Deep Brain Stimulation for Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) can sometimes be difficult to treat with medication and psychotherapy. For these patients, we may employ deep brain stimulation (DBS), an advanced surgical treatment that uses electrical impulses. At Mount Sinai’s Center for Neuromodulation, our experts design a treatment plan specific to you and your OCD symptoms. We strive to give you the best results while minimizing side effects.
How It Works
Brain scans help us locate the part of your brain that is causing your symptoms. We implant two electrodes into that area. We also implant a neurostimulator, a small device similar to a pacemaker, that delivers mild electrical signals. We put the device near your collarbone. Then we connect the electrodes, which carry the electrical current to the neurostimulator. This system lets us send electrical signals to your brain, which helps with your OCD symptoms.
Doctors use DBS for OCD patients when they are severely ill or other treatments have not worked. It is effective for about 60 percent of these patients. If you receive DBS, you will likely feel relief soon after the procedure. The effects are long-term. DBS patients can generally take less medication, which decreases their side effects.
DBS is a safe and effective treatment. The U.S. Food and Drug Administration has approved DBS for treatment-resistant OCD under a Humanitarian Device Exemption. Mount Sinai is one of the few places offering DBS. We have extensive experience with the procedure and have been using it for more than a decade. Very few people have any side effects from implanting the device. Rarely, it may cause bleeding (1 percent) or infection (3 percent) in the brain. These side effects—if they happen—hardly ever have permanent consequences. The electrical current itself has minimal side effects. Most patients with OCD consider DBS to be, overall, less burdensome than medication.
Our doctors will determine if DBS would be an effective and appropriate treatment for you. We consider the best candidates to be patients who have had severe OCD for at least five years, and who were not helped by the following treatments:
- Cognitive behavioral therapy, with exposure and response prevention by an expert therapist for at least 25 sessions
- Medication regiments including:
- Two rounds of treatment with an SSRI at maximum dosage, for 18 weeks
- Treatment with an SSRI at maximum dosage, combined with an antipsychotic
- Treatment with clomipramine at maximum dosage, for at least 12 weeks
Meet the Team
All our team members are expert in the use of neuromodulation.
Martijn Figee, MD, PhD
Dr. Figee is the lead psychiatrist for the Deep Brain Stimulation for Obsessive-Compulsive Disorder program. He is expert in the treatment of DBS for OCD. Dr. Figee assesses whether patients are eligible for DBS, assists with the surgery, and programs the neurostimulator.
Brian H. Kopell, MD
A neurosurgeon, Dr. Kopell implants the DBS device in patients.
He serves as Director of the Center for Neuromodulation. Having performed more than 1,000 DBS procedures, he is an expert in using DBS to treat OCD as well as movement disorders.
Amy Aloysi, MD
Dr. Aloysi is a psychiatrist and an expert in neuromodulation. Her expertise is in DBS and non-invasive strategies such as electroconvulsive therapy (ECT) for OCD and depression.
Helen S. Mayberg, MD
Dr. Mayberg is a neurologist and an expert in DBS. She serves as Director of The Friedman Brain Institute's Nash Family Center for Advanced Circuit Therapeutics. Her work involves researching the mechanisms of DBS for neuropsychiatric disorders.
Ki Sueng Choi, PhD
Dr. Choi is a neuroscientist and an expert in neuroimaging. He generates highly advanced brain scans. These scans help the team identify the most precise place to implant and optimize the stimulation of electrodes.
Allison Waters, PhD
Dr. Waters is a neuroscientist and psychologist, and is an expert in electrophysiology. She measures the brain activity associated with DBS, to address OCD.
Shannon O’Neill, PhD
Dr. O’Neill is a psychologist and expert in cognitive behavioral therapy (CBT). She uses CBT and other techniques to help patients minimize their remaining OCD symptoms after DBS is completed.