Transcranial Magnetic Stimulation, OCD, and What to Know

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Obsessive-compulsive disorder, or OCD, is a mental health disorder that impacts many people of all ages and demographics. It occurs when a person is caught in a cycle of obsessions and compulsions

The obsessions can cause unwanted or intrusive thoughts and distressing feelings. The compulsions are attempts to get rid of the obsessions or decrease distress. Many individuals with OCD (up to 70%) can benefit from transcranial magnetic stimulation.

OCD affects between 1% and 3% of the population. Its clinical presentation often has comorbid symptoms of general anxiety or depression, representing a broad range of distinct syndromes. 

The obsessions found in patients with OCD occur repeatedly and are outside of the person’s control. Many with OCD recognize that these thoughts do not make sense, and they are accompanied by feelings like fear, disgust, or doubt. 

For those with OCD, these thoughts often come frequently and trigger extreme anxiety that impairs daily functioning. Common obsessions with OCD may include (but are not limited to): 

  • Contamination from bodily fluids, germs, environmental contaminants, chemicals, or dirt
  • Losing control and harming oneself or others, feeling violent 
  • Fear of blurting out obscenities or insults or stealing items
  • Being responsible for a tragedy or not being careful enough 
  • Concern about being perfect or losing important information or items
  • Experiencing unwanted sexual thoughts
  • Having concerns related to religious aspects

Compulsions represent the second part of obsessive-compulsive disorder and are the repetitive behavior a person uses to counteract or make obsessions go away. These compulsions often get in the way of day-to-day activities. And while the compulsions are often normal activities, the individual may feel driven to engage in the compulsive behavior and would rather not engage in these activities. Common compulsions in OCD are:

  • Washing and cleaning the body or household objects excessively
  • Checking and rechecking to ensure no harmful action has occurred
  • Repeating routine activities or body movements
  • Mental compulsions, such as praying or counting
  • Ordering or arranging things in a specific way

These obsessions and compulsions can make daily life very difficult for patients with OCD. TMS or other treatments may help reduce symptoms. 

What is Transcranial Magnetic Stimulation (TMS)?

Transcranial magnetic stimulation (TMS) is a type of noninvasive deep brain stimulation that can be used to treat OCD. TMS has also been used to treat major depressive disorders, anxiety disorders, chronic pain, post-traumatic stress disorder, Alzheimer’s disease, Parkinson’s disease, stroke rehabilitation, autism, fibromyalgia, tinnitus, and schizophrenia, among other conditions.

TMS is commonly used as an alternative for treatment-resistant OCD or when other treatment options have failed. There are two types of commonly-used TMS:

  • Repetitive Transcranial Magnetic Stimulation (rTMS): rTMS is a relatively non-invasive procedure that involves placing a device on the skull that contains wire. The wire carries electricity and generates a magnetic field that delivers repetitive pulses. 

The flow of electricity stimulates parts of the brain and changes the activity levels of neurons. While rTMS can effectively treat many conditions and can result in reduced OCD symptoms, most research indicates that dTMS is more effective. 

However, rTMS can indirectly improve the psychological well-being of patients with OCD. It is an appropriate treatment for medication-resistant depression and anxiety, which may accompany OCD.  

  • Deep Transcranial Magnetic Stimulation (dTMS): Deep TMS also uses a coil placed on the skull. The significant difference is that the pulses penetrate to deeper areas of the brain. 

It has demonstrated greater potential than rTMS for treating obsessive-compulsive disorder and other mental illnesses. One study has shown that people with treatment-resistant OCD experienced significant improvements in their OCD symptoms. 

Several TMS treatments have been approved by the Food & Drug Administration (FDA approved) to treat OCD. These include a combination of devices, protocols, and target areas of the brain. The FDA approved OCD treatment using TMS is:

  • A dTMS device (specifically the Brainsway dTMS H7 coil or the MagVenture cool DB80 coil devices.
  • Use of high-frequency stimulation (20 Hz).
  • Targeting the dorsomedial prefrontal cortex (dmPFC) or anterior cingulate cortex (ACC).
  • The pairing of the exposures or provocations that trigger OCD fears right before the TMS session begins.

Should I Try TMS for Obsessive-Compulsive Disorder?

Multiple treatments are available for patients with OCD, such as medications, cognitive behavioral therapy (CBT), or exposure and response prevention (ERP). These are generally the first options for treating obsessive-compulsive disorder and are usually effective treatments. 

However, there are instances when one may want to consider TMS as an alternative OCD therapy, such as:

  • After one has tried standard treatments without experiencing improvement.
  • When an OCD patient suffers from severe side effects when taking OCD medications.
  • When psychotherapy and medications have not done enough to reduce OCD symptoms.

Research related to Transcranial Magnetic Stimulation and OCD has found that about 45% of patients report reduced OCD symptoms after only one month of treatment. Many patients have to return for maintenance treatments periodically to continue experiencing benefits. 

There are relatively few side effects of TMS. Common ones include experiencing a headache, scalp discomfort, or lightheadedness. Patients may also experience tingling, spasms, or twitching of the facial muscles. In rare instances, TMS can induce seizures or hypomania/mania (mostly in patients with bipolar disorder). 

Some individuals should not undergo TMS treatment. This is mainly due to the interaction between the magnetic field and any metal devices or materials in the body. Those who should not seek TMS include: 

  • Patients with aneurysm clips or coils
  • Those with stents in the neck or brain
  • People with metal implants in the ears or eyes
  • Individuals with bullet fragments near the head
  • Those with facial tattoos with magnetic ink
  • Patients with implanted stimulators

TMS can be highly effective in treating OCD for some patients, particularly dTMS. The therapy is non-invasive, and patients are often very comfortable throughout much of the procedure. If you are considering TMS therapy for OCD, you should consult with your primary care physician as well as a TMS provider to determine whether it may help with your condition.

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