FDA Approves “deep brain stimulation” for OCD

The Food and Drug Administration has approved “deep brain stimulation” for treatment resistant obsessive-compulsive disorder, or OCD. This is the first instance that this procedure, which involves the surgical implantation of electrodes deep within the brain to trigger electrical activity, has been approved for use in a psychiatric syndrome. The implants have previously been used to treat movement disorders, mostly notably Parkinson’s disease.

Once the electrodes are surgically in place, clinicians control how the electrical impulses are delivered to the brain via a battery-operated, pacemaker device outside of the body. Through a trial and error process, physicians assess what electrical activity patterns are most apt to help patients while producing the least side effects.

Obsessive-compulsive disorder is an anxiety condition characterized by persistent thoughts and compulsions. It is a chronic condition fraught with considerable suffering, shame, guilt and self-doubt, and is often incapacitating as well. Obsessions are recurring anxiety-producing thoughts such as a fear of contamination, or “germophobia,” and safety concerns. Compulsions are ritualistic behavioral responses performed in response to obsessions. Common compulsions include repeated washing of the hands and repeated checking of door and window locks.

FDA approval of deep brain stimulation for OCD suggests that this regulatory body believes that this procedure might help ameliorate anxiety – a dominant factor in the disorder. The technique is reserved for intractable obsessive-compulsive disorder when conventional management, such as cognitive-behavioral therapies and medication, has failed to generate measurable results.

The device approved by the FDA is named Reclaim and is manufactured by Medtronic Inc. of Minneapolis, Minnesota.

The Power of Initiative: An Observation from my Recent Trip to Seattle

A couple of weeks ago, I presented three psychopharmacology seminars in the Spokane/Seattle area. On the day of my departure from Seattle, a misty rain was falling making for a slow go to the airport. After dropping off the rental car, I scurried into the main terminal arriving at the security checkpoint 45 minutes prior to my flight. There were at least a hundred people ahead of me, and my Seattle to Denver flight was on time. If I made it to the gate, it was going to be very close.

As I scanned the line ahead of me, I noticed a TSA official with an infectious smile passing out plastic bags to the throng of travelers, anxious as I was, to make it through the metal detector as quickly as possible. As he worked the line, this fellow repeatedly kept saying “we’re here to serve you, and to make this process as smooth as possible. Kindly remove all metal objects and place them in these bags.” I’ve traveled through every major airport in the country and had never seen this done before. Well, belts came off, jewelry was unfastened and change was removed from pockets. His call to action assisted in moving a hundred-plus people through security in under 20 minutes.

I mentioned the expediency with which this happened to another TSA official. He in turn answered, “oh, that’s because of Joel, he does this everyday on his break. It’s certainly not in any of our job descriptions.”

I so admire people whose self-imposed initiative drives them to perform above and beyond what their jobs merely require. In a culture that increasingly touts an attitude of  “that’s not my job,” this man’s actions were indeed most refreshing to witness.

New Indications for Symbyax

Eli Lilly has gained FDA approval for its combination psychotropic medication product Symbyax to be used in the management of treatment-resistant depression. Symbyax was previously approved only for the treatment of depressive episodes associated with bipolar disorder.

The drug is a combination of the antipsychotic Zyprexa (olanzapine) with the antidepressant Prozac (fluoxetine) and is now the first medication approved for treatment-resistant depression. Patients that have not responded to a minimum of two separate trials of different antidepressants over an adequate trial period for each (four to six weeks) are considered treatment-resistant.

The “Zyprexa (olanzapine)” component of this drug molecule is linked to weight gain, hyperglycemia, hyperlipidemia and hypercholesterolemia.

Communicating with Physicians during Office Visits

How well do you communicate with your physician? Do you feel intimidated or inferior in the presence of your doctor? Do you ever develop “white-coat brain lock” when it comes to asking questions? When leaving the office, do you wonder what foreign language or in what tongue your doctor was speaking? If you answered yes to any or even possibly all of the above questions, you’re not alone, because one of the biggest communication gaps going is between physicians and patients.

The relationship you have with your doctor drives the quality of your treatment, and a good relationship – one where you and your doctor exchange information freely and work collaboratively to make the best decisions about your health – is the cornerstone of optimal care. So prepare in advance of your appointment. Come armed with questions, in writing, and politely request that your physician take a few minutes to respond to them. If the doctor answers, “my assistant or nurse will address these issues,” hold your ground and simply say “you’re the expert, I’d much rather hear it from you.”

Understandably, it can be difficult to deal with impatient physicians. Remember though, you are the customer! So don’t leave the office without having your questions answered and understanding everything the doctor has told you. Also, don’t withhold information. Doctors aren’t mind readers, so if you’re not sharing information because you believe it is too sensitive or irrelevant to your visit, please reconsider. What you’re withholding just might be a key piece to the puzzle of finding out what’s wrong and how to treat you.

Building a trusting, positive and rewarding partnership with your doctor takes time, particularly if your visits are infrequent. Trust your instincts as to whether or not the relationship is a good fit for you, and if not, acknowledge that you probably need to hand over you care to someone else.

Have you had any communication difficulties with your physician? How did you handle the situation?