Is Deep Brain Stimulation an Established Treatment for Severe OCD?

What you need to know

• Deep brain stimulation (DBS) is showing promise as a treatment for severe obsessive-compulsive disorder (OCD) that has not responded to other therapies.
• Two randomized controlled trials have shown positive effects of DBS for OCD, but more research is still needed before it can be considered a fully established treatment.
• DBS should only be considered for carefully selected patients with severe, treatment-resistant OCD after other options have been exhausted.
• Close collaboration between psychiatrists and neurosurgeons is essential when considering DBS for psychiatric conditions.

Deep brain stimulation as a treatment for OCD

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by recurring, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). For some people with severe OCD, standard treatments like cognitive-behavioral therapy and medication are not effective. In these cases, deep brain stimulation (DBS) is emerging as a potential treatment option.

DBS involves surgically implanting electrodes in specific areas of the brain and connecting them to a device that delivers electrical pulses. This can help regulate abnormal brain activity. While DBS is an established treatment for movement disorders like Parkinson’s disease, its use for psychiatric conditions is still considered experimental in many places.

Current evidence for DBS in OCD

The authors review the existing evidence for using DBS to treat severe, treatment-resistant OCD:

• Two blinded randomized controlled trials have been published, showing improvements in OCD symptoms with DBS. One study found a 37% improvement in symptoms, while the other found a 25% improvement.
• A clinical study of 70 patients showed a 40% reduction in OCD symptoms after 12 months of DBS treatment.
• An international study of 30 patients found a 42% improvement in symptoms after 12 months.

These results are promising, suggesting DBS can provide significant benefits for some patients with severe OCD that has not responded to other treatments. However, the authors note that more research is still needed before DBS can be considered a fully established therapy for OCD.

Safety considerations

The studies reviewed found that adverse effects of DBS for OCD were generally mild to moderate and often resolved by adjusting the stimulation settings. Some reported side effects included:

• Temporary symptoms of hypomania (elevated mood)
• Agitation
• Impulsivity
• Sleep disturbances

While encouraging, these findings highlight the need for careful patient selection and close monitoring when using DBS for psychiatric conditions. The procedure is not without risks, and patients require long-term follow-up care.

The role of psychiatrists

The authors emphasize that psychiatrists should play a central role in considering surgical treatments like DBS for psychiatric disorders. They note that relatively few psychiatrists currently refer patients for neurosurgical consultations, even in cases of severe, treatment-resistant OCD.

The paper argues that psychiatrists should take the initiative in evaluating when neurosurgical options may benefit a patient, after other evidence-based treatments have been thoroughly tried. Close collaboration between psychiatrists and neurosurgeons is essential to implement ethical, scientific programs for surgical treatment of refractory psychiatric conditions.

Current status of DBS for OCD

Based on their review of the evidence, the authors conclude that DBS for severe OCD should be considered an “emerging therapy” rather than an established treatment at this time. They note that at least one additional well-designed clinical trial will likely be needed before DBS for OCD meets the criteria for an established therapy.

In the meantime, DBS can be offered to carefully selected patients with treatment-resistant OCD, but with proper oversight. In the United States, review by an institutional review board is still required despite FDA approval of DBS for OCD under a humanitarian device exemption.

The authors recommend that clinicians consult their local institutional review boards or research ethics committees when undertaking DBS for OCD, as it is still considered investigational in many jurisdictions.

Conclusions

• DBS shows promise for treating severe OCD that has not responded to other therapies, but more research is needed before it can be considered fully established.
• DBS should only be considered for carefully selected patients after other evidence-based treatments have been exhausted.
• Close collaboration between psychiatrists and neurosurgeons is essential when evaluating surgical options for psychiatric conditions.
• More randomized controlled trials are needed to further evaluate DBS as a treatment for OCD and investigate optimal brain targets.
• Psychiatrists should take a more active role in driving research and clinical implementation of neurosurgical treatments for severe psychiatric disorders.

While DBS offers hope for some patients with otherwise treatment-resistant OCD, it remains a treatment of last resort that requires careful consideration of the potential risks and benefits for each individual patient. Ongoing research will help clarify its role in treating severe psychiatric conditions.