OCD alternative treatment

Question 1

Antidepressants side-effects (SSRIs)

Answer 1

Nausea
Sweating
Headache
Dry mouth
Drowsiness
Sexual

Question 2

Antidepressants and protocol

Answer 2

Work on serotonergic system
We’re not sure how it’s involved

Protocol:
1. start with SSRI max dose 3 mths (serotonin)
2. Switch to diff SSRI max dose 3mths (serotonin)
3. Switch to clomipramine (Tricyclic), max dose 3 mths (more side eff.) (serotonin)
4. Add low dose of antipsychotic 1mth (dopamine, 30% response rate)

Question 3

Duration

Answer 3

1-2 yrs continuation

No dosage lowering

Gradually lowering the dosage in case of prolonged remission. Stopping instantly is high risk of relapse.

Question 4

neuromodulation

Answer 4

10% don’t respond, they get neuromodulation.

Deep brain stimulation in basal ganglia. Connected to neurostimulator. Can take year to find the correct

Question 5

rTMS

Answer 5

Electromagnetic coil induces current in the brain. 3 week treatment, half hour per day, no side effects.

Effective target:
Low freq to preSMA
High freq to bilateral dorsolateral prefontal cortex
Low freq to right dlPFC (highest efficacy)

Mean Y-BOCS decrese 4 points

Question 6

Cortical-Striatal-Thalamo-Cortical Loop

Answer 6

This loop is involved in OCD. Higher activity in the CSTC circuit, this is modulated after rTMS treatment.

Question 7

DBS

Answer 7

Used for parkinson, first in motor loop bc of that.

In OCD, only max of 500 patients are treated w this.

The Motivational loop (vmPFC, ventral striatum and amygdala).
4 electrodes in the brain, can vary in voltage. Optimally 3-12 months.