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For untreatable OCD, a deep-brain solution
February 18th, 2011
05:16 PM ET

For untreatable OCD, a deep-brain solution

Obsessive-compulsive disorder can be a severely disabling illness. People with this condition tend to have troubling, unwanted thoughts and engage in compulsive behaviors to try to neutralize those feelings.

About 2.2 million Americans over age 18 have it, according to the National Institutes of Mental Health. But in some cases, no medical or behavioral therapy intervention works, and patients' lives become entirely consumed with anxiety and obsessive rituals.

A more radical solution for those who don't improve with conventional methods is gaining support. It's called deep brain stimulation, and it involves implanting an electrode deep into the brain to deliver an electrical current directly in the circuitry scientists believe is involved in the disorder.

Dr. Benjamin Greenberg, a psychiatrist at Brown University and at Butler Hospital, presented the latest results from his research on deep brain stimulation Friday at the American Association for the Advancement of Science annual meeting in Washington, D.C.

Deep brain stimulation therapy for OCD involves an implanted device designed to be worn for life, somewhat akin to a cardiac pacemaker for someone with heart problems, except the wires go through a hole in the skull into the brain instead of the heart, he says.

In the United States, there are about 60 or 70 patients who have had deep brain stimulation for OCD since 2000, Greenspan said. But the technology has been used for Parkinson's disease and other disorders; about 70,000 people have deep brain stimulation devices worldwide, said Michael Okun, neurologist at the University of Florida.

Greenspan is doing a small NIH-supported controlled trial to investigate deep brain stimulation. His newest results using Medtronic electrodes suggest in eight or more years of followup, patients who showed initial improvement and continued the deep brain stimulation have less severe symptoms than they did initially. It is not an instant cure, but it improves functioning, he said.

"They gain a lot more time in the day where what they’re doing is not OCD," he said.

A device slightly different from Greenspan's can be obtained under a U.S. Food and Drug Administration "humanitarian device exemption." That means when there are less than 4,000 patients yearly who have a specific condition - in this case, untreatable OCD - the FDA can approve a device for which research and development costs may be bigger than market returns if full clinical trials were run.

But the technique is still controversial. Dr. Joseph Fins, chief of medical ethics at NewYork-Presbyterian/Weill Cornell Hospital, argued that there is not enough evidence to support having this therapy approved, and that its approval is putting patients at risk, in addition to restricting further scientific inquiry and benefiting the device manufacturers.

There are also, of course, documented side effects. Whenever you put something in the brain, there can be bleeding, which can have transient or permanent side effects. The rate of these is low, but it's still possible, Greenberg said. Infection and seizures at the time of the operation are also possible, and there's even the potential for seizures to emerge later in treatment. Behavioral side effects may include too much energy and trouble sleeping. And when a battery dies or a wire breaks or the patient goes through a metal detector, OCD symptoms get worse, sometimes very suddenly.

Deep brain stimulation is about as effective as permanent surgeries involving making lesions in the brain, although that's still being studied, Greenberg said. The advantage of deep brain stimulation is that the device is removable and adjustable, so the electrical current can be changed to suit the individual's treatment. But about half of patients who could choose this route instead elect surgical lesions because permanent surgery doesn't require maintaining a device or remaining connected to a specialized treatment center.

Deep brain stimulation is also being used in depression, targeted at the same brain circuits: Connecting the front part of the brain with deeper regions. These circuits are recognized as being key to behavioral disorders. There's a lot of commonality in the pharmacological treatments used in OCD and other mood disorders already, so it makes sense that deep brain stimulation would also target the same areas, Greenberg said.


soundoff (59 Responses)
  1. Bob Zmuda

    I am only lightly OCD and I'm very thankful for that fact. It makes my life a little challenging but certainly not impossible.

    February 19, 2011 at 01:10 | Report abuse | Reply
    • yeahitapain

      OCD is a PAIN. I have it. Why? I don't know.
      it really wears on the soul though I know that...
      I have stopped alot of my rituals on my own as I realized I had to live my
      life. but my case is not that deep like others. but to any one reading this...
      if you don't do ritual and you think you are gonna die. then your wrong.
      if you believe in God then you know that he has the final say on when you die.
      not some silly ritual. and thats what they are silly. the world was fine before your rituals and fine after.
      I had to learn that my self. A doctor told me once. when you feel your stress levels rise just let it go to the extream
      it will pass and all will be fine. just control your breathing. I still have panic attackes and I am not compleatly cured. but I am not a slave to OCD anymore.

      February 20, 2011 at 16:40 | Report abuse |
    • Bob

      Hey,
      I want to recommend a great book that has helped me tremendously with ocd, anxiety, and depression. It's called the UltraMind Solution. It talks about how our guts really are like a second brain and that we need to be treating it like our brain in terms of what we put in it. Take a look at it. Amazing studies. Hope it helps.

      February 21, 2011 at 08:16 | Report abuse |
  2. OCDave

    I have only for the past five years started to realize that I have OCD. Certainly, they cause me problems. One of the most difficult is explaining to other people what the OCD's are like. Especially when they result in behaviors that are not socially acceptable. Like morning rituals that make you late to work no matter how much you desire to be on time. Extreme dislike of large crowds or shopping areas. Things like that. Much of what I've read about various mental illnesses' symptoms is similar, which I decided is because they are all centered around problems with the same part of the brain. For example, anxiety disorders and OCD seem to be linked. At least in my case. Is it anxiety disorder that makes large crowds difficult, or a compulsion of some kind that just so happens to be centered around crowds and people? How closely are they related? I have other obsessions and compulsions that are benign, or even beneficial. One moment I can be relatively normal, and then I find an object of obsession. It can be a subject to learn. In which case, I will consume every last detail there is to know about the desired subject. Or if it's a song, painting or other project – all I can think about is this one consuming task. Maybe I find a new type of food I really like, then all I ever want to eat is that particular meal. Randomly, they come and go. But the worst part is at the end when those subjects of obsession are no longer interesting, they become bland. Emotionally, or taste-wise, they are like going from salted to unsalted chips. That film I obsessed about for months (and can't even tell you why) isn't possible to watch anymore. It triggers negative sensations. And I start to wonder how many different unique pieces of knowledge can I find before there's nothing left and all that's left is the negative feeling. The empty cup that needs filled. Then what?

    This I have not gotten an answer through research or talking to doctors. I have consulted with several; all seemed mostly interested in prescribing me with expensive drugs. Now I want to know more about this deep brain scan. I don't want to feel drugged. I want to escape the prison within my own mind. I want to be able to go places with my girlfriend and be able to keep my mind in the hear and now, instead of in my head, trapped inside my waking prison. That alter id which decides what I do without my control over it. People who are normal have no idea what it's like. I say this not for sympathy but as an honest observation. So the prison metaphor is the best description I could put on it. You are trapped by the OCD. You are the OCD. What people see of you, and your personality, is largely dictated by behaviors stemming from OCD. The trouble with the drug option is that it does not heal. I think they have the key if this method does heal the part of your brain necessary to for a functionally normal life.

    February 19, 2011 at 01:43 | Report abuse | Reply
    • Mike

      Your story sounds very similar to mine. I have ADD, moderate OCD and several characteristics of Asperger's Syndrome.

      Of the medications I've tried, Celexa (30 mg) has helped take the edge off the OCD with tolerable side effects. It's far from perfect, but has made life easier. Reading this article, I fantasized about the idea of having a procedure like this done. But with my luck I'd die in the OR and leave my wife and son without a husband/father. I think I'll stick with the goofballs.

      February 19, 2011 at 04:11 | Report abuse |
    • jay1

      Thank you for sharing your story. I, too, have OCD and find your prison metaphor extremely appropriate. I attend therapy regularly and take seven pills a day. I have suffered from drug addiction as a means to slow down my ever-racing mind. Frankly, the idea of a wire in my skull scares the crap out of me. I wonder to what degree it is a cure and to what degree the effects would be similar to medications. With my medicine, though I feel a degree of relief, the thoughts and behaviors are still always there.

      February 19, 2011 at 10:06 | Report abuse |
    • drtdwood

      Dave, thanks for sharing this. But I also want to encourage you not to discount the possibility of drug therapy. I'm talking from experience–I had SEVERE OCD and was becoming increasingly isolated in this world. I, too, was averse to drug therapy but I didn't see any other option at the time. Drug therapy proved extremely effective–while we did have to go to 60 mg of fluoxetine a day, it almost completely eliminated my obsessions. Today, a 40mg dose per day is still totally effective. I feel as if I have been "cured". The only side effect is that I seem to need more sleep, but with caffeine I can function extremely well and am productive. It's like a miracle. So please, at least be open to that treatment option. It made a huge difference in my life.

      February 19, 2011 at 12:03 | Report abuse |
    • Randy

      Dave: I feel your pain. I have had OCD/Hypochondriasis since I was about 13, am 31 now. I've had my ups and downs and recently had a major down spell, to the point where I was once again admitted to a pysch hospital (which as usual is pretty much worthless.) I did find this article interesting though because the doctor I worked with while in the hospital just last weak mentioned this treatment as an option to investigate. However, for me, and my overwhelming and consuming concerns about my health, this treatment would an absolute last resort for me. Too much risk and not enough history with it yet. I am still hoping they will come up with a 'miracle' pill but I am not holding my breathe. One of the most effective treatments according to the experts (along with some drug therapy) is cognative behavior therapy. The problem is, that therapy is usually too uncomfortable for most people to experience and therfore is infective. I am one of those people that struggles with it. I have tried several drugs and Paxil worked well for me several years and now has sort of lost it's effectivness. Doc's want me to try Abilify but you watch the commercial and even someone completely in their right mind would think twice about all the side effects of that drug. For now we increased paxil, switched from xanax to klonopin, and I am rely on God to make it all work. Good luck to you and all who suffer this nightmare.

      February 19, 2011 at 18:57 | Report abuse |
    • Ann

      Get "The OCD Workbook: Your Guide to Breaking Free from Obsessive Compulsive Disorder," by Bruce M. Hyman and Cherry Pedrick. I've found that it really helps a lot. Though it isn't a replacement for a licensed therapist or psychologist, it comes very close. In general, it's good to become as informed as possible with this disorder. Best of luck!

      February 19, 2011 at 19:11 | Report abuse |
    • sshaffer77

      As a person with OCD and ADD I will tell you that OCD IS an anxiety disorder. OCD is the way your body reacts to the situations that cause you to feel anxious. Although there are numerous drugs you can take, you might want to try some non-drug treatments too. There is the usual therapy but there is also Bio Feedback. If you haven't heard of it before, it is a way to work with your brain and "train" it to use naturally occurring brain ways in a more constructive way. It is mentally exhausting, but I found great results with it. Just remember that everyone is different and will react differently to treatments.

      February 19, 2011 at 21:00 | Report abuse |
    • LS

      Have you tried therapy with an OCD therapist?

      February 19, 2011 at 23:47 | Report abuse |
    • Steve Marklar

      http://www.anxiety-and-depression-solutions.com/articles/news/psychedelic_OCD_0307.php

      February 20, 2011 at 20:20 | Report abuse |
    • Bob

      Hey,
      I want to recommend a great book that has helped me tremendously with ocd, anxiety, and depression. It's called the UltraMind Solution. It talks about how our guts really are like a second brain and that we need to be treating it like our brain in terms of what we put in it. Take a look at it. Amazing studies. Hope it helps.

      February 21, 2011 at 08:17 | Report abuse |
    • Ohio

      My husband has ADD and OCD. With counseling and being put on Effexor 300mg, his OCD is under control. Yes, when the stress level is high his OCD does kick in more than normal. He is able now to CONTROL his OCD and NOT have the OCD control him. I feel for the person with the OCD, but you also feel for the significant other as this is a huge strain on them also.

      February 21, 2011 at 10:32 | Report abuse |
  3. QloQ

    I wonder if in another hundred years this tx will be regarded the same way we now regard using leeches to purify blood?

    February 19, 2011 at 01:48 | Report abuse | Reply
    • Thud

      The only thing worse than psychiatric illness is psychiatric treatment.

      February 19, 2011 at 23:28 | Report abuse |
  4. Moonslice

    Is the guy's name Greenberg or Greenspan?? Are these two people?

    February 19, 2011 at 02:38 | Report abuse | Reply
    • dew44

      It's Ben Greenberg. Greesspan was a typo.

      February 20, 2011 at 12:37 | Report abuse |
  5. QloQ

    It starts out as Greenberg, then becomes Greenspan, then is Greenberg again. Clark Kent...Superman...Clarke Kent?

    February 19, 2011 at 03:42 | Report abuse | Reply
  6. whiteonrice

    Did I turn the stove off?

    February 19, 2011 at 08:40 | Report abuse | Reply
    • Iron Celt

      We are NOT amused.

      February 19, 2011 at 12:47 | Report abuse |
    • Praveen

      and also

      Have a turned off the faucet ?
      Have I disconnected the iron box from the wall ?
      Have I locked the door ?

      Checking these ad-infinitum makes me so crazy. I carry the iron box with me, thats one off the list.
      Then, I tell myself, what the heck, I have insurance if something floods or burns down, inspite of the million times I check. Then, i walk out the house tired out, and then, sometime, drive back again, quickly to make another round of checks.

      And finally, did I lock that front door ? Keep yanking on it till it makes a lot of sound and your brain remembers that sound, and tells you, yes, you locked it.

      It can be sooo tiring and waste your time.

      February 19, 2011 at 16:12 | Report abuse |
    • DaisyinAZ

      Really? I have ocd and I thought it was hilarious! Laughter can be a very effective medicine 🙂

      February 20, 2011 at 22:50 | Report abuse |
  7. Tammy

    Its interesting research. If i were affected by ocd though i would want a few years standing behind it before making a decision on the use of something like this. Foreign objects in your brain..kind of scary. Dave you should write a book of your experience with ocd. You are very well written. Thanks for sharing your story.

    February 19, 2011 at 10:51 | Report abuse | Reply
    • Not-a-Yes Man

      I have suffered with this disease since I was 23 years old. I am now 63 and manage to get by but much of my life has been robbed by this illness. It has to be one of the worst mental maladies of any on the roster of them. My wanting to experience a lengthy life has probably been my biggest plus along the way, as I love life in general. Daily, I remind myself of the wonderfulness of life despite the shortcomings OCD has rendered me with. I am going to my doctor today for a change in medications for this problem, having never experienced a really good medicine that took away at least some of the symptoms of my rituals. Anyway, this invasive surgery sounds rather dangerous to me and when any doctor enters the skull and brain, there has to be serious concerns to address. So be it...I hope success continues with the various treatments for this bane on anyone's life who suffers with it.

      February 21, 2011 at 07:59 | Report abuse |
  8. Iwonder...

    Hmmm..."lives become entirely consumed with anxiety and obsessive rituals." Sure sounds like religiously-obsessed people all through history. Perhaps rather than being consumed by the 'spirit', they are just OCD, obsessing on a group fantasy. Preachers certainly play to the OCD by alternately heightening anxiety with fanciful descriptions of divine punishments, then holding out the lure of 'eternal life' if the adherents redouble their efforts to comply.

    February 19, 2011 at 11:28 | Report abuse | Reply
    • Jamie

      People are talking about debilitating medical disorders and you think it is appropriate to make such comments. Show some respect for other people and develop some compassion. Would you make such comments about cancer patients? To all those who suffer from this disorder I hope a cure is discovered soon.

      February 19, 2011 at 20:18 | Report abuse |
    • Fuyuko

      There are religiously obsessive OCD people. The condition is called scrupulousity.

      February 20, 2011 at 18:01 | Report abuse |
    • TJ

      If this was an attempt to be clever, it failed.

      This comment is so far from being appropriate, it's not even funny. OCD is an illness and you're using it to mock religion. Would you do the same with cancer patients? Probably not but then it appears you have no common sense what so ever.

      February 21, 2011 at 15:39 | Report abuse |
  9. Fellow sufferer

    @Dave Thank you for sharing your story. I suffer from very much the same problems. I take 800 mgs of seroquel 90 mgs of cymbalta and 45 mgs of remoron per day. All are required to keep my symptoms tolerable. I have had symptoms all my life. I selfmedicated with alcohol in my youth. Never realized what was wrong till 7 years ago. I have gained alot of weight due to meds but finally with the necessary meds i have stopped having mood swings and acting out. Still cannot deal with crowds but i pray as time goes on this too shall pass. Anyway thanks again Dave!

    February 19, 2011 at 11:55 | Report abuse | Reply
  10. Carolyn

    It's C D O. Not O C D. It must be in alphabetical order!

    February 19, 2011 at 13:18 | Report abuse | Reply
  11. Dennis

    Does it mean I'm OCD if everything in my house needs to be perfectly straight and symetrical. All labels facing forward, everything folded the same way, clothes hanging the same way sorted by color. Nothing out of place. Bending over to pick up a speck of dirt on the floor. No wrinkles on the bed.
    I start a task and get sidetracked because I see something else out of place, then forget what I started out doing.
    Only time I can relax is when I can't find anything else to clean.
    Certainly does interfere with the fun things in life, don't it?

    February 19, 2011 at 16:36 | Report abuse | Reply
    • Donna

      Sounds like you have a bit of ADD there too.

      February 21, 2011 at 15:06 | Report abuse |
  12. Bob Brown

    That's CDO ... in alphabetical order, the way it's *supposed* to be!

    February 19, 2011 at 17:04 | Report abuse | Reply
  13. Jen

    This is an intriguing study. I hope that more studies will be done to provie if it is efficacious. I suffer from depression and I can testify to its debilitating effects.

    February 19, 2011 at 18:36 | Report abuse | Reply
  14. Blessed Geek

    Greenspan vs Greenberg. Typo?

    February 19, 2011 at 23:06 | Report abuse | Reply
    • Has Same Question as Blessed Geek

      [Blessed Geek]: Greenspan vs Greenberg. Typo?

      February 21, 2011 at 00:43 | Report abuse |
  15. Lia

    OCD and Anxiety disorder run in my family. I've had OCD for years, and so has my sister, although she has it worse. I tend to be able to control my compulsions, most of the time. . I used to have the OCD Thoughts and they would last and torment me. However, what has worked for me is accepting the thoughts. Most OCD resist the presence of an unwelcome thought, and this dichotamy is what causes the compulsions, but accepting the thought- not the content, allows me to get on with business most of the time. Also desensitization via writing the thoughts out, and by reading them, has helped me desensitize. After a while I am so bored, I can't think about them.

    I'm glad more treatments are available. Books on cognitve behavioral therapy really helped me. The drugs also helped me, but they caused weight gain and had other unpleasant side affects. I found the habituation was the best for teaching me coping skills.

    Peace.

    This is a rotten anxiety disorder, but you can live with it.

    February 20, 2011 at 00:42 | Report abuse | Reply
  16. D

    I don't have OCD but reading the posts from those who do has given me a bit more of an understanding of what it must be like. I am inspired by seeing others share their experiences and helpful insights to others. Thanks, Dave!

    February 20, 2011 at 01:57 | Report abuse | Reply
  17. DB

    My child has OCD, as well as early onset bipolar disease, and ADHD. His 'imprisonment' is heartbreaking! I hope that this device, as well as others, and medications, continue to be studied to their fullest potential. Then maybe one day, there may be hope for my little boy . . .

    February 20, 2011 at 09:43 | Report abuse | Reply
    • Sandy

      Hang in there- my son is 19, with Apergers, ADHD and bipolar. My best advice is to do whatever he needs-even if it's incredibaly hard on you. If it comes to this, early inpatient treatment is MUCH easier to deal with then it would be when he's older. I wish we had been more aggressive in helping him (although we did a lot). There are so many more programs for kids than for young adults. Good luck and God bless you and your family

      February 21, 2011 at 12:12 | Report abuse |
  18. elijah smith

    Oh well if there's a chip that can make us smarter I will be first in line cnn

    February 20, 2011 at 16:14 | Report abuse | Reply
  19. Alex

    OCD can be really difficult to deal with and the information out there there is abundant. I find that a great place to find information on this is http://www.YourCity.md (no .com!) It is hyperlocal, so you can find doctors and hospitals in your area that specialize in OCD treatment. The best part is that all of the articles are doctor approved, so you dont have to worry about sorting through illegitimate opinioniated sites- everything there is completely reliable. The site is great for any health questions you have and the expert blogs and videos are not only interesting but also helpful. its a great site to check out for sure!

    February 20, 2011 at 16:14 | Report abuse | Reply
  20. needs an ocd proofreader

    If you're writing an article about OCD, you should have it proofread. You know we'll find all the errors.

    February 20, 2011 at 19:53 | Report abuse | Reply
  21. Bernie

    I am 53 and have had OCD since the last day of 8th grade at the water fountain. I have been on Clomiprimine for 20 years and have taken control of my ritiuals. I saw a Dr. for 5 years, but have been able to handle it, for the last 15 years. I work with the mentally ill.

    February 20, 2011 at 22:44 | Report abuse | Reply
    • brent

      bernie im 53 too and take chlomipramine and seroquel with the latter helping to alleviate ocd symptoms and sleep more normally.

      February 21, 2011 at 03:18 | Report abuse |
    • busted nut

      I'm curious...what da hell happened at the water fountain???

      February 21, 2011 at 14:11 | Report abuse |
  22. Steve

    I had severe OCD. I treated it by coming to the realization that I am sane but the world is crazy.

    Look at caged animals – they also frequently develop OCD. But there is nothing wrong with the animals – they are trapped and cannot escape. A cage is not a natural environment for those animals.

    People are animals. We respond similarly to stressful situations that we cannot resolve.

    If you have OCD and people tell you are crazy or broken, just ignore them because they will only set you back. Realize that you have LEARNED inappropriate cognitive behaviors for coping with stress. Through that path of realization lies successful treatment.

    The answer is within yourself: change your environment to better suit who you are and learn better methods for coping with stress.

    Good luck!

    February 21, 2011 at 11:10 | Report abuse | Reply
  23. nanarbor

    What is the psychiatric definition of OCD.? My mom was always calling my dad OCD, but if he hadn't been a 'checker' I swear the house would have burned down.

    February 21, 2011 at 13:50 | Report abuse | Reply
  24. Dee

    One thing the article doesn't mention is that it is only for severe OCD – and because it is still being "studied" you have to fit into their list of requirements before you can have it. Insurance won't pay for experimental stuff so the study grant $ has to be used. The rules don't allow anyone with other mental problems, you have to have failed at every med possible, you must have taken and failed 3 series of electric shock treatments, you must have had lots of cognitive exposure treatments, etc... So, since my son has autism and possible psychosis, and since I won't consider blasting him with electric shocks, he won't be able to get DBS. Even though we have done years of CBT, exposures, tons of meds, and he still suffers every minute from severe OCD. So, no humanitarian help for him!

    February 21, 2011 at 14:07 | Report abuse | Reply
  25. Sharon

    I had OCD as a child, but I'm OK now thanks to Prozac. Still get the thoughts occasionally, but have the ability to think that it's all silliness.

    February 21, 2011 at 15:42 | Report abuse | Reply
  26. Bwalt1

    Does any have any contact information for doctors using / testing DBS ? I have been on meds 20 years and each one failed, I am running out of options.

    February 21, 2011 at 17:49 | Report abuse | Reply
  27. Twocentworth

    For me, OCD started when I was 16 years old. All of a sudden I was convinced that I had a terrible disease, and even though my parents took my to the Dr's for blood tests and X-rays, I was still convinced I was gonna die. Now I'm 44, and I deal with it a little bit every day. When it comes on strong, it just feels like a tape recorder playing the same message over and over again. I have two kids now, and one of them is showing similar traits. It's very sad because this disease robs a part of your daily life and it just wears on you.

    May 12, 2011 at 01:05 | Report abuse | Reply
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