Fact checked by Nick Blackmer
Fast Facts
- Deep brain stimulation (DBS) may be a helpful treatment option for people with severe obsessive-compulsive disorder (OCD).
- A new review found that DBS can cut symptoms of severe OCD in half.
- The treatment is not without risks, and is costly and commitment-heavy—but it may still help those for whom other OCD treatments have failed.
When other treatments are unsuccessful, some patients with severe obsessive-compulsive disorder (OCD) may benefit from deep brain stimulation—a therapy in which an implant delivers electric impulses to the brain.
The news comes from a recent review published in the Journal of Neurology, Neurosurgery, and Psychiatry, which found that deep brain stimulation (DBS) can cut symptoms of severe OCD in half—and two-thirds of patients experienced “substantial improvement” within two years.
“Two-thirds of patients will attain what we call a response,” lead study author Sameer Sheth, MD, PhD, associate professor of neurosurgery at Baylor College of Medicine, told Health. “That doesn’t mean they are cured,’’ he added, but their symptoms are reduced enough to improve their lives and relationships.
But while the results show promise for the therapy as treatment for severe OCD, researchers warn that it’s not without risks.
“While these results are encouraging, it is important to remember that [deep brain stimulation] is not without its limitations,” researchers wrote, noting that the therapy “requires chronic implantation of hardware and carries the associated risk of complications.”
Here’s a closer look at DBS, along with the potential benefits and risks of the therapy for severe OCD.
An Established and Growing Approach for OCD
Deep brain stimulation has been available for years, but the surgical procedure has gained acceptance slowly.
DBS has been approved for the treatment of movement disorders—specifically essential tremor and tremor in severe Parkinson’s disease—since 1996. Since then, it’s also been allowed as treatment for dystonia and OCD under a humanitarian device exemption, and it’s also been under investigation for other conditions like major depressive disorder, Alzheimer’s disease, and binge-eating disorder.
Placement of the device can take up to two separate surgeries: One to implant the electrodes into the affected brain areas (those used in decision-making and balancing emotions); the other to place a neurostimulator, connected to the electrodes, under the skin, usually near the collarbone.
Once the two are connected, the neurostimulator sends electric pulses to the electrodes in the brain, which can help control abnormal brain activity. In OCD, those electric pulses can also adjust for chemical imbalances in the brain that cause symptoms.
For the new research, Dr. Sheth and his team assessed the current evidence surrounding the efficacy of DBS in alleviating OCD. To do this, researchers conducted a systematic review and meta-analysis of previously published research and re-evaluated it.
“To really understand how well it may work, we have to do these meta analyses, which takes data from many studies and puts [it] all together so we can have a decent sample size,” said Dr. Sheth. Looking at all the available research and analyzing it in this way can help pinpoint how effective the procedure really is, he added.
The researchers included 31 studies conducted between 2005 and 2021 with 345 adults, average age 40, who had struggled with severe to extreme OCD for nearly 25 years. In addition to the OCD, many of the patients had depression, anxiety or personality disorders, which commonly accompany the OCD diagnosis. The follow-up was about two years.
Overall, 66% of the patients responded to DBS, the researchers found, with the patient’s symptoms reduced by about half.
Noticeable results and improvement are typically seen in a few months, according to Dr. Sheth, and with many patients, the DBS also improves their coexisting depression. About 1 in 5 had a serious side effect, such as stroke or a new OCD symptom.
About 10% or 20% of the estimated 7 million of OCD patients are severe enough to be candidates for DBS, said Dr. Sheth—that translates to about 7,000 people.
A Treatment Reserved for Most Serious Cases
The new research conducted by Dr. Sheth and his team confirms what is seen in clinical practice, according to Darin Dougherty, MD, director of the Division of Neurotherapeutics at Massachusetts General Hospital and associate professor of psychiatry at Harvard Medical School.
“The treatment is reserved for patients who have no benefit from all the conventional treatments,” said Dr. Dougherty, who was not involved in the study, but is an expert in DBS and OCD.
Those conventional treatments often include first-line therapies, like psychotherapy and certain medications including antidepressants and psychiatric drugs. Other treatment options—exposure and response prevention (ERP) and transcranial magnetic stimulation (TMS) therapies—may also be tried first.
But in people with severe OCD for whom those therapies did not work, a 66% response rate is not only remarkable, said Dr. Doherty, but “life-changing.”
“These patients are debilitated,” said Dr. Dougherty.
Dr. Sheth mentioned one woman whose OCD got so severe that she wasn’t able to leave her bedroom. Though she had sought treatment from psychiatrists and was prescribed several treatments, nothing seemed to quell her severe symptoms—until she tried DBS.
“She did a total 180,” Dr. Sheth said. “Her depression improved first, within weeks. Her mood was better, her anxiety less,” he added, and within months, her OCD symptoms had decreased greatly.
A Costly Procedure—and a Heavy Commitment
Deep brain stimulation is a commitment, with ongoing care and monitoring needed.
After implantation of the device, patients must avoid overexertion as healing progresses. At about four weeks, the physician turns on the neurostimulator. It can take a few months after that to notice results, according to the device maker.
Regular follow up visits to the clinic are needed so the neurostimulator programming can be checked and adjusted as needed. “It’s a lifelong treatment,” said Dr. Sheth.
Costs for DBS vary greatly, said Dr. Sheth, noting that it’s dependent on the hospital and the location. The device itself costs about $30,000, plus the costs for hospitalization, follow up visits and other services.
Insurance coverage is usually made on a case-by-case basis by private insurers as well as by Medicare and Medicaid, according to Medtronic, the maker of the device approved for OCD.
“We fight hard to get insurance to cover,” Sheth said. “Most of the time we are successful.”
As promising as the DBS is for OCD, Sheth said there’s a long way to go to better help those severely affected. Reducing the stigma of mental health issues is still needed, he said. Access to the device must be expanded. And insurance coverage should be better.
