Abstract
Improvement of obsessions and compulsions by deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) is often preceded by a rapid and transient mood elevation (hypomania). In a previous study we showed that improvement of mood by DBS for OCD is associated with a decreased activity of the hypothalamus–pituitary adrenal axis. The aim of our present study was to evaluate the time course of rapid clinical changes following DBS reactivation in more detail and to assess their association with additional neuroendocrine parameters. We included therapy-refractory OCD patients treated with DBS (>1 year) and performed a baseline assessment of symptoms, as well as plasma concentrations of thyroid-stimulating hormone (TSH), prolactin, growth hormone, copeptin and homovanillic acid. This was repeated after a 1-week DBS OFF condition. Next, we assessed the rapid effects of DBS reactivation by measuring psychiatric symptom changes using visual analog scales as well as repeated neuroendocrine measures after 30 min, 2 h and 6 h. OCD, anxiety and depressive symptoms markedly increased during the 1-week OFF condition and decreased again to a similar extent already 2 h after DBS reactivation. We found lower plasma prolactin (41% decrease, P=0.003) and TSH (39% decrease, P=0.003) levels during DBS OFF, which increased significantly already 30 min after DBS reactivation. The rapid and simultaneous increase in TSH and prolactin is likely to result from stimulation of hypothalamic thyrotropin-releasing hormone (TRH), which may underlie the commonly observed transient mood elevation following DBS.
Highlights
Deep brain stimulation (DBS) is an effective treatment for therapyresistant obsessive-compulsive disorder (OCD), with a mean 50% improvement of obsessive-compulsive symptoms.[1]
We investigated the long-term as well as the acute effects of DBS on plasma thyroid-stimulating hormone (TSH), prolactin, growth hormone (GH), copeptin and the dopamine metabolite homovanillic acid (HVA)
We found no significant changes after DBS reactivation for GH
Summary
Deep brain stimulation (DBS) is an effective treatment for therapyresistant obsessive-compulsive disorder (OCD), with a mean 50% improvement of obsessive-compulsive symptoms.[1] After finding optimal DBS parameter settings, improvement in obsessions and compulsions usually occurs within days to weeks.[2] This clinical response is often preceded by a rapid (minutes to hours) transient mood elevation or even hypomania (Luigjes J et al Hypomania as side effect of DBS in psychiatric patients, submitted). These rapid mood alterations have been suggested to predict a long-term response of DBS for OCD. The underlying mechanism of this transient mood elevation remains unknown
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