Magazine article Clinical Psychiatry News

Deep Brain Stimulation Shows Promise for OCD and TRD

Magazine article Clinical Psychiatry News

Deep Brain Stimulation Shows Promise for OCD and TRD

Article excerpt

SAVANNAH, GA. -- Deep brain stimulation shows potential for treatment of geriatric psychiatric disorders, particularly treatment-resistant depression and obsessive-compulsive disorder.

Deep brain stimulation (DBS), an effective therapy for Parkinson's disease and essential tremor, may hold promise for treatment of geriatric psychiatric disorders, Dr. Paul Holtzheimer said in a symposium on neuromodulation therapies at the meeting.

Research into DBS for treatment-resistant depression (TRD) and for obsessive-compulsive disorder (OCD), as well as for other psychiatric disorders, has been advancing, noted Dr. Holtzheimer of the department of psychiatry and behavioral sciences at Emory University, Atlanta. But more studies into efficacy, mechanisms of action, and side-effect profile--and especially long-term effects--are needed.

DBS delivers targeted electrical stimulation into the brain through a device that consists of an electrode connected to an insulated wire, inserted through a small opening in the skull. The wire is run under the skin of the head, neck, and shoulder, connecting the electrode to an implantable pulse generator (a "pacemaker"), which is implanted near the collarbone.

One advantage of a DBS device is that it can be tuned, Dr. Holtzheimer said. The electrode has four contacts, allowing the stimulation level to be adjusted and revised.

Implantation is a relatively safe procedure--"as simple as it can be," Dr. Holtzheimer said--with a low complication rate (around 10%). The most common complication is infection; stroke is a less common but far more worrisome one, he said.

Early research in TRD suggests efficacy and safety for subcallosal cingulate, ventral capsule/ventral striatum (VC/VS), and nucleus accumbens targets. Dr. Holtzheimer called the results so far "reasonably positive. …

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