Bipolar Disorder Treatment Treating OCD and Depression With Bilateral Cingulotomy By Marcia Purse Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial process Updated on September 25, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print TEK IMAGE/SCIENCE PHOTO LIBRARY/Getty Images Bilateral cingulotomy is a type of brain surgery considered a last resort for people with obsessive-compulsive disorder (OCD). It is also used to treat major depression and occasionally chronic pain for persons who haven't found relief from any other form of therapy. This surgery targets two parts of the brain: The cingulate gyrus, which helps regulate emotions and painThe frontal lobes, whose functions include reasoning, impulse control, and judgment Surgical procedures in psychiatry are controversial, and most doctors will not perform a bilateral cingulotomy unless all other avenues of treatment have been exhausted. Many neurosurgeons, in fact, will require consent from both the patient and a close family member before proceeding with the operation. Bilateral cingulotomy was first proposed as an alternative to the lobotomy in 1947 by American physiologist John Farquhar Fulton. Rationale for Bilateral Cingulotomy The cingulate gyrus serves a unique purpose in the brain, connecting experiences and sensations to either pleasant or unpleasant memory. Among other things, it induces an emotional response to pain and can connect that response to one or more of our senses (sight, smell, taste, touch, sound). The cingulate gyrus also completes the circuit to another part of the brain called the caudate nucleus, whose function it is to form habits. It is believed that by disrupting these circuits, the connection between painful emotion and habitual behavior will also be disrupted. How the Surgery Is Performed To perform a bilateral cingulotomy, an electrode or gamma knife (a targeted radiation device) is guided to the cingulate gyrus by means of magnetic resonance imaging (MRI). There, the surgeon will make a half-inch cut or burn to severe the circuit. Recovery from the operation takes around four days. Side effects are generally mild, with some experiencing headache, nausea, and vomiting in the days following the surgery. The surgery may also trigger seizures in some, although this typically happens in those with a previous history of seizures. Some people complain of apathy following surgery, while others will experience memory lapses. These are uncommon side effects, but potential risks that candidates of the surgery would need to consider. Effectiveness of Bilateral Cingulotomy While bilateral cingulotomy can offer an improvement to some living with OCD, it is by no means a cure-all. A 2016 review of clinical studies concluded that 41 percent of patients who had undergone a bilateral cingulotomy had responded to the procedure with 14 percent experiencing short-term side effects and five percent experiencing serious side effects. Bilateral cingulotomy appears to be least effective in persons with treatment-refractory OCD. Treatment-refractory OCD is diagnosed in persons who have achieved little if any response to at least two different selective serotonin reuptake inhibitor (SSRI) drugs. It is also seen to be less useful in persons with more severe manifestations of the disorder, including OCD-related hoarding. Bilateral cingulotomy has also been used to treat people with chronic refractory pain (pain which cannot be treated by any known means). A systematic review of studies has shown that the procedure resulted in significant pain relief in more than 60 percent of patients for up to a year following surgery. Of these, more than half of these indicated that they no longer needed painkillers. While some studies have proposed bilateral cingulotomy for persons with treatment-resistant bipolar disorder, studies have thus far been inconclusive. As such, it is currently not endorsed as a means of bipolar treatment. 4 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Agarwal N, Choi PA, et al. Anterior cingulotomy for intractable pain. Interdisciplinary Neurosurgery. 2016;(6):80-83. doi:10.1016/j.inat.2016.10.005 Volpini M, Giacobbe P, Cosgrove GR, Levitt A, Lozano AM, Lipsman N. The History and Future of Ablative Neurosurgery for Major Depressive Disorder. Stereotact Funct Neurosurg. 2017;95(4):216-228. doi:10.1159/000478025 Brown LT, Mikell CB, Youngerman BE, Zhang Y, Mckhann GM, Sheth SA. Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies. J Neurosurg. 2016;(124)1:77-89. doi:10.3171/2015.1.JNS14681 Sharim J, Pouratian N. Anterior Cingulotomy for the Treatment of Chronic Intractable Pain: A Systematic Review. Pain Physician. 2016;(19)8:537-550. Additional Reading Brown, L.; Mikell, C.; Youngerman, B.; et al. "Dorsal Anterior Cingulotomy and Anterior Capsulotomy for Severe, Refractory Obsessive-Compulsive Disorder: A Systematic Review of Observational Studies." Journal of Neurosurgery. 2016; 124(1):77-89. Gentil, A.; Lopes, A.; Dougherty, D.; et al. "Hoarding Symptoms and Prediction of Poor Response to Limbic System Surgery for Treatment-Refractory Obsessive-Compulsive Disorder." Journal of Neurosurgery. 2014; 121(1):123-30. Shah, D.; Pesiridou, A.; Baltuch, G.; et al. "Functional Neurosurgery in the Treatment of Severe Obsessive Compulsive Disorder and Major Depression: Overview of Disease Circuits and Therapeutic Targeting for the Clinician." Psychiatry. 2008; 5(9):24-33. Zhang, Q.; Wang, W.; and X. Wei. "Long-Term Efficacy of Stereotactic Bilateral Anterior Cingulotomy and Bilateral Anterior Capsulotomy as a Treatment for Refractory Obsessive-Compulsive Disorder." Stereotactic and Functional Neurosurgery. 2013; 91(4):258-61. By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.