title: Deep brain stimulation for obsessive-compulsive disorder is associated with cortisol changes.
abstract: Deep brain stimulation (DBS) is an effective treatment for obsessive-compulsive disorder (OCD), but its mechanism of action is largely unknown. Since DBS may induce rapid symptomatic changes and the pathophysiology of OCD has been linked to the hypothalamic-pituitary-adrenal (HPA) axis, we set out to study whether DBS affects the HPA axis in OCD patients. We compared a stimulation ON and OFF condition with a one-week interval in 16 therapy-refractory OCD patients, treated with DBS for at least one year, targeted at the nucleus accumbens (NAc). We measured changes in 24-h urinary excretion of free cortisol (UFC), adrenaline and noradrenaline and changes in obsessive-compulsive (Y-BOCS), depressive (HAM-D) and anxiety (HAM-A) symptom scores. Median UFC levels increased with 53% in the OFF condition (from 93 to 143nmol/24h, p=0.12). There were no changes in urinary adrenaline or noradrenaline excretion. The increase in Y-BOCS (39%), and HAM-D (78%) scores correlated strongly with increased UFC levels in the OFF condition. Our findings indicate that symptom changes following DBS for OCD patients are associated with changes in UFC levels.
authors: Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. p.p.dekoning@amc.uva.nl
authors: Pelle P
authors: PP
authors: de Koning
authors: Martijn
authors: M
authors: Figee
authors: Erik
authors: E
authors: Endert
authors: Jitschak G
authors: JG
authors: Storosum
authors: Eric
authors: E
authors: Fliers
authors: Damiaan
authors: D
authors: Denys
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications / Q000628:therapy / Q000652:urine; D046690:Deep Brain Stimulation; D003863:Depression / Q000150:complications / Q000628:therapy / Q000652:urine; D004837:Epinephrine / Q000652:urine; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000652:urine; D009714:Nucleus Accumbens / Q000502:physiology; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000628:therapy* / Q000652:urine*; D011569:Psychiatric Status Rating Scales
chemical_list: D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine