Focused Ultrasound (FUS) Therapy

Reviewed by the HeyPsych Medical Review Board

Board-certified psychiatrists and mental health professionals

Indications

Primary Indications

Treatment-resistant depressionObsessive-compulsive disorderGeneralized anxiety disorderAddiction (exploratory)Essential tremor (established indication)

Mechanism

Focused Ultrasound uses acoustic energy to influence neural activity. Low-intensity (LIFU) alters neuronal membrane potentials and network dynamics, producing reversible neuromodulation without tissue destruction. High-intensity (HIFU), when combined with MRI targeting, creates precise ablations of dysfunctional brain circuits implicated in psychiatric or neurological disease.

Protocol

Preparation

Patient screening, MRI planning, neurosurgical consultation. Shaved scalp for optimal acoustic transmission.

Procedure

Patient positioned in MRI with FUS device coupled to scalp via water bath or transducer array
Real-time MR thermometry ensures precise targeting
Low- or high-intensity ultrasound delivered to chosen brain region

Frequency: Single session for lesioning; repeated sessions possible for LIFU

Duration: 1–3 hours per procedure

Total Treatment Time: One-time or short-term intervention depending on protocol

Expected Outcomes

Immediate

Reduced tremor in approved neurological uses
Transient changes in mood or anxiety (experimental)

Short Term

Symptom reduction in depression or OCD in some trials

Long Term

Potential durable circuit-level change; long-term efficacy in psychiatry still under investigation

Side Effects

common

Mild headache
Scalp discomfort
Temporary dizziness

uncommon

Edema at lesion site
Transient neurological symptoms

rare

Permanent unintended lesioning
Seizures

Contraindications

absolute

Incompatible implanted devices
Inability to undergo MRI

relative

Pregnancy
Severe medical comorbidity

special considerations

Skull thickness and density can affect efficacy

Research Evidence

studies

MRgFUS thalamotomy FDA-approved for essential tremor
Pilot studies show feasibility of anterior cingulate and amygdala LIFU neuromodulation in depression and anxiety
Case reports suggest OCD symptom reduction after targeted lesioning

limitations: Small sample sizes, limited psychiatric efficacy data, technical challenges with skull penetration and targeting

Cost Considerations

typical session cost: >$20,000 (for essential tremor, clinical use)

total treatment cost: Variable; dependent on technology access

insurance coverage: Approved coverage for essential tremor; not for psychiatric uses

cost effectiveness: Uncertain for psychiatric disorders pending further trials

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Integration Support

concurrent therapies

Psychotherapy and pharmacotherapy in psychiatric protocols
Physical therapy in neurological contexts

lifestyle recommendations

Supportive psychiatric care post-treatment
Healthy lifestyle for long-term maintenance

References

Rezai AR et al., 'Noninvasive neuromodulation using focused ultrasound', Brain Stimul. (2020)Elias WJ et al., 'A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor', N Engl J Med (2016)Dallapiazza RF et al., 'Noninvasive neuromodulation and lesioning with focused ultrasound for psychiatric disorders', Mol Psychiatry (2019)

This treatment information is for educational purposes only. Treatment decisions should be made in consultation with qualified healthcare professionals based on individual circumstances, symptoms, and medical history. Do not attempt treatment without professional guidance.

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