Deep Brain Stimulation for Obsessive-Compulsive Disorder and Major Depressive Disorder

Abstract

This chapter discusses the use of deep brain stimulation for obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). A subset of patients with OCD and depression are not responsive to medication or psychological/behavioral therapies. After other avenues of treatment have been attempted, neurosurgery, including DBS, has been used as a treatment for a very small number of patients with "intractable" OCD or depression. Although neurosurgery for psychiatric disorders has been conducted for decades, current techniques have evolved past the initial, relatively primitive methods. Surgical interventions include lesion procedures, with ablative surgeries requiring craniotomy, and radiosurgery that allows stereotactic lesion placement without craniotomy. Although not fully clarified, the pathophysiology of OCD appears to involve abnormal functioning in the medial and orbital frontal-basal ganglia- thalamic circuits. Lesions and stimulation in the anterior limb of the internal capsule, the anterior cingulate, and/or the subcaudate region, all of which are involved in this circuit, seem to be useful in the treatment of highly refractory OCD. Likewise, the pathophysiology of depression seems to be due to dysfunction in the interaction between limbic-cortical brain systems, including the prefrontal and cingulate cortex, the hippocampus, the striatum, the amygdala, and the hypothalamus. care. In February 2009, the FDA approved DBS for a humanitarian device exemption (HDE) for the treatment of OCD. The use of DBS for depression remains investigational. (PsycINFO Database Record (c) 2016 APA, all rights reserved)