Can Deep Brain Stimulation Treat Severe Obsessive-Compulsive Disorder Long-Term?

What you need to know

• Deep brain stimulation (DBS) can significantly reduce symptoms in people with severe, treatment-resistant obsessive-compulsive disorder (OCD) over many years
• About 56% of patients treated with DBS had a major reduction in OCD symptoms long-term, compared to only 8% of patients who received standard treatment
• DBS also improved depression symptoms and overall functioning in many patients
• While DBS can have side effects, most were mild and temporary in this study

Deep Brain Stimulation as a Treatment for Severe OCD

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by recurring, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). For most people with OCD, standard treatments like cognitive-behavioral therapy and medication are effective. However, about 10% of patients have severe, treatment-resistant OCD that does not improve with these approaches.

For these individuals with extremely severe OCD that has not responded to other treatments, deep brain stimulation (DBS) has emerged as a potential option. DBS involves surgically implanting electrodes in specific areas of the brain and delivering electrical pulses to those regions. It has been used to treat movement disorders like Parkinson’s disease for many years.

A Long-Term Study of DBS for OCD

While previous research has suggested DBS may help with severe OCD, most studies have been small and short-term. This new study provides important long-term data on the effectiveness of DBS for treatment-resistant OCD.

The researchers followed 25 patients with severe OCD who received DBS treatment for an average of over 6 years. They compared these patients to a control group of 25 severe OCD patients who were offered DBS but declined and continued their usual treatment.

Significant Reduction in OCD Symptoms

The study found that DBS led to a substantial decrease in OCD symptoms that was maintained long-term:

• Patients treated with DBS had a 42.5% reduction in their scores on a standard OCD symptom scale (the Yale-Brown Obsessive Compulsive Scale or Y-BOCS).
• In contrast, patients who did not receive DBS only had a 4.8% reduction in Y-BOCS scores.
• 56% of DBS patients were considered “responders,” meaning their Y-BOCS scores decreased by more than 35%.
• An additional 28% of DBS patients were “partial responders” with a 25-35% reduction in Y-BOCS scores.
• Only 8% of patients in the control group were partial responders, and none met full response criteria.

This suggests that DBS can provide significant symptom relief for many patients with severe, treatment-resistant OCD, even years after the initial treatment.

Improvements in Depression and Functioning

In addition to reducing OCD symptoms, DBS also led to improvements in other areas:

• Scores on a depression rating scale decreased by 39.2% in the DBS group, compared to only 6.2% in the control group.
• Scores on a measure of overall functioning increased by 43.6% with DBS, versus just 4.2% in controls.

This indicates that DBS may have broader benefits beyond just OCD symptoms, improving mood and ability to function in daily life for many patients.

Side Effects and Safety

While DBS did cause some side effects, most were mild and temporary:

• The most common device-related side effects were feelings of tightness where the wires pass through the neck/ear (60%) and post-surgical headache (32%).
• Common other side effects included memory issues (44%), headache (40%), and insomnia (32%).
• More serious side effects like wound infections requiring device removal occurred in 12% of patients.
• Some patients experienced temporary psychiatric symptoms like hypomania (44%) or anxiety (28%).

Overall, DBS appeared to be reasonably well-tolerated, with most side effects resolving on their own or with adjustments to the stimulation settings. However, the potential for serious complications means DBS should only be considered for the most severe, treatment-resistant cases.

Who Might Benefit from DBS?

The researchers were not able to identify clear predictors of who would respond best to DBS treatment. Factors like age of OCD onset, gender, and types of OCD symptoms were not significantly associated with treatment response.

This suggests it may be difficult to predict in advance which severe OCD patients are most likely to benefit from DBS. More research is needed to potentially identify biomarkers or other characteristics that could help guide treatment selection.

Conclusions

• DBS appears to be an effective long-term treatment option for some patients with severe, treatment-resistant OCD
• About 56% of patients had a significant reduction in OCD symptoms that was maintained for years
• DBS also improved depression and overall functioning for many patients
• While generally well-tolerated, DBS can have side effects and should only be considered for the most severe cases that have not responded to other treatments
• More research is needed to better predict which patients are most likely to benefit from DBS for OCD

For patients with extremely severe OCD that has not improved with standard treatments, DBS may offer hope for long-lasting symptom relief and improved quality of life. However, given the invasive nature of the treatment and potential for side effects, the decision to pursue DBS should be made carefully in consultation with an experienced medical team. As our understanding of DBS for psychiatric conditions continues to advance, we may be able to better target and optimize this promising treatment approach for those who need it most.