February 2007

Acupuncture for Depression: Missing the Point
Depression-specific acupuncture was no better than nonspecific acupuncture for patients with major depression.

Adjunctive Galantamine in Schizophrenia
Galantamine (formerly Reminyl, currently Razadyne) added to risperidone (Risperdal) treatment for schizophrenia patients offered some benefits.

Adverse Effects of Erectile Dysfunction Drugs
Drugs for erectile dysfunction, such as sildenafil (Viagra) and vardenafil (Levitra), may worsen sleep apnea and can cause seizures.

Deep brain stimulation decreased obsessive compulsive symptoms in 10 patients.

Clozapine for Treatment-Resistant Schizophrenia
Clozapine (Clozaril and others) was superior to other second-generation antipsychotics for treatment-resistant patients with schizophrenia.

In Brief
Rasagiline Approved for Treatment of Parkinson's Disease; Paliperidone Approved for Treatment of Schizophrenia; PCOS Reversed When Valproate Discontinued.

Antipsychotics and New MIs
A large study suggests that antipsychotic drugs do not increase the risk of a new myocardial infarction (heart attack).

Take Ziprasidone with Food
Adequate absorption of ziprasidone is promoted by taking it with a meal that contains at least 30% fat.


February 2007

Obsessive compulsive disorder (OCD) can be extremely disabling. At their best, available treatments are imperfect (BTP 2006;29:28, 2004;27:22-23). For many patients, symptoms and functional impairment remain despite medication and behavioral therapy. In the past, the most difficult cases were sometimes referred for neurosurgical ablative procedures, such as anterior capsulotomy or anterior cingulotomy. More recently, deep brain stimulation (DBS) is being used for neurological and psychiatric disorders in lieu of ablation (BTP 2005;28:28-29).

Greenberg and coauthors have published a collaboration involving six male and four female adult patients with OCD who were treated with DBS.1 The subjects, aged 22 to 59 years, were implanted with electrodes in the anterior limb of the internal capsule. One patient died from cancer before the end of her first year. Another patient has been followed for only 2 years, while the remaining eight have been followed for 3 years. In two patients, stimulation was discontinued at 12 and 24 months, respectively, because of insufficient response.

The mean group scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) had decreased by over a third at 36 months. Four of the eight patients who reached 36 months had more than a 35% decrease in Y-BOCS severity. Improvement was also seen in depression, anxiety, self-care, independent living, and work, school, and social functioning. Surgical adverse effects included a small, asymptomatic intracerebral hemorrhage after lead insertion, which resolved without intervention; a seizure after lead implantation that responded to an anticonvulsant; and a superficial wound infection. Acute adverse effects included mood changes and motor effects. Five patients developed a transient elevation in mood. Six of nine patients who experienced DBS interruption (usually due to stimulator battery depletion) became depressed.

Obviously, DBS is an invasive procedure with accompanying risks. But these preliminary data are encouraging for this disabled population with OCD. Additional research clearly is warranted.

1Greenberg BD, Malone DA, Friehs GM, Rezai AR, Kubu CS, Malloy PF, Salloway SP, Okun MS, Goodman WK, Rasmussen SA: Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology 2006;31:2384-2393.