Several psychiatric conditions can benefit from neuromodulation including major depression, obsessive-compulsive disorder, and Tourette syndrome. Our expert team can help determine the best treatment modality for you or your loved one.
Obsessive-compulsive disorder (OCD) is a mental disorder that affects 3.3 million Americans (1 in 40 adults and 1 in 100 children). People suffering from OCD have unwanted and repeated thoughts, feelings, and/or mental images, known as obsessions. Examples can include fear of germs, need for order, and thoughts related to sex, religion, or harming oneself or others. They also engage in behaviors that drive them to do or think something repeatedly, known as compulsions. Compulsions can include checking and rechecking (e.g. locking the door), counting, organizing, hand washing, word repetition, and prayer. Often, the person carries out the compulsive behaviors to get rid of the obsessive thoughts, but this only provides short-term relief. In addition, not performing the compulsive rituals can cause great anxiety and distress.
People usually first experience symptoms of OCD between childhood and early adulthood. Though the cause of the disorder is currently unknown, research indicates that neurotransmitters are involved, as well as abnormalities in the circuits that connect the basal ganglia and frontal lobes of the brain. There is also a genetic component. If left untreated, OCD can be a chronic condition.
Treatment typically consists of behavioral therapy and medication, but these modalities do not work for everyone. For those with treatment-resistant OCD, neuromodulation techniques—transcranial magnetic stimulation (TMS) or deep brain stimulation (DBS)—have been shown to be effective in approximately 65 percent of cases.
TMS or DBS are considered as a treatment option if there is no response or an insufficient response to therapy and medication.
For DBS the below criteria also have to be met:
- Primary diagnosis of severe OCD for more than five years
- Age 18 to 75 years old
- No or insufficient response to:
- Two adequate trials of at least two different SSRIs for 12 weeks
- One adequate trial of clomipramine 225-300 mg for 12 weeks
- One adequate trial of augmentation with antipsychotic medication
- One adequate trial of CBT for OCD, defined as 25 hours of documented exposure and response prevention (ERP) by an expert therapist
- No other current unstable medical condition
- No schizophrenia or current psychotic disorder
- No primary axis II personality disorder
- No cerebrovascular risk factors or a previous stroke or major head trauma
- No cardiac pacemaker/defibrillator or other implanted devices
- No alcohol or substance abuse (including benzodiazepines) during the last six months
- No pregnancy
- No intellectual disabilities or cognitive impairment
Transcranial magnetic stimulation for OCD (if accompanied by depressive symptoms) at Mount Sinai is covered by Medicare, some types of Medicaid, and most insurance companies. We also provide a five-day course of accelerated TMS with or without accelerated exposure and response prevention for OCD as an additional out-of-pocket cost. Deep brain stimulation for OCD at Mount Sinai is covered by Medicare, Medicaid, and most insurance companies.
PBS Docuseries: Mysteries of Mental Illness
Tourette syndrome is a complex neurological disorder that causes motor and vocal tics repeatedly and can interfere with daily activities. These tics can range from simple to complex and include eye blinking, head jerking, jumping, grunting or throat-clearing, and touching an object repeatedly. Some people with the syndrome cannot control saying obscene or socially unacceptable words. If you have Tourette syndrome, you can usually suppress the motor and vocal tics temporarily, but with great stress. Often you feel a great need to reduce the associated anxiety, resulting in the repetition of tics.
We do not know what causes Tourette syndrome, but research indicates that neurotransmitters are involved as well as abnormalities in the circuits that connect the basal ganglia, frontal lobes, and cortex of the brain. There is also a genetic component.
People usually first experience symptoms in childhood, around elementary school years, and it subsides by early adulthood in more than two-thirds of cases. If you have a severe form of the disease, it can last into adulthood.
We offer both transcranial magnetic stimulation and deep brain stimulation for Tourette syndrome.
Most people feel a little sad now and then. Major depression, though, is very different. It is a serious medical condition that upsets your daily life over a long period of time. Major depression affects millions of Americans each year. People with major depression suffer from depressed mood or loss of interest or pleasure. In addition, they also have other symptoms, such as suicidal thoughts or problems with sleep, eating, energy, concentration, and self-image.
Researchers do not know what causes major depression. Studies suggest neurotransmitters are involved. In addition, depressed people often have abnormalities in the brain circuits that regulate emotions, motivation, and thoughts. Many other factors can also contribute. These include genetics, personality traits, substance abuse, trauma, and loss and other stressful life events. You can develop major depression at any age.
We offer transcranial magnetic stimulation, Electroconvulsive Therapy, Vagus Nerve Stimulation (VNS), and experimental deep brain stimulation for depression.
PBS Healthy Minds With Jeffrey Borenstein, MD
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