Obsessive-compulsive disorder: Current and emerging treatment options
DOI:
https://doi.org/10.47611/jsrhs.v12i4.5492Keywords:
obsessive-compulsive disorder, OCD, cognitive behavioral therapy, exposure response therapy, ERP, SSRI, clomipramine, ketamine, Bergen 4-day treatment, Transcranial magnetic stimulation, TMS, CBTAbstract
Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder that can result in significant functional impairment. The cost to society is both direct due to increased healthcare costs and indirect due to reduced productivity. For patients, it can lead to profound disability and greatly affect their quality of life. Due to the complex nature of the disorder, both diagnosis and treatment are often delayed, leading to poorer outcomes. Currently, first-line treatments for OCD consist of psychotherapy, medications or both. Unfortunately, both interventions, in conjunction or as monotherapy, take several months to take effect. In addition, only a fraction of patients with OCD sees a sufficient response to treatment. As a result, it is important for researchers and health care providers to continue investigating new treatments that may be more efficacious or reduce the time it takes for patients to respond. Three such treatments - the Bergen 4-day treatment, ketamine, and transcranial magnetic stimulation - will be discussed as well as reviewing the currently recommended treatments.
Downloads
References or Bibliography
Adams, T. G., Bloch, M. H., & Pittenger, C. (2017). Intranasal Ketamine and Cognitive-Behavioral Therapy for
Treatment-Refractory Obsessive-Compulsive Disorder. Journal of clinical psychopharmacology, 37(2),
–271. https://doi.org/10.1097/JCP.0000000000000659
American Psychiatric Association (APA). (2007) Practice Guidelines for the Treatment of Patients with Obsessive-
Compulsive Disorder. American Psychiatric Association (APA).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition.
American Psychiatric Association.
Bandeira, I. D., Lins-Silva, D. H., Cavenaghi, V. B., Dorea-Bandeira, I., Faria-Guimarães, D., Barouh, J. L., Jesus-
Nunes, A. P., Beanes, G., Souza, L. S., Leal, G. C., Sanacora, G., Miguel, E. C., Sampaio, A. S., &
Quarantini, L. C. (2022). Ketamine in the Treatment of Obsessive-Compulsive Disorder: A Systematic
Review. Harvard review of psychiatry, 30(2), 135–145. https://doi.org/10.1097/HRP.0000000000000330
Bloch, M. H., Wasylink, S., Landeros-Weisenberger, A., Panza, K. E., Billingslea, E., Leckman, J. F., Krystal, J. H.,
Bhagwagar, Z., Sanacora, G., & Pittenger, C. (2012). Effects of ketamine in treatment-refractory obsessive-
compulsive disorder. Biological psychiatry, 72(11), 964–970.
https://doi.org/10.1016/j.biopsych.2012.05.028
Bottemanne, H. & Arnould, A. (2021) Ketamine Augmentation of Exposure Response Prevention Therapy for
Obsessive-compulsive Disorder. Innovations in clinical neuroscience, 18(10-12), 9-11.
Carmi, L., Tendler, A., Bystritsky, A., Hollander, E., Blumberger, D. M., Daskalakis, J., Ward, H., Lapidus, K.,
Goodman, W., Casuto, L., Feifel, D., Barnea-Ygael, N., Roth, Y., Zangen, A., & Zohar, J. (2019). Efficacy
and Safety of Deep Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Prospective
Multicenter Randomized Double-Blind Placebo-Controlled Trial. The American journal of
psychiatry, 176(11), 931–938. https://doi.org/10.1176/appi.ajp.2019.18101180
Davíðsdóttir, S. D., Sigurjónsdóttir, Ó., Ludvigsdóttir, S. J., Hansen, B., Laukvik, I. L., Hagen, K., Björgvinsson, T.,
& Kvale, G. (2019). Implementation of the Bergen 4-Day Treatment for Obsessive Compulsive Disorder in
Iceland. Clinical neuropsychiatry, 16(1), 33–38.
Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D.A., Rapinesi, C., Sani, G., Girardi, P.,
Kotzalidis, G.D., & Pompili, M. (2019). Psychopharmacological Treatment of Obsessive-Compulsive
Disorder (OCD). Current neuropharmacology 17(8), 710-736.
https://doi.org/10.2174/1570159X16666180813155017
Dell'Osso, B., Benatti, B., Grancini, B., Vismara, M., De Carlo, V., Cirnigliaro, G., Albert, U., & Viganò, C. (2019).
Investigating duration of illness and duration of untreated illness in obsessive compulsive disorder reveals
patients remain at length pharmacologically untreated. International journal of psychiatry in clinical
practice, 23(4), 311–313. https://doi.org/10.1080/13651501.2019.1621348
Dinur-Klein, L., Dannon, P., Hadar, A., Rosenberg, O., Roth, Y., Kotler, M., & Zangen, A. (2014). Smoking
cessation induced by deep repetitive transcranial magnetic stimulation of the prefrontal and insular cortices:
a prospective, randomized controlled trial. Biological psychiatry, 76(9), 742–749.
https://doi.org/10.1016/j.biopsych.2014.05.020
Fineberg, N. A., Pampaloni, I., Pallanti, S., Ipser, J., & Stein, D. J. (2007). Sustained response versus relapse: the
pharmacotherapeutic goal for obsessive-compulsive disorder. International clinical
psychopharmacology, 22(6), 313–322. https://doi.org/10.1097/YIC.0b013e32825ea312
Fineberg, N. A., Reghunandanan, S., Simpson, H. B., Phillips, K. A., Richter, M. A., Matthews, K., Stein, D. J.,
Sareen, J., Brown, A., Sookman, D., & Accreditation Task Force of The Canadian Institute for Obsessive
Compulsive Disorders (2015). Obsessive-compulsive disorder (OCD): Practical strategies for
pharmacological and somatic treatment in adults. Psychiatry research, 227(1), 114–125.
https://doi.org/10.1016/j.psychres.2014.12.003
Fineberg, N.A., Dell’Osso B., Albert U., Maina, G., Geller, D., Carmi, L., Sireau, N., Walitza, S., Grassi, G.,
Pallanti, S., Hollander, E., Brakoulias, V., Menchon, J.M., Marazziti, D., Ioannidis, K., Apergis-Schoute,
A., Stein, D.J., Cath, D.C., Veltman, D.J.,…Zohar, J. (2019). Early intervention for obsessive compulsive
disorder: An expert consensus statement. European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology, 29(4): 549-565. https://doi.org/10.1016/j.euroneuro.2019.02.002
Hansen, B., Hagen, K., Öst, L. G., Solem, S., & Kvale, G. (2018). The Bergen 4-Day OCD Treatment Delivered in a
Group Setting: 12-Month Follow-Up. Frontiers in psychology, 9, 639.
https://doi.org/10.3389/fpsyg.2018.00639
Hansen, B., Kvale, G., Hagen, K., Havnen, A., & Öst, L. G. (2019). The Bergen 4-day treatment for OCD: four
years follow-up of concentrated ERP in a clinical mental health setting. Cognitive behaviour
therapy, 48(2), 89–105. https://doi.org/10.1080/16506073.2018.1478447
Hirschtritt, M.E., Bloch, M.H., & Mathews, C.A. (2017). Obsessive-compulsive disorder: advances in diagnosis and
treatment. JAMA, 317(13): 1358-1367. https://doi.org/10.1001/jama.2017.2200
Isserles, M., Shalev, A. Y., Roth, Y., Peri, T., Kutz, I., Zlotnick, E., & Zangen, A. (2013). Effectiveness of deep
transcranial magnetic stimulation combined with a brief exposure procedure in post-traumatic stress
disorder--a pilot study. Brain stimulation, 6(3), 377–383. https://doi.org/10.1016/j.brs.2012.07.008
Kammen, A., Cavaleri, J., Lam, J., Frank, A. C., Mason, X., Choi, W., Penn, M., Brasfield, K., Van Noppen, B.,
Murray, S. B., & Lee, D. J. (2022). Neuromodulation of OCD: A review of invasive and non-invasive
methods. Frontiers in neurology, 13, 909264. https://doi.org/10.3389/fneur.2022.909264
Katerberg, H., Delucchi, K. L., Stewart, S. E., Lochner, C., Denys, D. A., Stack, D. E., Andresen, J. M., Grant, J. E.,
Kim, S. W., Williams, K. A., den Boer, J. A., van Balkom, A. J., Smit, J. H., van Oppen, P., Polman, A.,
Jenike, M. A., Stein, D. J., Mathews, C. A., & Cath, D. C. (2010). Symptom dimensions in OCD: item-level
factor analysis and heritability estimates. Behavior genetics, 40(4), 505–517.
https://doi.org/10.1007/s10519-010-9339-z
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence
and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey
Replication. Archives of general psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593
Koran, L.M., Hanna, G.I., Hollander, E., Nestadt, G., Simpson, H.B., & American Psychiatric Association (2007).
Practice guideline for the treatment of patients with obsessive-compulsive disorder. The American journal
of psychiatry, 164(7 Suppl), 5-53.
Launes, G., Hagen, K., Sunde, T., Öst, L. G., Klovning, I., Laukvik, I. L., Himle, J. A., Solem, S., Hystad, S. W.,
Hansen, B., & Kvale, G. (2019). A Randomized Controlled Trial of Concentrated ERP, Self-Help and
Waiting List for Obsessive-Compulsive Disorder: The Bergen 4-Day Treatment. Frontiers in
psychology, 10, 2500. https://doi.org/10.3389/fpsyg.2019.02500
Lenz, M., Galanis, C., Müller-Dahlhaus, F., Opitz, A., Wierenga, C.J., Szabó, G., Ziemann, U., Deller, T., Funke, K.
& Vlachos, A. (2016). Repetitive magnetic stimulation induces plasticity of inhibitory synapses. Nature
Communications, 7, 10020. https://doi.org/10.1038/ncomms10020
Liang, K., Li, H., Bu, X., Li, X., Cao, L., Liu, J., Gao, Y., Li, B., Qiu, C., Bao, W., Zhang, S., Hu, X., Xing, H.,
Gong, Q., & Huang, X. (2021). Efficacy and tolerability of repetitive transcranial magnetic stimulation for
the treatment of obsessive-compulsive disorder in adults: a systematic review and network meta-
analysis. Translational psychiatry, 11(1), 332. https://doi.org/10.1038/s41398-021-01453-0
Mataix-Cols, D., Wooderson, S., Lawrence, N., Brammer, M. J., Speckens, A., & Phillips, M. L. (2004). Distinct
neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive
disorder. Archives of general psychiatry, 61(6), 564–576. https://doi.org/10.1001/archpsyc.61.6.564
National Institute for Health and Care Excellence (NICE). (2005) Obsessive-compulsive disorder and body
dysmorphic disorder: treatment. National Institute for Health and Care Excellence (NICE).
Perera, M. P. N., Mallawaarachchi, S., Miljevic, A., Bailey, N. W., Herring, S. E., & Fitzgerald, P. B. (2021).
Repetitive Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Meta-analysis of
Randomized, Sham-Controlled Trials. Biological psychiatry. Cognitive neuroscience and
neuroimaging, 6(10), 947–960. https://doi.org/10.1016/j.bpsc.2021.03.010
Rapinesi, C., Kotzalidis, G. D., Ferracuti, S., Sani, G., Girardi, P., & Del Casale, A. (2019). Brain Stimulation in
Obsessive-Compulsive Disorder (OCD): A Systematic Review. Current neuropharmacology, 17(8), 787–
https://doi.org/10.2174/1570159X17666190409142555
Rasmussen, S.A., & Eisen, J.L. (1994). The epidemiology and differential diagnosis of obsessive compulsive
disorder. The Journal of clinical psychiatry, 55 Suppl, 5-14.
Reid, J.E., Laws, K.R., Drummond, L., Vismara, M., Grancini, B., Mpavaenda, D., & Fineberg, N.A. (2021)
Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-
compulsive disorder: A systematic review and meta-analysis of randomized controlled trials. Comprehensive Psychiatry, 106, 152223. https://doi.org/10.1016/j.comppsych.2021.152223
Rodriguez, C.I., Kegeles, L.S., Flood, P., & Simpson, H.B. (2011). Rapid Resolution of Obsessions After an Infusion
of Intravenous Ketamine in a Patient with Treatment-Resistant Obsessive-Compulsive Disorder: A Case
Report. (2011) Journal of clinical psychiatry, 72(4), 567-569. https://doi.org/10.4088/JCP.10I06653
Rodriguez, C. I., Kegeles, L. S., Levinson, A., Feng, T., Marcus, S. M., Vermes, D., Flood, P., & Simpson, H. B.
(2013). Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-
concept. Neuropsychopharmacology: official publication of the American College of
Neuropsychopharmacology, 38(12), 2475–2483. https://doi.org/10.1038/npp.2013.150
Rodriguez, C. I., Kegeles, L. S., Levinson, A., Ogden, R. T., Mao, X., Milak, M. S., Vermes, D., Xie, S., Hunter, L.,
Flood, P., Moore, H., Shungu, D. C., & Simpson, H. B. (2015). In vivo effects of ketamine on glutamate-
glutamine and gamma-aminobutyric acid in obsessive-compulsive disorder: Proof of concept. Psychiatry
research, 233(2), 141–147. https://doi.org/10.1016/j.pscychresns.2015.06.001
Ruscio, A.M., Stein, D.J., Chiu, W.T., & Kessler, R.C. (2010). The epidemiology of obsessive-compulsive disorder
in the National Comorbidity Survey Replication. Molecular psychiatry, 15(1), 53-63.
https://doi.org/10.1038/mp.2008.94
Sharma, L. P., Thamby, A., Balachander, S., Janardhanan, C. N., Jaisoorya, T. S., Arumugham, S. S., & Reddy, Y. C.
J. (2020). Clinical utility of repeated intravenous ketamine treatment for resistant obsessive-compulsive
disorder. Asian journal of psychiatry, 52, 102183. https://doi.org/10.1016/j.ajp.2020.102183
Simpson, H.B., Maher, M.J., Wang, Y., Bao, Y., Foa, E.B., & Franklin, M. (2011). Patient adherence predicts
outcome from cognitive-behavioral therapy in obsessive-compulsive disorder.
Journal of Consulting and Clinical Psychology, 79(2), 247-252. https://doi.org/10.1037/a0022659
Stein, D.J., Costa, D.L.C., Lochner, C., Miguel, E.C., Reddy, Y.C.J., Shavitt, R.G., van den Heuvel, O.A., &
Simpson, H.B. (2019). Obsessive-compulsive disorder. Nature reviews. Disease primers, 5(1): 52.
https://doi.org/10.1038/s41572-019-0102-3.
Szechtman, H., Harvey, B.H., Woody, E.Z., & Hoffman, K.L. (2020) The Psychopharmacology of Obsessive-
Compulsive Disorder: A Preclinical Roadmap. Pharmacological reviews, 72(1), 80-151.
https://doi.org/10.1124.pr.119.017772
Van den Eynde, F., Claudino, A. M., Mogg, A., Horrell, L., Stahl, D., Ribeiro, W., Uher, R., Campbell, I., &
Schmidt, U. (2010). Repetitive transcranial magnetic stimulation reduces cue-induced food craving in
bulimic disorders. Biological psychiatry, 67(8), 793–795. https://doi.org/10.1016/j.biopsych.2009.11.023
World Health Organization (WHO). (2008). The Global Burden of Disease: 2004 Update. World Health
Organization.
Published
How to Cite
Issue
Section
Copyright (c) 2023 Ella Kim; Scott Godsen
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright holder(s) granted JSR a perpetual, non-exclusive license to distriute & display this article.