A guideline-based perspective on neurostimulation in treatment-resistant obsessive-compulsive disorder: An international overview

Abstract

Background

Obsessive-compulsive disorder (OCD) is a severe psychiatric illness associated with substantial psychosocial burden. Although evidence-based first- and second-line treatments are often effective, a significant proportion of patients continue to experience treatment-resistant symptoms. In such cases, brain neurostimulation is gaining increasing attention. This study aims to provide a structured overview of national and international clinical guidelines for the management of treatment-resistant OCD, with a particular focus on neurostimulation techniques.

Materials and methods

Relevant clinical guidelines were identified and compared with respect to their recommendations on various neurostimulatory procedures. Among the approaches examined were transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), Deep Brain Stimulation (DBS), ablative neurosurgical procedures, and further techniques such as transcranial direct current stimulation (tDCS).

Results

Across guidelines, DBS is regarded as a potentially effective treatment option for carefully selected, severely affected patients. Its use is restricted to specialized centers and requires an interdisciplinary treatment approach. Ablative procedures are endorsed by certain guidelines solely in exceptionally severe cases. The evidence basis for TMS remains inconsistent, though certain stimulation protocols have shown short-term efficacy. For ECT and tDCS, current evidence is insufficient to support their use in targeting core OCD symptoms.

Conclusions

Overall, the reviewed guidelines emphasize the need for clearly defined indications, standardized treatment protocols, and continuous scientific evaluation. Invasive procedures are not considered standard treatment but represent highly specialized therapeutic options within interdisciplinary care frameworks.