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Is Deep Brain Stimulation Able to Make Antidepressants Effective in Resistant Obsessive-Compulsive Disorder?

Published:November 24, 2011DOI:https://doi.org/10.1016/j.biopsych.2011.10.013
Is Deep Brain Stimulation Able to Make Antidepressants Effective in Resistant Obsessive-Compulsive Disorder?
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      Deep brain stimulation (DBS), a nonablative, reversible, and adjustable neurosurgical procedure, has recently been considered as a potential therapeutic alternative for the management of resistant obsessive-compulsive disorder (OCD). The ventral striatum (VS) has been proposed as a subcortical target of special interest for DBS (
      • Nuttin B.
      • Cosyns P.
      • Demeulemeester H.
      • Gybels J.
      • Meyerson B.
      Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder.
      Lancet. 1999; 354: 1526
      ,
      • Aouizerate B.
      • Martin-Guehl C.
      • Cuny E.
      • Guehl D.
      • Amieva H.
      • Benazzouz A.
      • et al.
      Deep brain stimulation for OCD and major depression.
      Am J Psychiatry. 2005; 162: 2192
      ,
      • Aouizerate B.
      • Cuny E.
      • Bardinet E.
      • Yelnik J.
      • Martin-Guehl C.
      • Rotge J.Y.
      • et al.
      Distinct striatal targets in treating obsessive-compulsive disorder and major depression.
      J Neurosurg. 2009; 111: 775-779
      ,
      • Denys D.
      • Mantione M.
      • Figee M.
      • van den Munckhof P.
      • Koerselman F.
      • Westenberg H.
      • et al.
      Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder.
      Arch Gen Psychiatry. 2010; 67: 1061-1068
      ,
      • Greenberg B.D.
      • Gabriels L.A.
      • Malone Jr, D.A.
      • Rezai A.R.
      • Friehs G.M.
      • Okun M.S.
      • et al.
      Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience.
      Mol Psychiatry. 2010; 15: 64-79
      ). It has been extensively demonstrated to play a major role in the pathophysiology of OCD regarding convergent functional neuroimaging data and electrophysiologic recordings (
      • Aouizerate B.
      • Guehl D.
      • Cuny E.
      • Rougier A.
      • Bioulac B.
      • Tignol J.
      • et al.
      Pathophysiology of obsessive-compulsive disorder: A necessary link between phenomenology, neuropsychology, imagery and physiology.
      Prog Neurobiol. 2004; 72: 195-221
      ,
      • Rotge J.Y.
      • Guehl D.
      • Dilharreguy B.
      • Cuny E.
      • Tignol J.
      • Bioulac B.
      • et al.
      Provocation of obsessive-compulsive symptoms: A quantitative voxel-based meta-analysis of functional neuroimaging studies.
      J Psychiatry Neurosci. 2008; 33: 405-412
      ,
      • Guehl D.
      • Benazzouz A.
      • Aouizerate B.
      • Cuny E.
      • Rotge J.Y.
      • Rougier A.
      • et al.
      Neuronal correlates of obsessions in the caudate nucleus.
      Biol Psychiatry. 2008; 63: 557-562
      ,
      • Haynes W.I.
      • Mallet L.
      High-frequency stimulation of deep brain structures in obsessive-compulsive disorder: the search for a valid circuit.
      Eur J Neurosci. 2010; 32: 1118-1127
      ). Here, we report the long-term course of OC symptoms during DBS of the VS and following its discontinuation in two patients suffering from severe, chronic, and incapacitating OCD and showing unsatisfactory responses to 1) the serotonin reuptake inhibitor (SRI) antidepressants fluoxetine, sertraline, paroxetine, fluvoxamine, and clomipramine; 2) augmentation with buspirone or lithium; and 3) adjunctive cognitive-behavioral therapy (
      • Aouizerate B.
      • Martin-Guehl C.
      • Cuny E.
      • Guehl D.
      • Amieva H.
      • Benazzouz A.
      • et al.
      Deep brain stimulation for OCD and major depression.
      Am J Psychiatry. 2005; 162: 2192
      ,
      • Aouizerate B.
      • Cuny E.
      • Bardinet E.
      • Yelnik J.
      • Martin-Guehl C.
      • Rotge J.Y.
      • et al.
      Distinct striatal targets in treating obsessive-compulsive disorder and major depression.
      J Neurosurg. 2009; 111: 775-779
      ). The standard instrument Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess clinical severity (
      • Goodman W.K.
      • Price L.H.
      • Rasmussen S.A.
      • Mazure C.
      • Fleischmann R.L.
      • Hill C.L.
      • et al.
      The Yale-Brown Obsessive Compulsive Scale I. Development, use, and reliability.
      Arch Gen Psychiatry. 1989; 46: 1006-1011
      ). Written informed consent was obtained after the study had been fully explained.
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      References

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        • Cosyns P.
        • Demeulemeester H.
        • Gybels J.
        • Meyerson B.
        Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder.
        Lancet. 1999; 354: 1526
        View in Article
        • Aouizerate B.
        • Martin-Guehl C.
        • Cuny E.
        • Guehl D.
        • Amieva H.
        • Benazzouz A.
        • et al.
        Deep brain stimulation for OCD and major depression.
        Am J Psychiatry. 2005; 162: 2192
        View in Article
        • Aouizerate B.
        • Cuny E.
        • Bardinet E.
        • Yelnik J.
        • Martin-Guehl C.
        • Rotge J.Y.
        • et al.
        Distinct striatal targets in treating obsessive-compulsive disorder and major depression.
        J Neurosurg. 2009; 111: 775-779
        View in Article
        • Denys D.
        • Mantione M.
        • Figee M.
        • van den Munckhof P.
        • Koerselman F.
        • Westenberg H.
        • et al.
        Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder.
        Arch Gen Psychiatry. 2010; 67: 1061-1068
        View in Article
        • Greenberg B.D.
        • Gabriels L.A.
        • Malone Jr, D.A.
        • Rezai A.R.
        • Friehs G.M.
        • Okun M.S.
        • et al.
        Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience.
        Mol Psychiatry. 2010; 15: 64-79
        View in Article
        • Aouizerate B.
        • Guehl D.
        • Cuny E.
        • Rougier A.
        • Bioulac B.
        • Tignol J.
        • et al.
        Pathophysiology of obsessive-compulsive disorder: A necessary link between phenomenology, neuropsychology, imagery and physiology.
        Prog Neurobiol. 2004; 72: 195-221
        View in Article
        • Rotge J.Y.
        • Guehl D.
        • Dilharreguy B.
        • Cuny E.
        • Tignol J.
        • Bioulac B.
        • et al.
        Provocation of obsessive-compulsive symptoms: A quantitative voxel-based meta-analysis of functional neuroimaging studies.
        J Psychiatry Neurosci. 2008; 33: 405-412
        View in Article
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        • Benazzouz A.
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        View in Article
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        High-frequency stimulation of deep brain structures in obsessive-compulsive disorder: the search for a valid circuit.
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        View in Article
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      Article info

      Publication history

      Published online: November 24, 2011

      Identification

      DOI: https://doi.org/10.1016/j.biopsych.2011.10.013

      Copyright

      © 2012 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

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