We researchers do not yet have a precise understanding of exactly how deep brain stimulation works, but we do know that it normalizes the communication between parts of the brain responsible for taking in information and those responsible for acting on this information. These areas are hyperconnected in people with OCD, leading to a reduced ability to make thoughtful, value-driven decisions and an over-reliance on reflexive or habitual behaviors. And the changes induced by deep brain stimulation correlate with a reduction in OCD symptoms.

This type of neurostimulation is most commonly used to manage symptoms of Parkinson’s disease, a movement disorder that leads to tremors and body rigidity. OCD is the only psychiatric disorder that currently has approval from the Food and Drug Administration for deep brain stimulation treatment. But deep brain stimulation has been investigated in other conditions, including major depression, Tourette syndrome, schizophrenia, substance use disorders, post-traumatic stress disorder and eating disorders.

Deep brain stimulation is a procedure of last resort for patients with OCD. Because of the invasive nature of brain surgery and the potential for serious adverse effects such as infection or hemorrhage, individuals need to try standard, less invasive treatments first and meet the criteria for severe and persistent OCD, which have been established based on OCD and brain stimulation research.

But for those who do undergo the procedure for OCD treatment and receive ongoing stimulation, up to 70% have a good long-term response. “Good” is considered to be a 35% reduction in OCD symptoms based on a standardized scale for obsessive-compulsive behavior that experts in our field rely on.

This, for example, could mean that someone goes from spending more than eight hours per day on OCD behaviors and not leaving the house at all to spending four hours per day and being able to go to school with significant support. Such progress is remarkable, given how ill these individuals are.

There aren’t very many treatment centers anywhere in the world, so patients who need this procedure may have trouble getting to one. Additionally, as our team has described in published research, getting insurance coverage for the procedure is often time-consuming and sometimes prohibitive.

Another barrier is the stigma associated with brain surgery for psychiatric illness. The reasons behind this stigma are complicated, and some factors have historical roots. In the early to mid-1900s, destructive, dangerous and not very effective brain surgeries such as lobotomies were performed routinely for mental illness without regulation, ethical guidelines or regulatory oversight.

After I worked with Patel for about a year, including trials of six additional medications and ongoing exposure and response prevention therapy, his symptoms remained severe. I recommended he begin the extensive evaluation process for deep brain stimulation surgery.

Three weeks after his surgery, I turned on electrical stimulation, and we began the intensive programming procedure to determine the optimal settings. This process takes several hours a day over the course of several days, with fine-tuning in the following weeks and months.

Patel recalls that early on, during programming, he experienced a roller coaster of feelings, shifting between “giddiness and sadness.” Most individuals experience gradual improvement over the course of six to 12 months. At first, they feel happier and less anxious, and weeks to months later they experience a decrease in OCD symptoms.

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