Can Deep Brain Stimulation Help Treat Severe Obsessive-Compulsive Disorder?

What you need to know

• Deep brain stimulation (DBS) significantly improved OCD symptoms in people who hadn’t responded to standard treatments
• The treatment involves implanting electrodes that deliver electrical stimulation to a specific brain region called the bed nucleus of the stria terminalis
• Adding cognitive behavioral therapy (CBT) after DBS was working led to additional symptom improvement

What is Deep Brain Stimulation?

Deep brain stimulation is a surgical treatment where thin electrical wires (electrodes) are placed into specific areas of the brain. These electrodes are connected to a device similar to a pacemaker that is implanted under the skin of the chest. The device sends electrical pulses to the brain area being targeted.

DBS has been used successfully for over 25 years to treat movement disorders like Parkinson’s disease. More recently, researchers have been studying whether it can help treat severe psychiatric conditions like obsessive-compulsive disorder (OCD) that haven’t improved with standard treatments.

The Research Study

This study included 9 people with severe OCD who hadn’t improved after trying multiple medications and cognitive behavioral therapy. Each person had electrodes surgically implanted in an area of the brain called the bed nucleus of the stria terminalis (BNST). The BNST helps regulate anxiety and fear responses.

The study had several phases:

• First month after surgery: All devices were turned off to allow recovery
• Next 3 months: Participants were randomly assigned to have their device either turned on or kept off, while both they and the researchers assessing them didn’t know which group they were in
• Following 12 months: All devices were turned on and participants also received cognitive behavioral therapy

What They Found

During the 3-month blinded phase, the group with active DBS had significantly greater improvement in their OCD symptoms compared to the group with inactive devices.

After 12 months of all devices being turned on:

• 7 out of 9 participants (78%) had meaningful improvement in their OCD symptoms
• The average reduction in symptom severity was about 50%
• Adding cognitive behavioral therapy led to additional improvement
• Depression symptoms also improved significantly in most participants

How DBS May Work

The researchers used brain imaging to understand how DBS was helping. They found that the electrical stimulation affected brain circuits involved in:

• Processing fear and anxiety
• Emotion regulation
• Behavioral inhibition and control

Specifically, the stimulation seemed to help by:

• Modulating activity in the amygdala (a key brain region for processing fear)
• Improving communication between different brain regions
• Making it easier for participants to engage with therapy targeting their fears

Side Effects and Safety

Two serious device-related complications occurred:

• One participant developed an infection requiring removal of the device
• One participant needed an electrode repositioned during initial surgery

There were no serious psychiatric side effects from the stimulation. Some participants experienced mild effects like:

• Slight anxiety feelings at higher stimulation levels
• Changes in sleep patterns
• Decreased sex drive

Conclusions

• DBS of the BNST region appears to be a safe and effective treatment option for severe OCD that hasn’t responded to standard therapies
• The treatment works best when combined with cognitive behavioral therapy once symptoms begin improving
• The benefits seem to come from modulating brain circuits involved in fear, anxiety and behavioral control
• More research is still needed in larger groups of patients to further confirm these findings

Clinical Implications

This research suggests that DBS could provide hope for people with severe, treatment-resistant OCD. The ability to later add cognitive behavioral therapy successfully is particularly promising, since many people with severe OCD find therapy too overwhelming before their symptoms are partially controlled.

However, DBS is an invasive surgical procedure that requires careful patient selection and should only be considered after standard treatments have failed. The findings support DBS as part of a comprehensive treatment approach, not a standalone solution.