DBS for OCD? OMG!
As I read on the Triage health blog at the Chicago Tribune, deep brain stimulation (DBS) has been approved by the FDA as a treatment for obsessive-compulsive disorder (OCD).
Medtronic was given "humanitarian device exemption" for its DBS device based on the data: 26 patients were shown to have a 40% reduction in their symptoms after using the device for a year.
It seems like a rather extreme therapy for such a disorder, and based on rather a small data set.
Plus this is certain to be precedent setting. It is the first time, according to Triage, that DBS has been approved for a psychological disorder. One can only guess that others will be sure to follow.
Summer Johnson, PhD
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I understand your initial reaction that this is a "a rather extreme therapy for such a disorder." I don't know if OCD just occurs to you as a minor disorder, or a nuisance. The reality is very different, particularly for those who are potential recipients of this new technology.
I think it is important to clarify the facts: the procedures are for people with severe illness who are not receiving appropriate benefit from current treatment. That is the reason for the humanitarian device exemption.
The question I have is whether one would consider surgery for treatment of a brain tumor or other intracranial disease? If a good surgical site could be found for OCD (as it has), is it any less acceptable to take advantage of that? I fear that the implication is that mental illnesses are somehow less real, a perception that professionals have worked hard to counter.
If, after looking at the data and nature of the disease and treatment, you had objections to it, I would certainly respect that. It is important to try to avoid knee-jerk reactions and sensationalism, if only because this blog appears in the top 10 results when searching for information about DBS for OCD. While most informed people would take this opinion with a grain of salt, I am concerned that those who could benefit could take this as fact. Even a blog can have a great impact, especially if the writer has a lot of credibility otherwise.
- by Concerned clinician on Feb 24, 2009 at 8:17 PM | link
I'm unclear on what, exactly, your objection is. I can see a basis in perhaps wanting more data prior to granting the waiver, but this post carries an undertone of disapproval of the whole notion of DBS for OCD.
"It seems like a rather extreme therapy for such a disorder" In my clinical experience, OCD is can be an incredibly debilitating disease. If medical management and therapy fail to adequately address symptoms, what possible ethical objection can there be to pursuing DBS as a further therapy?
Although, yes, I agree that the data are hardly compelling and this would best be done in the context of an RCT, there is nothing about DBS itself which sets off alarm bells in my mind; am I missing something?
- by Bimal P Chaudhari, MPH on Feb 27, 2009 at 11:55 AM | link