Researchers from Amsterdam UMC and Maastricht UMC recently published a systematic review in the scientific journal Translational Psychiatry on the barriers and facilitating factors in the use of deep brain stimulation for obsessive-compulsive disorder and treatment-resistant depression.

What is deep brain stimulation?

Deep brain stimulation (DBS) is a treatment in which electrodes are placed in specific areas of the brain through a neurosurgical procedure. These electrodes then deliver continuous electrical impulses, influencing brain activity. The procedure is reversible: the stimulation can be adjusted or stopped. Side effects are generally mild and disappear when the settings are changed.

DBS has been successfully used for decades in neurological conditions such as Parkinson’s disease. Research now also shows convincing results for obsessive-compulsive disorder (OCD) and treatment-resistant depression.

Proven Effective — but Hardly Used

The effectiveness of DBS for OCD and treatment-resistant depression is well established. Scientific research shows significant improvements in quality of life, and the treatment has been found to be cost-saving in the long term compared to standard care. For OCD, DBS is included in the Dutch clinical guidelines and is reimbursed by health insurers.

To date, only around 600 patients worldwide have been treated with DBS for a psychiatric disorder. By comparison, for neurological conditions, the number is 300,000. This is a strikingly large difference, especially given that the severity of the conditions and the effectiveness of DBS are comparable. Even in the Netherlands, where DBS for OCD is fully reimbursed, the number of treatments remains low. Of the 225 patients with treatment-resistant depression who applied for DBS, only 9.2% ultimately underwent the procedure.

What Holds People Back?

The researchers analysed 28 scientific studies on the factors that hinder or facilitate the use of DBS for OCD and treatment-resistant depression. This revealed a wide range of barriers.

A major obstacle is stigma—both surrounding psychiatric disorders in general and, more specifically, neurosurgical treatments for these conditions. This negative perception is partly rooted in the past, when controversial brain surgeries for psychiatric patients caused significant harm. Negative media coverage of related treatments, such as electroconvulsive therapy, also plays a role. In addition, there are concerns—among both patients and clinicians—about possible changes in personality or identity after DBS. However, scientific research does not support these concerns: DBS reduces symptoms without fundamentally changing personality. On the contrary, patients with OCD who are successfully treated report a greater sense of freedom and autonomy.

There are also knowledge gaps among clinicians. Psychiatrists are not always familiar with the criteria for treatment resistance or with the referral procedures for DBS. As a result, patients who might benefit from DBS are not referred, or are referred too late. Neurosurgeons regularly encounter reluctance from psychiatrists when it comes to referrals, even when patients meet all the inclusion criteria.

Finally, limited accessibility is a practical barrier: there are only a few specialised centres where DBS for psychiatric disorders is performed and where patients can also receive long-term follow-up.

What Does Help?

The review identifies factors that can promote the use of DBS. Targeted education—for psychiatrists, but also for patients and the wider public—is the most frequently mentioned and promising approach. It is important that social media is also utilised, as this is the main source of information for many people and where misinformation is common. Improved collaboration between psychiatrists and neurosurgeons, clearer referral guidelines, and greater involvement of patients and patient organisations are also highlighted as important steps forward.

What Does This Mean for Patients and Clinicians?

For patients with severe OCD or long-term treatment-resistant depression, DBS is a treatment option that may be unjustly overlooked. The message from this research is that the barriers to accessing DBS are largely not medical in nature, but relate to knowledge, perception, and the organisation of care—and are therefore addressable.

For clinicians, this research underlines the importance of being familiar with referral criteria and of open communication with patients about all available treatment options, including DBS.

Source: Nedkad Diepe hersenstimulatie bij dwang en depressie: effectief, maar nog te weinig toegepast – Nedkad