Is DBS for me? - Obsessive-Compulsive Disorder
Deep brain stimulation (DBS) is currently being used on a case-by-case basis for obsessive-compulsive disorder (OCD) under a Humanitarian Device Exemption (HDE) from the FDA. Patients must meet several criteria in order to be considered a candidate for DBS. This is the first psychological disorder that uses DBS for treatment, but it will most likely not be the last as more research is conducted into this groundbreaking therapy.
DBS works on patients with OCD by stimulating the region of the brain where circuits are working overtime. The electrical signal sent by the DBS device interrupts the overactive circuits, leading to reduced anxiety and reduced compulsive behaviors. This allows patients to participate more effectively in cognitive behavioral therapy (CBT) and/or respond to medication therapies. For this reason, DBS for OCD should be considered a treatment rather than a cure.
Dr. David VanSickle, MD, of the Denver DBS Center was recently featured on The Doctors for work he is doing with OCD patients.
OCD is an anxiety disorder that affects and disrupts a person’s life through unwanted or repeated thoughts, feelings, or behaviors that make them feel driven to do something. The person carries out a behavior to get rid of the repeated thoughts, but this only provides temporary relief, and not performing the behavior can cause even more anxiety.
There are many theories about the cause of OCD, none of which have been confirmed. More research is needed, but some specialists believe OCD may be related to Tourette syndrome, brain abnormalities, head injuries, or infections. It’s believed that overactive circuits in the brain add to a high level of anxiety. Patients engage in repetitive behaviors as a way of controlling this anxiety.
There are many types of obsessions and compulsions a person with OCD may experience. One example is a person with an obsessive fear of germs that leads them to wash their hands again and again in the hopes of avoiding infection. The person usually recognizes their behavior is excessive or unreasonable. OCD is best defined as obsessions or compulsions that:
- Are not caused by medical illness or drug use
- Cause distress or interfere with daily life
Your psychiatrist may be able to diagnose OCD based on a description of the behaviors and thoughts you have experienced. A physical exam with a psychiatric evaluation can rule out other possible physical or mental causes or disorders. One tool, called the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) can help diagnose and track the progress of OCD before and after treatment.
Treating OCD can involve multiple medications and therapies. Doctors often start medication therapy by prescribing anti-depressants. Variations on this type of drug may be tried alone or in combination.
Cognitive behavioral therapy (CBT) has been shown to be one of the most effective treatments for OCD. CBT places the patient in a situation that triggers the obsessive thoughts, allowing them to gradually tolerate the anxiety and resist the urge to perform the behavior. CBT may be combined with medication therapy for better results than either therapy by itself.
DBS is currently being used for OCD patients on a case-by-case basis under strict criteria.