How Does Deep Brain Stimulation Help Manage OCD? A Comprehensive Guide

Have you tried traditional OCD treatments but none of them have worked? Are you looking for an alternative way to treat your type of OCD because you are tired of struggling with non-stop obsessions and compulsions? If so, you may want to consider deep brain stimulation.

Obsessive-compulsive disorder (OCD) is a debilitating condition that affects people all around the globe. This common anxiety condition can cause people to struggle with intrusive thoughts, urges, images, fears, and/or repetitive behaviors. These thoughts and behaviors can significantly interfere with a person’s quality of life. Fortunately, there are treatments available to help manage OCD symptoms, so people with this condition can have more comfortable lives.

OCD treatment typically involves a combination of therapies like cognitive-behavioral therapy (CBT), exposure response and prevention (ERP) therapy, a form of CBT, and/or acceptance and commitment therapy (ACT), although other therapies, such as trauma, addiction, individual, family, and group therapies have been recommended as possible supplemental treatments.

In recent years, brain stimulation therapies have taken off as viable treatments for OCD and other mental health conditions. These therapies consist of transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), and deep brain stimulation (DBS). The most common brain stimulation for OCD is deep brain stimulation (DBS).

This comprehensive guide will discuss how deep brain stimulation helps manage OCD, the process of the surgery, and what the risks and benefits are. With the help of this guide, you will gain a better understanding of deep brain stimulation and how it may be a viable treatment option for OCD.

What is Deep Brain Stimulation?

Deep brain stimulation (DBS), a minimally invasive brain surgery that consists of implanting electrodes in certain areas of the brain and placing a generator in the chest to control the electrical pulses. The goal of DBS is to transmit electrical pulses or signals to specific areas of the brain. 

Although it is unclear exactly how DBS reduces anxiety, depression, or OCD, researchers suggest that the DBS pulses help to “reset” the malfunctioning brain regions, so they can function normally. These pulses help control the firing of the brain neurons that appear to be causing the various symptoms, diseases, and conditions, such as OCD. While DBS is often used to treat movement disorders like Parkinson’s disease, it can also be an effective treatment for mental health conditions like OCD. 

Similar to the non-invasive electroconvulsive therapy (ECT), deep brain stimulation (DBS) is a controversial treatment used to treat severe mood and mental health conditions. The only difference between the two procedures is that ECT sends a strong electrical current throughout the entire brain, while DBS only sends electrical pulses to the areas where it is needed.

Does Deep Brain Stimulation Have Side Effects?

Yes, similar to other medications, DBS does come with side effects, such as:

• Bleeding in the brain 
• Strokes
• Infections
• Disorientation or mental confusion
• Sudden and uncharacteristic mood swings or behavioral changes
• Mobility issues or movement disorders
• Lightheadedness or dizziness
• Sleep disorders like insomnia

Note: Understand that DBS is still being studied, therefore, some side effects may not be known at this time. As a result, the long-term benefits and side effects are still unknown.

Is Deep Brain Stimulation An FDA-Approved OCD Treatment?

Yes, it is. The FDA approved DBS for treatment-resistant OCD under a Humanitarian Device Exemption (HDE). HDE approval means that a small number of people can receive this treatment for their OCD. Understand, however, the placement of the electrodes, and the amount of stimulation administered is vital. Keep in mind that using DBS to treat treatment-resistant OCD is considered a very specialized procedure. 

Therefore, it is recommended that it be administered by medical professionals who have experience with this procedure. According to a 2021 study, DBS reduces moderate-to-severe OCD symptoms that were unable to be eased with traditional OCD treatments like psychotherapy and/or medication(s). Thus, DBS appears to be a promising therapy for people with treatment-resistant OCD.

How Does Deep Brain Stimulation Help Manage OCD?

Studies suggest that DBS can help reduce OCD symptoms by lowering levels of dopamine, a hormone/neurotransmitter in the brain. According to researchers, the two main parts of the brain that are involved in OCD are the basal ganglia and the cortex. The basal ganglia is responsible for producing dopamine, while the cortex is responsible for processing it. DBS is known for reducing dopamine levels in the basal ganglia, which may be why it is an effective OCD treatment.

The Process of Deep Brain Stimulation Surgery

Before undergoing deep brain stimulation surgery, you will meet with a medical team to discuss your symptoms, and determine if DBS is an appropriate treatment for your type of OCD. Next, your medical team will provide you with information on the procedure, so you can make an informed decision about whether or not you should have it done. 

If you and your medical team agree that DBS is the right treatment for you, you will be scheduled and prepped for the procedure. During the surgery, a medical team will make a small incision in the side of your scalp. Then, they will insert a thin wire with an electrode at the tip into the part of the brain that is responsible for regulating your moods and behaviors. 

Once the electrode is inserted into your brain, it is connected to a small device outside your body designed to send electrical pulses to the electrode, thereby stimulating a specific area of your brain. After the medical team has placed the electrode in the appropriate area of your brain, the device is turned on and electrical impulses are sent to the electrode. These pulses help reduce the OCD symptoms by increasing the amount of dopamine and lowering the amount of serotonin in your brain.

Are You Put To Sleep During the Deep Brain Stimulation Procedure?

Yes, you will be placed under general anesthesia during the procedure, so you will not feel anything.

Is Deep Brain Stimulation for OCD Safe?

It depends. 

While many researchers feel that DBS is a safe and effective treatment for people struggling with severe or treatment-resistant OCD, some researchers feel that there is not enough data or evidence to determine if it is truly safe for OCD sufferers. These researchers suggest that DBS be used in research instances, such as in clinical trials.

Risks and Benefits of Deep Brain Stimulation

Although DBS appears to be an effective treatment for some mental health conditions, it does carry some potential risks. These risks include headaches, mild cognitive impairment, infections, and the displacement of the generator or device. Long-term risks include hearing loss, blood clots, and worsening OCD symptoms. 

Other issues that can occur during the surgery include hemorrhaging, surgical site infections, and/or nerve or blood vessels damage. Even though there are risks to having DBS, many OCD sufferers report a significant improvement in their quality of life after having the procedure. For instance, some OCD sufferers need SSRIs or other medications for their OCD symptoms after having DBS. OCD sufferers who have the DBS procedure also report fewer and less distressing obsessions and/or compulsions. Moreover, some people with OCD experience an improvement in their OCD symptoms weeks or days after the procedure.

According to researchers, DBS does come with significant risks, such as a punctured blood vessel, which can lead to a stroke or stroke-like syndrome (i.e., weakness, numbness, sensory loss, visual difficulties, etc.), changes in mood, laughter, memory, severe infections, and in severe cases – death. Conversely, a 2017 study found that although costly, DBS may reduce OCD symptoms by 25%.

Who Is a Good Candidate for Deep Brain Stimulation?

To be a good candidate for deep brain stimulation, you must meet some criteria. People with severe and intractable OCD (OCD that has not been controlled with medication(s) or responded to other treatments) are good candidates for DBS treatment. Researchers suggest that DBS may also be an effective treatment option for people suffering from intractable OCD. In fact, people with this type of OCD may experience a significant reduction in OCD symptoms after getting the procedure. But keep in mind that DBS is only appropriate for patients, who are willing to and able to commit to lifelong monitoring and care. 

Thus, determining if deep brain stimulation could be a good treatment option will likely consist of you and your medical team reviewing your symptoms and medical history, and conducting a thorough assessment of your OCD symptoms. Your team may also have a serious discussion about the potential risks, side effects, and benefits of having the procedure for your type of OCD.

How Long Do The Effects of DBS For OCD Last? Does It Need to Be Repeated?

The length of time that the effects of DBS last varies from person to person, but it will likely need to be repeated at some point. In many cases, DBS will need to be repeated indefinitely to reap its benefits. Therefore, it is vital that you find a psychiatrist, who has extensive experience treating DBS, and who wants to be directly involved indefinitely in your care following the surgery.

What is It Like to Have Deep Brain Stimulation for OCD?

People who have had DBS once or many times describe it as being like a pacemaker for the brain. A cardiac pacemaker alters a person’s heart rate and activity, while DBS alters the rate and activity of the electrical pulses in the brain.

Listed below is an example of what it may be like to get deep brain stimulation for OCD:

“I actually know a woman whose daughter got deep brain stimulation a few years ago after a lifetime of trying every medication, treatment center, therapy, etc. available. She had such a severe case that she was chosen to be one of the first to get it for OCD, actually. It did not cure her and she is still not able to live a normal life (I believe she has moved into a housing unit where she can get some extra support, while maintaining as much of an independence as possible), but they feel like it has helped a lot. It was so bad for her that even a little bit helped.

It is a really big step, but if you really cannot function at all because of OCD, I definitely understand why you might give it serious consideration.

Edit: I just looked at something this woman wrote to friends a few days ago. Her daughter had DBS surgery again a week or two ago to adjust the amount of stimulation and to change the battery (her symptoms began 12-31-22 to worsen because her battery was low), but she noticed a lot of improvement in her OCD symptoms because of DBS.”

What Other Methods Can Be Combined with Deep Brain Stimulation?

A few weeks after having DBD for your OCD, you can add natural remedies like CBD, mindfulness meditation, and/or hypnotherapy/hypnosis to your treatment protocol if you still experience mild OCD symptoms. You can also turn to OCD helplines, podcasts, and forums if you need further information and support. Online OCD treatment programs, like Impulse Therapy, and OCD support groups are also good options if you continue to experience OCD symptoms from time to time. Understand that DBS may not take away all of your OCD symptoms (obsessions and/or compulsions) so it is important to ask for OCD help if you feel like your symptoms are returning.

Conclusion

Deep brain stimulation (DBS) has recently become a viable option for people with OCD. DBS is an invasive surgical procedure that involves sending electrical signals or pulses to specific areas of the brain in an effort to regulate or control severe or uncontrollable OCD symptoms. Although there are some potential risks and side effects associated with this procedure, many OCD sufferers experience a noticeable reduction and significant improvement in their quality of life following the procedure. 

Therefore, if you or someone you care about is struggling with moderate to severe, intractable OCD that cannot be controlled with medication(s) and has not responded to other treatments, like CBT or ERP therapy, deep brain stimulation (DBS) may be a viable alternative treatment option for you.

References

• Mar-Barrutia, L., Real, E., Segalás, C., Bertolín, S., Menchón, J. M., & Alonso, P. (2021). Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years. World Journal of Psychiatry, 11(9), 659–680. Retrieved from https://doi.org/10.5498/wjp.v11.i9.659
• Figee, M., de Koning, P., Klaassen, S., Vulink, N., Mantione, M., van den Munckhof, P., Schuurman, R., van Wingen, G., van Amelsvoort, T., Booij, J., & Denys, D. (2014). Deep brain stimulation induces striatal dopamine release in obsessive-compulsive disorder. Biological Psychiatry, 75(8), 647–652. Retrieved from https://doi.org/10.1016/j.biopsych.2013.06.021
• Huey, E. D., Zahn, R., Krueger, F., Moll, J., Kapogiannis, D., Wassermann, E. M., & Grafman, J. (2008). A psychological and neuroanatomical model of obsessive-compulsive disorder. The Journal of Neuropsychiatry and Clinical Neurosciences, 20(4), 390–408. Retrieved from https://doi.org/10.1176/jnp.2008.20.4.390
• University of Florida Health. (n.d.). What are the Risks of DBS? Retrieved from https://movementdisorders.ufhealth.org/for-patients/deep-brain-stimulation-information/uf-what-a-patient-needs-to-know-about-dbs/what-are-the-risks-of-dbs
• Moon, W., Kim, S. N., Park, S., Paek, S. H., & Kwon, J. S. (2017). The cost-effectiveness of deep brain stimulation for patients with treatment-resistant obsessive-compulsive disorder. Medicine, 96(27), e7397. Retrieved from https://doi.org/10.1097/MD.0000000000007397
• National Institute of Mental Health. (n.d.). Brain stimulation therapies. Retrieved from https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies
• Borron, B. M., & Dougherty, D. D. (2022). Deep brain stimulation for intractable obsessive-compulsive disorder and treatment-resistant depression. Focus (American Psychiatric Publishing), 20(1), 55–63. Retrieved from https://doi.org/10.1176/appi.focus.20210029
• International OCD Foundation. (n.d.) Deep brain stimulation. Retrieved from https://iocdf.org/about-ocd/ocd-treatment/dbs
• Tyulmankov, D., Tass, P. A., & Bokil, H. (2018). Periodic flashing coordinated reset stimulation paradigm reduces sensitivity to ON and OFF period durations. PloS one, 13(9), e0203782. Retrieved from https://doi.org/10.1371/journal.pone.0203782
• OCD UK. (2021). Deep brain stimulation (DBS) for OCD. Retrieved from https://www.ocduk.org/dbs-for-ocd
•  Blomstedt, P., Sjöberg, R. L., Hansson, M., Bodlund, O., & Hariz, M. I. (2013). Deep brain stimulation in the treatment of obsessive-compulsive disorder. World Neurosurgery, 80(6), e245–e253. Retrieved from https://doi.org/10.1016/j.wneu.2012.10.006