Living with obsessive-compulsive disorder (OCD) can be overwhelming, especially when traditional treatments like therapy and medication don’t provide relief. If you’re struggling with finding effective treatments for OCD, know that you’re not alone and help is available.
Transcranial magnetic stimulation (TMS) is an innovative, FDA-approved treatment that targets specific regions of the brain associated with OCD. This treatment is non-invasive and painless, offering an alternative treatment option for those who haven’t found success with other approaches.
In this article, we’ll walk you through everything you need to know about TMS for OCD – including what it is, how it works, and what to expect during treatment.
What is obsessive-compulsive disorder (OCD)?
Obsessive-compulsive disorder (OCD) is a mental health condition that causes recurring, intrusive thoughts, images, or urges (obsessions) that create intense feelings of distress. To alleviate this discomfort or anxiety, people with OCD engage in repetitive behaviors or mental rituals known as compulsions. These compulsions can provide temporary relief, however they ultimately create a cycle that can consume hours of a person’s day and interfere with normal functioning.
Obsessions in OCD often revolve around fears of contamination, harm, or doubt, while compulsions can involve behaviors like excessive cleaning, checking, or counting. For example, someone with a fear of germs might wash their hands so often that their skin becomes raw.
While many of us experience unwanted thoughts every now and again, it’s important to recognize that OCD is more than just the occasional worry or habit. It’s a debilitating condition that requires professional attention. Thankfully, OCD is treatable. Like other mental health conditions, early diagnosis and intervention is key to managing symptoms and improving quality of life.
Symptoms of OCD
The two main symptoms of OCD are obsessions and compulsions. These symptoms can become overwhelming and interfere with daily life, making it difficult for a person to perform routine tasks or maintain relationships. People with OCD will know that their behavior is problematic but will not be able to stop.
Below, we look at what obsessions and compulsions look like for people with OCD.
Obsessions in OCD
Obsessions are persistent, unwanted thoughts, fears, or mental images that cause significant distress or anxiety. These thoughts are intrusive and can feel overwhelming and impossible to control. No matter how much a person tries to stop thinking about them, the thoughts keep returning again and again.
There are many different types of obsessions in OCD, but common examples include:
- Anxiety about coming into contact with perceived contaminants, like germs or dirt
- Fear of becoming sick or dying
- Worries that a loved one will get sick, hurt, or killed
- Fear that you have broken a rule and deserve to be punished
- Worry that performing tasks in the ‘wrong’ order will lead to negative consequences
- Colors or numbers that seem bad or unlucky
- Fear of making mistakes
- Intrusive thoughts about things that seem bad, rude, or wrong
- Unwanted thoughts or mental images about sex
- Strong need for order, symmetry, or perfection
- Constantly seeking reassurance from others.
Compulsions in OCD
Compulsions are repetitive behaviors or mental rituals performed to reduce the anxiety caused by obsessions. People with OCD often feel a strong urge to perform these compulsions repetitively in a specific, rigid order. If not done perfectly, they may start over out of fear that something bad will happen.
While compulsions can provide temporary relief, they often reinforce the obsessive-compulsive cycle. These actions are time-consuming and can interfere with a person’s daily life, work, and relationships.
Examples of compulsions include:
- Repeatedly bathing, cleaning, or washing hands
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- Mentally repeating a phrase until it ‘feels right’
- Checking locks, switches, or doors multiple times
- Walking in and out of doorways several times in a row
- Erasing, rewriting, redoing, or rereading things in a specific way multiple times
- Chewing each bite on each side of the month equal times
- Constantly checking that you haven’t harmed someone
- Touching, tapping, or stepping a set number of times
- Arranging objects in a perfectly symmetrical order.
Read More: Everything You Need To Know About OCD in Kids and Teens
OCD treatment options
The first line treatment for OCD is often a combination of psychotherapy and medication. If these treatments don’t work, a person may be recommended alternative therapies like transcranial magnetic stimulation (TMS).
Psychotherapy for OCD
Psychotherapy, or talk therapy, involves working with a mental health professional to identify and change unhelpful thoughts and behaviors. The most common types of psychotherapy for treating OCD include:
- Cognitive Behavioral Therapy (CBT): CBT focuses on understanding the thoughts and emotions that drive compulsive behaviors. Over several sessions, a person may learn to identify and change negative patterns and replace them with healthier coping mechanisms.
- Exposure and Response Prevention (ERP): ERP is a type of CBT that involves a therapist exposing patients to situations or thoughts that trigger obsessions and helping them resist performing compulsions. For example, a therapist may ask an OCD patient to touch a ‘contaminated’ object but stop them from washing their hands. This teaches individuals that the feared outcome is unlikely or irrational.
- Acceptance and Commitment Therapy (ACT): ACT helps OCD patients learn to accept obsessive thoughts as just thoughts. This can help reduce their power, allowing individuals to live a meaningful life despite their OCD symptoms.
Medication for OCD
The most common medications used to treat OCD are selective serotonin reuptake inhibitors (SSRIs), serotonin reuptake inhibitors (SRIs), and tricyclic antidepressants. Of these medications, SSRIs are the most commonly prescribed. These include fluoxetine, sertraline, paroxetine, and fluvoxamine, which are often given at higher doses than when treating anxiety and depression.
It can take anywhere between 8 to 12 weeks to notice improvements after taking medication.
Transcranial Magnetic Stimulation (TMS) therapy
Transcranial Magnetic Stimulation (TMS) therapy is a non-invasive therapy that uses magnetic pulses to stimulate specific regions of the brain associated with OCD symptoms. This therapy is typically recommended when a person has tried standard treatments without relief or experiences undesirable side effects when taking OCD medications.
While still relatively new in the treatment of OCD, TMS offers a promising alternative for OCD patients who don’t respond to psychotherapy or medication.
What is Transcranial Magnetic Stimulation (TMS)?
TMS therapy is a non-systemic procedure that uses magnetic pulses to stimulate specific nerve cells in the brain. This innovative treatment is designed to target regions associated with various mental health and neurological conditions, including OCD, depression, anxiety disorders, and more.
During a TMS session, an electromagnetic coil is placed against the scalp. This coil emits magnetic pulses that stimulate targeted brain areas depending on the condition being treated. For patients with OCD, the targeted brain region is usually the prefrontal cortex which is linked to mood regulation and anxiety.
There are two primary types of TMS therapy:
- Repetitive TMS (rTMS): rTMS delivers rapid magnetic pulses to stimulate surface-level brain areas.
- Deep TMS (dTMS): dTMS uses specialized coils to reach deeper brain tissues.
TMS therapy was approved by the U.S. Food and Drug Administration (FDA) as a treatment for OCD in 2018 – specifically for individuals who haven’t found relief through conventional treatments like medication or psychotherapy. It’s also used to treat various other conditions, including major depressive disorder, anxiety, post-traumatic stress disorder (PTSD), and neurological conditions like Parkinson’s and fibromyalgia.
The key benefits of TMS is that it doesn’t require anesthesia, surgery, or systemic medication, and it has minimal side effects compared to other treatment methods.
How does TMS work for OCD?
TMS helps regulate activity in parts of the brain that are considered overactive in people with OCD. By regulating brain activity, TMS can help reduce the obsessive thoughts and compulsive behaviors characterized by this condition.
The treatment is especially effective for people with treatment-resistant OCD or those who haven’t responded to traditional treatments like medication or psychotherapy. As mentioned, there are two key types of TMS therapy: rTMS and dTMS.
Repetitive TMS (rTMS)
In rTMS, a device containing an electromagnetic coil is placed on the scalp. This coil generates a magnetic field that relievers repetitive pulses to the brain and stimulates neurons. rTMS is effective for treating many health conditions, including OCD symptoms, however research suggests that dTMS can be more beneficial.
That said, because rTMS can improve a patient’s overall psychological well-being, it may be particularly effective for those with comorbid depression or anxiety, which often occur alongside OCD.
Deep TMS
dTMS works similarly to rTMS, only it penetrates deeper brain regions. dTMS specifically targets areas like the dorsomedial prefrontal cortex (dmPFC) or anterior cingulate cortex (ACC) which are involved in OCD symptoms.
Studies have shown that dTMS can significantly reduce OCD symptoms in people who haven’t responded to other treatments.
See: How Successful is TMS Therapy?
Is TMS effective for OCD?
TMS is an FDA-approved treatment for OCD, with numerous studies and psychiatric research highlighting its potential in relieving symptoms associated with the condition.
In one 2020 study, TMS was found to significantly improveOCD symptoms in individuals who hadn’t responded to traditional treatments like medication and CBT. Similarly, a 2021 research review suggests that TMS was effective in reducing OCD symptoms. This review found that low-frequency TMS focused on the dorsolateral prefrontal cortex and supplementary motor area seemed to be successful.
Studies focused on dTMS found that approximately 45% of OCD patients experienced reduced symptoms after just one month of treatment. Data from Brainsway, a dTMS device manufacturer, suggests that this number could even exceed 55% in some cases.
Some patients may require ‘maintenance’ treatment sessions to sustain these results. For example, they may return for a single session every one or two weeks.
What to expect from TMS treatments for OCD
TMS therapy for OCD is usually prescribed for a total of 36 sessions administered over several weeks. Here’s what to expect from the treatment:
- Preparation: You’ll be seated comfortably in a reclining chair and a TMS technician will position your head, explain the procedure, and answer any questions you have.
- Placing the coil: Next, an electromagnetic coil is placed against your scalp, near your forehead. This wire coil will target specific regions of the brain associated with OCD.
- Brain mapping: Your first TMS session will involve brain mapping. This helps the technician identify the optimal location for treatments and adjust the strength of the magnetic pulses to ensure your treatment is effective and comfortable.
- Stimulation: Once the treatment area is identified, repetitive magnetic pulses will be delivered through the coil to the targeted regions of your brain. These pulses are painless, although you may feel a mild tapping or tingling sensation.
- Monitoring: The technician will be continuously monitoring your comfort and adjusting the intensity of pulses as needed.
- Post-session: After the session, you’re free to go home and resume your daily activities as usual. Because TMS doesn’t involve sedation, you can even drive yourself back to school or work.
- Follow-up sessions: TMS treatments typically consist of 30-36 sessions scheduled over several weeks. The exact number will depend on your symptoms and how you respond to the therapy.
Some people are unable to commit to a standard TMS treatment schedule. For these patients, accelerated TMS may be a more suitable option. This form of TMS condenses the therapy into a period of two weeks.
Learn More: Accelerated TMS vs. Traditional TMS: Which One Makes Sense for You?
Potential side effects of TMS
TMS is a well-tolerated treatment, however some people may experience mild side effects. These can include:
- Headaches
- Lightheadedness
- Scalp discomfort at the treatment site
- Tingling or twitching of the facial muscles
- Fatigue or drowsiness.
These side effects are usually short-lived and resolve on their own within a few hours. As the body adjusts to therapy, the symptoms tend to disappear altogether.
TMS may induce seizures in extremely rare cases – about 0.1% of patients. This risk is extremely low, however if you have any concerns, don’t hesitate to discuss them with your provider before the treatment.
Keep Reading: TMS Side Effects: All You Need to Know
Is TMS right for everyone?
TMS is safe for most individuals, but it may not be advised in certain cases. TMS may not be suitable for you if you:
- Have a history of seizures, epilepsy, or neurological conditions
- Are pregnant or breastfeeding
- Have experienced brain injuries, such as traumatic brain injury, stroke, or tumors
- Are currently using stimulant medications.
Because TMS uses magnetic pulses, it is also not safe for people with metal devices or implants in their body. You should not do TMs if you have:
- Cochlear implants
- Deep brain stimulators
- Aneurysm clips or coils
- Implanted electrodes or stents
- Shrapnel or bullet fragments
- Vagus nerve stimulators.
This doesn’t include dental fillings and braces, which are completely safe with TMS therapy.
If you’re not sure if you’re eligible for TMS therapy, feel free to contact our team to discuss the treatment and whether it may be suitable for you.
Explore TMS therapy for OCD
TMS therapy is a non-invasive, well-tolerated treatment that has shown promise in reducing OCD symptoms. If you’re curious about whether TMS might be right for you or a loved one, we’re here to help.
Contact our team at BestMind Behavioral Health today to learn more about TMS therapy and how it can help treat OCD.
