Deep brain stimulation among individuals with severe obsessive-compulsive disorder (OCD) who are resistant to pharmacological treatment shows significant improvement in symptoms of anxiety, depression, and functionality, in particular improvement in Yale Brown Obsessive Compulsive Scale (YBOCS) scores, according to results of a meta-analysis published in Psychiatry Research.
Researchers conducted a systematic review and meta-analysis of MEDLINE/PubMed, COCHRANE Library, Fisterra, SciELO, and Medes databases from inception through December 2020 without language restriction. A total of 303 patients from 25 studies who were evaluated before and after DBS were included in the analysis. All patients had previous DBS scores of at least 24 on the YBOCS and proved resistant to at least 12 weeks of treatment with high-dose selective serotonin reuptake inhibitors. Overall, global quality of included studies (10 case series, 6 observational studies, 8 double-blind clinical trials) was medium.
Among the 303 patients (mean age, 38.78±8.72 years; 44.85% women), the mean OCD duration was 21.31±8.76 years and the mean age at onset was 16±7.21 years. Most patients were undergoing pharmacological treatment during DBS (74.4% received antidepressants, 55.82% antipsychotics, 22.95% anxiolytics, and 10.34% mood stabilizers).
Patients with OCD who were resistant to pharmacological treatment showed significant improvement following DBS treatment for anxiety measured by the Hamilton Anxiety Rating Scale (5 studies; standardized mean difference [SMD]=1.00; 95% CI, 0.32-1.69; P =.004), depression measured by the Hamilton Depression Rating Scale (9 studies; SMD=1.19; 95% CI, 0.84-1.54; P <.0001), functionality measured by the Global Assessment of Function (7 studies; SMD=-3.51; 95% CI, -5.00 to -2.02; P =.005), and obsessive-compulsive symptoms measured by the YBOCS (25 studies; SMD=2.39; 95% CI, 1.91-2.87; P <.0001). Funnel plots were used to eliminate the likelihood of publication bias.
Limitations of the analysis include the use of primarily observational and case series studies, the clinical heterogeneity among these studies, and unaccounted for duration of analyzed studies.
Researchers concluded, “[T]his meta-analysis highlight the statistically significant effectiveness of DBS in patients with severe OCD who are resistant to conventional pharmacological treatments, underlying its role in global functioning apart from obsessive-compulsive symptoms.” They added, “[S]evere patients could have a significant reduction of obsessive-compulsive symptoms, however, a persistence of symptomatology has been described in almost 40% of patients.”
Cruz S, Gutiérrez-Rojas L, González-Domenech P, Díaz-Atienza F, Martínez-Ortega JM, Jiménez-Fernández S. Deep brain stimulation in obsessive-compulsive disorder: results from meta-analysis. Psychiatry Res. Published online September 28, 2022. doi:10.1016/j.psychres.2022.114869