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By Dr. David Woo - September 15, 2022
Welcome to Madison Avenue TMS & Psychiatry’s Mental Health in the News weekly update. Below are some current news events relating to mental health and mental health treatments.
Study Finds OCD Patients with Severe Symptoms Experience Relief with Deep TMS Treatment
The Journal of Psychiatric Research recently published the results of a double-blind study from Baylor College of Medicine that found that obsessive-compulsive disorder (OCD) patients with stronger symptoms are responsive to deep transcranial magnetic stimulation (dTMS). Deep TMS is a non-invasive, FDA-approved treatment that uses magnetic pulses to reduce OCD symptoms by regulating brain activity in target regions of the brain.
The study ran from 2014 to 2017, and observed 100 OCD patients whose symptoms were rated as severe (7%), moderate to severe (57%), and moderate (35%). Fifty OCD patients in one treatment group underwent 29 sessions of active dTMS treatments using an H-shaped coil over the course of six weeks, while 50 OCD patients in the control group received a sham (placebo) treatment. Participants in the active treatment group received dTMS that targeted the dorsal medial prefrontal cortex (dmPFC) and anterior cingulate cortex (ACC), areas responsible for regulating emotional behavior.
At the end of the trial, older age, lower baseline severity of OCD symptoms, and lower baseline disability were correlated with a faster reduction of symptoms following dTMS treatment. Using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), a standard scale used to quantify the severity of OCD symptoms, patients in the treatment group were recorded showing a 6.3-point average reduction from their baseline Y-BOCS scores, compared to a 4.4-point average reduction in sham group participants.
However, patients with higher Y-BOCS baseline scores (³28 points), and therefore more severe symptoms, demonstrated a more significant reduction of symptoms four weeks after dTMS treatment than those with less severe symptoms and lower baseline scores. At the end of the study, participants with more severe symptoms reported a 5.9-point average reduction in the active treatment group and a 2.0-point average reduction in the sham group. But at four weeks following dTMS treatment, the active treatment group reported a 7.1-point average reduction in symptoms and the sham treatment group reported a 2.9-point average reduction.
The results from this study suggest that TMS is a safe and effective treatment, with lasting effects, for patients with severe OCD symptoms.
To read the original news article, click here.
Correlation and Similarities between OCD and Depression
Obsessive-compulsive disorder, commonly referred to as OCD, affects approximately 1-3% of people worldwide and it’s estimated that 50% of those individuals also suffer from major depressive disorder.
As an anxiety disorder, OCD is characterized by persistent thoughts and compulsive behavior, such as obsessively:
- Counting
- Arranging
- Cleaning
- Repeating patterns or rituals
Depression is a mood disorder characterized by extreme sadness and other symptoms that last longer than two weeks. Symptoms of depression usually include:
- Depressive thoughts
- Loss of joy and interest in activities that one used to enjoy
- Inability to focus
- Changes in sleep patterns, such as insomnia or sleeping too much
- Changes in eating habits, like loss of appetite or overeating
- Thoughts of suicide or self-harm
Depression and OCD Often Co-Occur
Depression has been linked to OCD. The two conditions may even have some of the same precursors, and research shows that people with OCD have a 10 times greater risk of developing depression symptoms.
Research also shows that the brains of people with OCD and depression differ from people who do not have these conditions; they have anatomical differences of the hypothalamic-pituitary-adrenal axis, a region of the brain which helps regulate mood.
The symptomatic urges associated with depression and OCD also differ; OCD may drive someone to obsessive actions while depression may lead to self-harm or substance abuse.
Mental health professionals believe that the struggle of dealing with OCD symptoms, such as isolation or the inability to relax, may be catalysts for depression.
Treatments for OCD and Depression
Exposure and Response Prevention
Exposure and response prevention (ERP) is a type of behavioral therapy that focuses on exposing patients to experiences that provoke their stress and obsessions in a safe environment. The goal of ERP is to reduce anxiety by having patients confront their stressors, instead of avoiding them. ERP is a highly effective treatment for OCD. Still, it may not work for those experiencing depression, due to the fact that ERP requires significant motivation which depression may inhibit.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps patients recognize negative thought and behavioral patterns that can worsen depression or anxiety symptoms, and help them develop healthier patterns. CBT may help someone overcome certain depressive symptoms, like lack of motivation, so that they can be successfully treated for OCD.
Medication
Selective serotonin reuptake inhibitors (SSRI) are a type of antidepressant medication that is often prescribed to treat OCD and depression.
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation or TMS is a medication-free treatment that is FDA-approved to treat depression symptoms and OCD symptoms. When paired with talk therapy, TMS can help patients with difficult-to-treat depression and OCD find relief from their symptoms.
If you or someone you love are struggling with symptoms of OCD and/or depression, it’s important to get help. Seeking help early-on increases the likelihood that treatment will be successful and reduces the risk of relapse (symptom return).
To read the original news article, click here.
Brain Stimulation May Treat Loss of Smell Associated with COVID-19
A double-blind study shows that a brain stimulation therapy, called anodal transcranial direct current stimulation (A-tDCS), in addition to olfactory training may restore smell in patients with covid-related smell loss.
Researchers used A-tDCS – a noninvasive procedure that administers low-intensity electrical currents passed through the brain to regulate brain activity – and olfactory training to treat COVIDrelated anosmia or hyposmia (loss of sense of smell). A-tDCS is an affordable, safe, and simple procedure, and this was the first use of this treatment for this type of issue.
About 1% of people suffer from chronic anosmia or hyposmia after COVID-19. Studies suggest that this is related to changes in neuronal activity in the orbitofrontal cortex (OFC), an area of the brain that is responsible for smell perception. However, A-tDCS in this study was used to target the left prefrontal cortex, since A-tDCS cannot directly target the OFC region.
At the time of the study, participants had reported impaired smell for at least six months, had scored below 12 out of 48 on a standard olfactory performance test known as the “Sniffin’ Sticks” test, and had not taken medication for their symptoms.
For two weeks, participants underwent daily sessions that included 20-minute olfactory training and simultaneous treatment with sham-transcranial direct current stimulation. This was followed by two weeks of sessions using active A-tDCS, instead of sham treatment. When comparing the results of smell assessment tests from immediately after sham sessions, active treatment sessions, and three months after the last treatment session, researchers found statistically significant improvements after active treatment and three months after total treatment.
While these results are encouraging, researchers call for further studies with larger participant sizes and control groups to verify efficacy. There is currently no treatment for COVID-related smell loss.
To read the original news article, click here.
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