5 OCD research findings that could drive new treatment, from gut microbiota to ketamine

This festive season, you may be spending time with loved ones who suffer from mental health conditions such as anxiety, depression or obsessive-compulsive disorder (OCD).

OCD is both common and commonly misunderstood. At least 1 per cent of people worldwide suffer from this disorder, the US-based International OCD Foundation estimates, making it the fourth most prevalent mental health disorder.

With this condition, a sufferer has obsessions — or intrusive thoughts — which they are compelled to try to ease by performing rituals or actions, such as handwashing.

They cannot switch off the condition, says Minal Mahtani, CEO and founder of Hong Kong mental health charity OCD & Anxiety Support HK (OCDAHK), adding that they cope with it in the best way they know how.

The holidays can trigger and exacerbate symptoms, Mahtani says. Those with contamination OCD may worry about being in contact with raw meat in the kitchen and about how clean their hands are.

When exchanging gifts, not knowing who else has touched them can trigger worries over whether they are "safe."

Lit candles, knives and even electric lights may trigger pre-existing harm-related thoughts. Mahtani urges others to be sensitive.

Fresh research into the causes of OCD is leading to greater understanding and the development of promising new treatments, bringing hope to sufferers and their families. We outline several advances below.

1. Understanding the role of neurotransmitters

Tobias Hauser and his team at the Wellcome Centre for Human Neuroimaging, at University College London in the U.K., have created a website called OCD and the Brain that uses animation to show how OCD has been linked to abnormalities in networks in the front of the brain, and impairments in decision-making and learning.

Think of these brain loops as a busy intersection, with sets of lights to direct the flow of thought traffic. A problem with the lights may lead to a jam. With OCD, sufferers have difficulty prioritising and cannot separate important thoughts from less meaningful ones.

If these loops are the circuit boards of OCD, then the brain's neurotransmitters — which include serotonin, dopamine, glutamate and gamma-aminobutyric acid (Gaba) — are the electrical signals that affect how they work.

There are more than 150 of these chemical messengers, says Trevor Robbins, a professor of cognitive neuroscience at the University of Cambridge in the U.K., but glutamate and Gaba are two of the most important.

Glutamate has been described as a signal booster, with a key role in learning and memory. Gaba slows thoughts down by blocking certain signals and it has a calming effect on stress and fear.

Using a powerful scanning device, Robbins' team studied the role of neurotransmitters in OCD and found that OCD sufferers had higher levels of glutamate and lower levels of Gaba in responsible areas of the brain. Understanding this might help researchers develop more effective drugs for OCD.

2. Elevated 'imood' protein in OCD patients

Many factors contribute to OCD and because of this there may be unexpected ways to manage it, says Fulvio D'Acquisto, a professor of immunology at the University of Roehampton in the U.K.

"One aspect of OCD that has not been fully explained yet is the fact that symptoms can relapse and remit, and that infections seem to make symptoms worse," he says.

In a little-known condition called Pandas (paediatric autoimmune neuropsychiatric disorder associated with streptococcus infections), "severe OCD symptoms can present within hours and from nowhere".

D'Acquisto's research found that patients with OCD have increased levels of a newly discovered protein called immunomodulin (imood), a type of immune cell.

We all have imood in our blood plasma, but patients with OCD and related conditions have higher levels — often over six times as much. D'Acquisto is now working to develop imood-targeting therapies.

3. Brain-gut connection highlighted in mice

There is also emerging evidence that gut microbiota plays a part in OCD.

A team at the Shanghai Jiao Tong University School of Medicine in China transplanted faecal gut microbiota from human OCD donors into mice. After two weeks, the mice began to exhibit signs of anxiety and repetitive behaviors.

Researcher Zhen Wang says this is the first evidence that OCD-associated alterations in the gut microbiota can drive OCD-type behavior in mice, which suggests "that the gut microbiota is a potential causative factor in OCD."

4. Ketamine could boost effectiveness of key therapy

Dr Carolyn Rodriguez, a researcher at Stanford University in the U.S. state of California, is trying to understand how psychedelics might alleviate OCD symptoms. She has found ketamine helpful in OCD management.

Introduced as an anaesthetic in the 1960s, ketamine became used as a recreational drug because of its dissociative and hallucinogenic impacts. Recently, it has been found to rapidly alleviate depression.

A study found that positive effects from a single intravenous infusion of ketamine persist for up to three weeks.

Rodriguez notes, however, that the drug comes with its own problems, adding, "I'm not advocating people with OCD rush to use ketamine."

Rodriguez considers ketamine's potential less as a treatment and more as a tool for understanding what is happening in the brain.

Ketamine is thought to be effective because it increases neuroplasticity — the brain's ability to absorb information and evolve to manage new challenges.

In doing so, it loosens the rigid thinking that accompanies OCD and makes a patient more receptive to cognitive behavioral therapy (CBT), the gold-standard therapy for OCD. Rodriguez is a strong supporter of this talk therapy that can help manage mental health problems by changing the way patients think and behave.

5. Magnetic stimulation may ease OCD symptoms

Transcranial magnetic stimulation (TMS) is becoming a mainstream treatment for OCD, Mahtani says.

The treatment, which involves placing electrodes on top of the skull, is thought to work by stimulating and resetting specific areas of the brain to provide relief from OCD symptoms, she explains.

"It's been used for the treatment of depression but only recently been introduced and trialed for OCD," she adds.

Studies have shown that 45 percent of patients who used TMS had reduced symptoms after one month of treatment.

The treatment is expensive. Mahtani says, however, that "it is a significant milestone treatment for OCD, is a new avenue for symptom relief, and it is proving to be a good option for people struggling to get relief using CBT ... and medication."

OCDAHK recently appointed Dr Paul Wong, an associate professor and clinical psychologist at the University of Hong Kong, as its clinical adviser. He promptly gave the group a new Chinese name, which translates as "Dancing with Anxiety."

"We can't live without negative emotions," Wong says, adding you can learn to live with, or dance with, OCD. You just need the right support.

Read the full story at SCMP.