A comprehensive review published yesterday (Oct 28) has offered new insights into cutting-edge techniques that could help treat people with obsessive-compulsive disorder (OCD) who haven’t responded to conventional therapy.
The review examines three neuromodulation approaches that are transforming how clinicians treat severe OCD cases.
OCD affects roughly two per cent of the population, causing intrusive thoughts and repetitive behaviours that significantly disrupt daily life.
While medication and cognitive behavioural therapy remain standard treatments, up to 60 per cent of patients experience incomplete or poor response.
The research, led by Dr. Kevin Swierkosz-Lenart and Dr. Carolina Viegas from Lausanne University Hospital, along with Prof. Luc Mallet from Paris-Est Créteil University, focuses on techniques that normalise abnormal activity in brain networks underlying decision-making and emotion regulation.
Dr Viegas said: “We are witnessing a convergence of clinical psychiatry and systems neuroscience.
“Neuromodulation allows us to interact with the circuits that maintain obsessions and compulsions.”
Transcranial direct current stimulation (tDCS) delivers low-intensity electrical current through scalp electrodes to alter brain cell activity.
Early trials have shown mixed results, with researchers attributing inconsistencies to variations in electrode placement and treatment protocols.
Dr. Swierkosz-Lenart said: “tDCS remains appealing because it is accessible and safe.
“But we need rigorous standardisation and larger trials before it becomes part of mainstream clinical care.”
Repetitive transcranial magnetic stimulation (rTMS) uses rapidly changing magnetic fields to induce electrical currents in specific brain regions.
In 2018, the U.S. Food and Drug Administration approved deep rTMS for treatment-resistant OCD, and subsequent research has confirmed significant symptom improvements.
Dr Viegas said: “rTMS represents the first noninvasive neuromodulation technique to achieve regulatory approval for OCD.
“It has demonstrated clinical benefits, but we are still learning how to tailor parameters to the individual patient.”
For the most severe cases, deep brain stimulation (DBS) has emerged as an established option.
The procedure involves implanting electrodes into specific deep brain regions, connected to a pulse generator that delivers continuous electrical stimulation. Multiple trials have shown symptom reductions ranging from 35 to 60 per cent.
Dr Swierkosz-Lenart said: “DBS offers hope for individuals who have exhausted every other form of therapy.
The review emphasises that personalisation is central to future success—stimulation parameters and targets should match each patient’s unique brain anatomy and symptom profile.
Dr Viegas said: “Moving forward, we must integrate neuroimaging, electrophysiology, and computational modeling into daily clinical decision-making,.
“That is how we will achieve true precision psychiatry.”
