Deep brain stimulation (DBS) for otherwise treatment-refractory obsessive-compulsive disorder (OCD) represents an emerging therapy. This umbrella review and meta-analysis aims to provide a comprehensive summary of studies published in the literature on the outcomes of DBS in the context of OCD.

In adherence to PRISMA guidelines, an umbrella review and meta-analysis was conducted in October 2023, systematically searching PubMed, Medline, Embase, and Web of Science for meta-analyses on the treatment of OCD with DBS. Individual studies within the included meta-analyses, along with new studies from 2023, were meticulously reviewed, and duplications were removed. They were further categorised based on stimulation targets. Their results were collected and pooled to generate forest plots. The primary outcome was the relative change in Y-BOCS, HAM-A, HAM-D and Global Assessment of Functioning (GAF) scores at last available follow-up after DBS.

This umbrella review encompassed seven meta-analyses evaluating the outcomes of DBS in patients with OCD published between 2014 and 2022. The analysis, including 40 studies, revealed a significant overall improvement in OCD symptoms following DBS, as measured by Y-BOCS (mean difference (MD)=1.94, 95%CI=1.70, 2.18, p<0.00001, I²=43%), HAM-A (MD=24.56, 95%CI=23.41, 25.72, p<0.00001, I²=99%), HAM-D (MD=9.36, 95%CI=7.94, 10.77, p<0.00001, I²=45%), and GAF scales (MD=-4.87, 95%CI=-5.58, -4.16, p<0.00001, I²=99%).

DBS is safe and effective for OCD. Careful patient selection according to clear definitions of "treatment refractoriness" is recommended. Further research is essential to better understand and assess the treatment's efficacy, as well as to determine the most optimal brain targets for OCD.