Obsessive-compulsive disorder (OCD) is a relatively common mental disorder, and if it's not promptly treated, it can be associated with significant distress and impairment in functioning. Unfortunately, many people who have OCD often wait many months or even years before seeking help. The primary reason for this delay is avoiding the stigma of being labeled as a person with a “mental disease."
Unfortunately, even when the disorder is diagnosed promptly, the treatment for OCD is not always successful. The mainstay of treatment for OCD is the use of pharmaceutical drugs combined with some type of behavior therapy. The first line of drugs for treatment of this disorder includes the SSRIs. Most people require doses higher than those required for depression, but the response is not immediate. Studies by Bart J. Nuttin, M.D., Ph.D., and his colleagues show that mood stabilization starts within several days after surgery, and the duration of benefit lasts anywhere from six to 21 months. Only about 30 to 50 percent of individuals see a reduction in symptoms, and many are left searching for other therapies (1).
In the last few years, deep brain stimulation has been attempted to treat a number of mental health disorders, including OCD. This minor neurosurgical procedure is only available at certain centers, and it is reserved for individuals who have severe and refractory symptoms of OCD. The procedure involves placement of electrodes into a localized part of the brain, and also implanting a small pacemaker-like device to stimulate the electrode and erase the symptoms.
Deep brain stimulation has only been performed in a few patients. The short-term results indicate that some patients with refractory OCD may benefit from this therapy. However, the procedure is also associated with risks like seizures, infection, insomnia, mild paralysis, shocking sensations and temporary pain. These complications may last for long periods, and are four times more common than in medically treated patients (2). In the last few years, Luc Mallet, M.D., Ph.D., and his colleagues have also identified other areas of the brain where electrode placement may help erase symptoms of OCD (3). The few patients who have benefited claim that depression and anxiety can improve, but the disorder is not cured.
So what should the patient with OCD do?
For now, deep brain stimulation is still considered experiential therapy. Implantation of electrodes into the brain is often described as a minor surgical procedure, but it still has the potential for many complications. The procedure is not curative and is prohibitively expensive ($30,000 plus physician and MRI fees). Prior to undertaking any such procedure, the patient is advised to read about the procedure, talk to people who have had it, and always seek a second opinion if there are any doubts. Just because a procedure is available and done, does not always mean that it helps patients.
1. Nuttin BJ, Gabriëls LA, Cosyns PR, Meyerson BA, Andréewitch S, Sunaert SG, Maes AF, Dupont PJ, Gybels JM, Gielen F, Demeulemeester HG. Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery. 2008 Jun;62(6 Suppl 3):966-77.
2. Deep Brain Stimulation Treatment For Advanced Parkinson's Disease Patients Provides Benefits, Risks. http://www.sciencedaily.com/releases/2009/01/090106161510.htm.
3. Mallet L, Polosan M, Jaafari N, Baup N, Welter ML, Fontaine D, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. 2008 Nov 13;359(20):2121-34
Reviewed June 29, 2011
Edited by Kate Kunkel