FAQ: Deep Brain Stimulation for Obsessive Compulsive Disorder

 

Who is Eligible for Deep Brain Stimulation for Obsessive Compulsive Disorder?


Eligible patients must be between 18 and 65 years old with severe OCD that does not respond to medications. There must be documented evidence of both severe symptoms and impairment for five years or more despite treatment with medications and behavioral therapy.

Patients must also be in good general health, able to understand and comply with instructions, and able to give full informed, written consent.

The severity of OCD can be measured using several tests administered by a psychiatrist (M.D.) or psychologist ( Ph.D). For potential treatment with DBS, patients must have OCD as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), confirmed by a Structured Clinical Interview for DSM-IV, and a Yale-Brown Obsessive Compulsive Scale severity score of at least 30.

What Medications Must Be Tried Before a Patient Can Be Considered for Deep Brain Stimulation for OCD?


Eligible patients must already have tried the following combinations of medications:
• Three different selective serotonin reuptake inhibitors (SSRI), taken at the maximum tolerable dose for at least 3 months (or documented inability to tolerate SSRIs)

• Clomipramine, either by itself or combined with another SSRI

• SSRI combined with clomipramine, clonazapam, and an antipsychotic (neuroleptic) for at least two weeks each

What Type of Behavioral Therapy Must Be Tried Before a Patient Can Be Considered for Deep Brain Stimulation for OCD?


Patients need to have done intensive cognitive behavioral therapy (CBT) at least twice a week, either inpatient or outpatient, and Exposure and Response Prevention (ERP) for 12 weeks minimum.

Patients must also have done at least 20 sessions of ERP with a therapist expert in OCD. One of these behavioral therapy trials must be in combination with medications.

Do Patients Need Medical Insurance?


Yes. Medicare is also accepted.

Who Is Not Eligible for Deep Brain Stimulation for OCD?


Patients with certain diagnoses in addition to their OCD are not eligible for DBS treatment. These diagnoses include:

• Psychotic Disorder – current or past diagnosis
• Bipolar Disorder – current or past diagnosis
• Neurological Disorder - current clinically significant neurological disorder or medical illness affecting brain function other than a tic disorder
• Substance Abuse – active substance abuse and/or positive urine toxicology screen
• Severe Personality Disorder – clinical history
• Suicide attempts - unable to control suicide attempts, imminent risk of suicide, history of serious suicidal behavior
• Body Dysmorphic Disorder – current diagnosis

Other criteria for ineligibility:

• Cognitive impairment that would affect patient’s ability to give informed consent or provide reliable self-report data
• Abnormal MRI. Normal MRI within 5 years is acceptable
• Inability to stop antiplatelet or anticoagulation therapy for surgery
• Pregnancy or women of childbearing age not using effective contraception, as determined by psychiatrist
• Inability to adhere to study requirements