapine potently antagonize this

receptor, and this action is thought to be involved in their antidepressant effects [. TeCAs block

the histamine H1 receptor similarly to the TCAs, but tend to be even stronger antihistamines than

TCAs. On the other hand, in to almost all TCAs, TeCAs have only low affinity for the muscarinic

acetylcholine receptors, and for this reason, are associated with few or no anticholinergic side

effects.Mianserin and mirtazapine are far less toxic than TCAs in overdose[1][2].

1. BUPROPION

Blocks alpha auto receptors on noradrenergic neurons and heteroceptors on 5-HT neurons

increases NA and 5 -HT neurons :increases NA and 5 HT release also blocks H1 -Receptors

2. TRAZADONE

Blocks 5-HT reuptake and 5-HT2 antagonist :blocks alpha -adrenergic receptors

3. MIANSERIN:

Mianserin increases NA release by blocking presynaptic alpha 2-receptors.

Tricyclic Antidepressants(TCAs):
  Tricyclic antidepressants (TCAs) are a class of antidepressant medications that

share a similar chemical structure and biological effects. Scientists believe that patients

with depression may have an imbalance in neurotransmitters, chemicals that nerves

make and use to communicate with other nerves. amitriptyline (Elavil),

 clomipramine (Anafranil),

 doxepin (Sinequan),

 imipramine (Tofranil),

 trimipramine (Surmontil),

 amoxapine (Amoxapine Tablets),

 desipramine (Norpramin),

 nortriptyline (Pamelor, Aventyl), and

 protriptyline (Vivactil).

MONOAMINE OXIDASE (MAOs):

Monoamine oxidase inhibitors (MAOIs) were the first type of antidepressant developed.

They're effective, but they've generally been replaced by antidepressants that are safer

and cause fewer side effects.

Antidepressants such as MAOIs ease depression by affecting chemical messengers

(neurotransmitters) used to communicate between brain cells. Like most

antidepressants, MAOIs work by ultimately effecting changes in the brain chemistry that

are operational in depression.

An enzyme called monoamine oxidase is involved in removing the neurotransmitters

norepinephrine, serotonin and dopamine from the brain. MAOIs prevent this from

happening, which makes more of these brain chemicals available to effect changes in

both cells and circuits that have been impacted by depression.

MAOIs also affect other neurotransmitters in the brain and digestive system, causing

side effects. MAOIs are sometimes used to treat conditions other than depression, such

as Parkinson's disease.

 Isocarboxazid (Marplan)

 Phenelzine (Nardil)

 Selegiline (Emsam)

 Tranylcypromine (Parnate)

ISOCARBOXAZID (Marplan):MAOs

Isocarboxazid works by irreversibly blocking the action of monoamine oxidases (MAO)

in the nervous system. MAO subtypes A and B are involved in the metabolism of

serotonin and catecholamine neurotransmitters such as epinephrine, norepinephrine,

and dopamine. Isocarboxazid, as a nonselective MAO inhibitor, binds irreversibly to

monoamine oxidase-A (MAO-A) and monoamine oxidase-B (MAO-B). 1 Isocarboxacid,

like other monoamine oxidase inhibitors, are unique psychopharmacological agents

whose clinical effect is related to the direct action of the monoamine oxidases to

transform them into reactive metabolites.

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)

Types of SSRIs

 citalopram (Cipramil)

 dapoxetine (Priligy)

 escitalopram (Cipralex)

 fluoxetine (Prozac or Oxactin)

 fluvoxamine (Faverin)

 paroxetine (Seroxasst)

 sertraline (Lustral)

 vortioxetine (Brintellix)

How it works?

SSRIs treat depression by increasing levels of serotonin in the brain. Serotonin is one of

the chemical messengers (neurotransmitters) that carry signals between brain nerve

cells (neurons).

SSRIs block the reabsorption (reuptake) of serotonin into neurons. This makes more

serotonin available to improve transmission of messages between neurons. SSRIs are

called selective because they mainly affect serotonin, not other neurotransmitters.

ESITALOPRAM mechanism of action:

Escitalopram is a selective serotonin reuptake inhibitor. The mechanism of action for SSRIs is to bind to

the serotonin transporter protein (SERT) and inhibit the reuptake of serotonin by the presynaptic

neuron.

FLUXETINE mechanism of action:

Fluoxetine exerts its effects by blocking the reuptake of serotonin into presynaptic serotonin

neurons by blocking the reuptake transporter protein located in the presynaptic terminal.

Fluoxetine also has mild activity at the 5HT2A and 5HT2C receptors.

Fluoxetine has minimal activity on noradrenergic reuptake. Due to its reuptake of serotonin,

fluoxetine produces an activating effect, and due to its long half-life (2 to 4 days), the initial

antidepressant effect emerges within 2 to 4 weeks. Fluoxetine's active metabolite is

norfluoxetine, which gets produced when the cytochrome P450 enzyme (CYP2D6) acts on it. It

is important to remember that fluoxetine has several drug-drug interactions due to its metabolism

at the CYP2D6 isoenzyme. Additionally, norfluoxetine can have an inhibitory effect on

CYP3A4. It is also important to keep in mind that fluoxetine has a half-life of 2 to 4 days, and its

active metabolite, norfluoxetine has a half-life of 7 to 9 days.[6][7]

FLUVOXAMINE:

Fluvoxamine is approved as immediate release and controlled release

formulations The immediate release formulation is approved for OCD and the

controlled release for OCD and social anxiety disorder. In the US, fluvoxamine

is not approved for the treatment of depression. However, it is approved for

this use in Europe, Australia, Latin America and other countries.

Serotonin and non-adrenaline reuptake inhibitors (SNRIs):

Inhibit the reuptake of serotonin and noradrenaline into the neuron(serotonin

and norepinephrine reuptake inhibitors).

 Venlafaxine

 Duloxetine

Describe and compare the effectiveness of EXPOSURE and response prevention

technique and anti-depressant medication as treatments for obsessive

compulsive disorder?

 In adults, ERP is as efficacious, if not more efficacious than existing, first-line pharmacological

treatments for OCD ( serotonin reuptake inhibitors (SRIs)). For example, in a randomized placebo-

controlled trial, (Foe etal )found that ERP alone and ERP + SRI were both superior to SRI alone in the

treatment of adults with OCD. Notably, there was no significant difference between the combined

treatment versus ERP monotherapy.In one research 45% to 89% of patients treated with SRIs have a

reoccurrence of OCD symptoms after medication discontinuation another research shows that

improvement after ERP tends to persist long-term. Further, adult patients who are nonresponsive to

medication have shown significant improvement in OCD symptoms when given ERP according to

research. Unlike adult studies, research in children and adolescents supports a combined approach to

treatment. Several RCTs have documented the superiority of ERP + SRIs compared to ERP alone for

youth with OCD. , several case studies have documented success using ERP to reduce OCD symptoms in

geriatric patients. Researchers have considered augmenting ERP to improve treatment outcome..

Overall, about 50–60% of patients who complete ERP treatment show clinically significant improvement

in OCD symptoms and treatment gains have shown to be maintained long-term. n Women who are

pregnant or are breastfeeding should weigh the decision to take these drugs with their doctor. If

severe OCD cannot be controlled any other way, research has indicated that these medications

seem to be safe. There might be several risk associated with taking Anafril or SSRI during

pregnancy complications in pregnant women may arise so exposure response prevention

therapy is more effective to choose in pregnancy to minimize complications. Some OCD patients

choose to use exposure and response prevention (ERP) to minimize medication use during the

first or last trimester of pregnancy. Similarly very elderly patients should avoid Antidepressants

since it has side effects can cause disturbance in the thinking of elderly patients and cause

confusion so exposure response therapy is more effective.Antidepressants have short term

effects and there are high chances of relapse in OCD patients while ERP has long term positive

effects and relapse chances are very low.There are lots of side effects such as

insomnia,dizziness,headaches, drowsiness,nausea ,dry mouth diarrhea there are OCD patients

who are intolerant to these side effects for them Exposure response therapy is best

suited.Patients with heart diseases should take special caution while taking antidepressents

such as Anafril fluoxetine for patients with OCD.