Dealing with resistant OCD. Other modalities
1 1. St.
John's Wort and OCD
Alternative
medicine such as herbal remedies have been growing in popularity in both Europe
and North America. Many people with anxiety disorders such as OCD
have tried alternative therapies at one time or another. One of the most
popular herbal remedies for anxiety is St. John's Wort. Because
antidepressant medications that target the serotonin system, such as Paroxetine and Clomipramine, are
effective in treating OCD, it has been suggested that St. John's Wort -- which
is said to also have antidepressant qualities -- could be an alternative
therapy for reducing OCD symptoms.
2.
Repetitive
Transcranial Magnetic Stimulation
r-TMS has got maximum popularity
in both Europe and North America as its is safest treatment modality. rTMS, is
a relatively non-invasive procedure that has received considerable attention as
a possible alternative treatment to reduce OCD symptoms. Repetitive TMS is a
relatively non-invasive procedure that involves placing a small device directly
on the skull. This sealed device contains a coil of wire that carries
electricity. The flow of electricity through the device causes cells in the
brain called neurons to become either more or less active. The activity level
of neurons has been linked to symptoms of mental illness like OCD. Recent
research has shown very good results of this treatment in Depression and OCD.
Also is approved by US-FDA.
3.
D-cycloserine
and Behavior Therapy
Psychotherapeutic
techniques such as exposure
and response prevention therapy are highly
effective in treating symptoms of OCD. However,
these treatments do not always work for
everyone, and the challenging nature of behavior therapy and the associated
cost cause many people to decline or drop out of treatment. Given this, there
has been a lot of interest in identifying ways that behavior therapy can be
made both more effective and accessible for more people. One possibility may be
to supplement behavior therapy with medication. A medication that has generated
a lot of interest with respect to this is the drug D-cycloserine.
4.
Exercise
and OCD
Most of us
are familiar with the many physical benefits of aerobic exercise, including
reduced cholesterol levels and lowered
risk of heart
disease and diabetes. However, there is growing
evidence that physical activity may also help to reduce symptoms of mental
illness. Indeed, it is now known that aerobic exercise can be used
therapeutically to improve mild to moderate symptoms of depression, as well as
reduce overall stress and anxiety levels. Recently, preliminary studies have
also examined whether aerobic exercise is helpful in reducing the severity of
OCD symptoms. Also Yoga and Pranayam helps in reducing anxiety symptoms.
5.
Deep
Brain Stimulation for OCD
Although a number of medications and psychological
therapies are available to treat OCD, it has been estimated that between 25 and
40% of people will not respond adequately to these first-line strategies. In
the past 20 years, the development of sophisticated brain imaging technologies,
such as functional
magnetic resonance imaging (FMRI) have led to an
explosive growth in our knowledge of the inner workings of the brain. Results
of these investigations have begun to explain the biological
and anatomical basis of OCD. In particular, these studies
have suggested that treatments targeting specific circuits in the brain could
be helpful in reducing OCD symptoms in those people who have severe symptoms
and do not respond to traditional treatment. Deep brain stimulation may offer
such a treatment.
Although there are many effective treatments for OCD, some people have
what is called treatment resistant OCD. Up to a third of people with OCD have
treatment resistant OCD and do not respond to standard treatment protocols.
Here are some options to consider when coping with treatment resistant OCD.
1. Explore Reasons Why Your Medication May Not Be
Working
Although there are many FDA
approved medications available for the treatment of OCD, medications do not
seem to work for one-third of people’s OCD symptoms. There are many reasons why
this can happen and there are things you can do about it.
2. Consider Augmentation Treatment Strategies
Augmentation therapy treats OCD
symptoms with medication. This strategy improves the odds of relieving symptoms
by using combinations of drugs, rather than a single drug. Augmentation
antidepressant treatment may be helpful for people who do not achieve remission
with mono-therapy.
3. Explore Reasons Why Psychotherapy May Not Be
Working
Although psychological treatments
have come to the forefront in the treatment of OCD, they are not always
effective. There are many reasons why psychotherapy for OCD may not be working
for you and there are things can do about it.
4. Investigate Intensive Treatment Programs
While there are many effective
medical and psychological treatments available for OCD, not all treatments work
for everybody. Unfortunately, for some people nothing seems to be effective. To
combat this, a number of intensive residential OCD treatment programs have been
developed.
5. Consider Taking Part in a Clinical Trial
There are a number of reasons why
people with OCD consider taking part in a clinical research trial. For
starters, clinical trials often offer cutting edge treatments that are not yet
widely available to the public.
6. Explore r-TMS, Psychosurgery and Deep Brain
Stimulation for Treatment-Resistant OCD
Although
a number of medications and psychological therapies are available for OCD, it
has been estimated that between 25 and 40% of people will not respond to
treatment. A very small minority of individuals with OCD have symptoms severe
enough to consider brain surgery. Surgical procedures for OCD involve
inactivating certain brain regions that are responsible for the symptoms
associated with OCD. In most cases, approximately 50% to 70% of people who have
these procedures see a significant improvement in symptoms. One of these
neurosurgical procedures is deep brain stimulation, which appears promising
although it is still in the experimental stage and often considered a last
resort.
In the last
20 years, the development of sophisticated brain imaging technologies such a functional
magnetic resonance imaging (FMRI) have led to an
explosive growth in our knowledge of the inner workings of the brain. Results
of these investigations have begun to explain the biological
and anatomical basis of OCD. In particular, these studies
have suggested that treatments targeting specific circuits in the brain could
be helpful in reducing OCD symptoms in those people who have severe symptoms
and do not respond to traditional treatment.
Repetitive
Transcranial Magnetic Stimulation & Deep brain stimulation may offer such a
treatment.
Deep Brain Stimulation - A Primer
Deep brain
stimulation is a technique that involves precise stimulation of particular
parts of the brain through the implantation of removable electrodes. rTMS is
non-invasive way of modulation. The way in which deep brain stimulation works
is still unknown, but it has been suggested that it restores normal activity to
areas of the brain that have become dysregulated.
Deep brain
stimulation and rTMS has shown considerable promise in the treatment of
movement disorders such as Parkinson’s disease, and there
is a growing body of evidence that it may be helpful for the treatment
of OCD.
Deep brain
stimulation and rTMS has a number of advantages over traditional brain surgery
for OCD.
·
Deep brain stimulation can be
used to treat symptoms with little risk of permanent changes in the brain.
·
The level of stimulation can
be adjusted up or down, and the stimulation can be used continuously or
intermittently depending on the treatment plan. This allows for greater
precision and tailoring of treatment.
·
The surgery is minimally
invasive, meaning there is a reduced potential for side effects. It is important
to keep in mind, however, that -- like any surgery -- there is risk of
complications or side effects, such as bleeding, infection or unanticipated
changes in symptoms or personality. For this reason, deep brain stimulation is
usually reserved for those people who have not responded to other forms of
treatment.
Deep Brain Stimulation and OCD
Deep brain stimulation for the
treatment of OCD has been evaluated in a handful of studies. However, because
different techniques have been used and diverse brain areas targeted, it has
been difficult to compare the results. These preliminary trials hold promise,
but it's important to note that this is still an unapproved and experimental
treatment for OCD.
Among the
most exciting of these studies is an investigation that
appeared in the New England Journal of Medicine. Over 10 months, half of
the 18 treatment-resistant patients enrolled in the study first received a
period of active stimulation of an area of the brain called the subthalamic
nucleus, followed by a period of placebo
stimulation. The other half of the patients received the placebo stimulation,
and then the real stimulation.
Following
active stimulation, the majority of patients showed a reduction in OCD symptoms as well as
an improvement in their overall ability to return to normal family life, engage
in new relationships or go back to work. Only a very small number of patients
achieved this while receiving the placebo stimulation.
Although this treatment did not work for
everyone, the results of this study are a very positive development in the treatment
of OCD. Future studies will have to further examine which brain areas to
target as well as determine the pattern of stimulation that works best.
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