TMS for OCD: What Is It and How Does It Work?

TMS has been shown to help with the symptoms of obsessive-compulsive disorder (OCD) through deep neurostimulation. Find out how TMS for OCD works in this article.

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Article Contents

What Is OCD?

If you suffer from obsessive-compulsive disorder (OCD), TMS for OCD might be right for you. Obsessive-compulsive disorder, commonly abbreviated to OCD, is a mental health diagnosis characterized by ongoing, unwanted obsessions and excessive compulsions to carry out a specific action. Even though individuals are aware their behavior is not logical, they are unable to stop in many cases.1

Although the cause of OCD is not currently known, mental health researchers believe neurological activity in some brain regions contributes to a diagnosis of OCD. Research has shown that for people with OCD, parts of the brain do not respond as well to serotonin. Serotonin is a brain chemical that helps your nerve cells talk to one another.  

As with many other behavioral health diagnoses, genetics also play a significant role in the likelihood of being diagnosed with OCD. For example, if a parent or a biological sibling has obsessive-compulsive disorder, there’s about a 25% chance that another immediate family member also has OCD.1

According to The National Institute of Mental Health Information Resource Center, “obsessions are repeated thoughts, urges, or mental images that cause anxiety, while compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought.”2

Signs of OCD 

Most people experience obsessive thoughts and compulsive behaviors occasionally throughout their life. For individuals with obsessive-compulsive disorder, these thoughts or behaviors generally occur for more than one hour per day and interfere with daily life. 

There are two primary categories for symptoms of obsessive-compulsive disorder: obsessions and compulsions. A few common OCD symptoms surrounding obsessions are: 

  • Thoughts of harming others or self
  • Repetitively checking whether an appliance is off 
  • Disturbing sexual images
  • Concern about saying something inappropriate while in public

Excessive hand washing, checking multiple times to ensure a door is locked, and repetitive mental checking are all OCD signs relating to compulsion. To relieve both obsession and compulsion OCD symptoms, individuals may try very hard not to carry out one of these acts but feel they have no other option to reduce their anxiety. 

How Is It Diagnosed?  

Medical doctors and mental health professionals can diagnose obsessive-compulsive disorder. In most cases, the provider will order a blood test to rule out other causes such as substance use, medication side effects, another mental health diagnosis, or a physical health condition. Diagnostic testing is vital for children and elderly adults that experience a sudden onset of OCD-like symptoms. 

To meet diagnostic criteria for obsessive-compulsive disorder, an individual must have obsessions, compulsions, or a combination of the two. These symptoms must upset the individual and cause difficulty at home, at work, or in relationships. Symptoms typically last for more than an hour each day. 

If this criterion resonates with your symptomology, it is imperative to ask your doctor or mental health professional about OCD testing.  

Treatment for OCD

In most cases, OCD treatment uses a combination of medication, psychotherapy, brain mapping, and, more recently, repetitive transcranial magnetic stimulation (rTMS). Some individuals who have OCD also have co-occurring mental health diagnoses. For example, a diagnosis of OCD and anxiety or depression. Mental health and physical health providers need to consider the whole person, including mental health diagnoses, when creating a treatment plan with patients.2

Medication 

Serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) relieve symptoms of OCD. For patients that do not respond to serotonin inhibitor medications after eight to twelve weeks, prescribers may suggest an antipsychotic medication.2

Psychotherapy 

In the behavioral health field, psychotherapy is an evidence-based treatment for adults and children diagnosed with OCD. Various psychotherapy modalities such as cognitive-behavioral therapy (CBT) and habit reversal training can be as effective as medications for treating OCD.  

Exposure and response prevention is a type of CBT therapy that encourages the patient to spend time in a situation that historically triggers compulsions without acting on it. Like physical health care, mental health treatment is highly individualized based on a multitude of factors.2

Brain Mapping 

Trained clinicians provide brain mapping using a qEEG (Quantitative Electroencephalogram) assessment. A qEEG assessment is a non-invasive diagnostic tool that evaluates and measures brain function. Brain mapping evaluates nineteen sites in the brain by measuring the electrical activity at each location.  

People can usually expect to complete the assessment with both eyes open and then eyes closed. Studies have concluded that brain mapping is a valuable diagnostic assessment for many clinical conditions, including OCD, dementia, ADHD, epilepsy, substance use, PTSD, and more.3

TMS 

Transcranial magnetic stimulation (TMS therapy) uses a magnet repetitively to activate the brain. Clinical scientist Anthony Barker first developed TMS treatment in 1985 to target specific areas in the brain using magnetic stimulation. Unlike electroconvulsive therapy (ECT), TMS therapy targets the brain strategically with the possibility of fewer side effects. Recently, in 2018, the FDA approved the use of TMS for OCD treatment in adults.4

How Can TMS Help In OCD Treatment?

Trained professionals treat OCD and other mental health diagnoses using TMS therapy. TMS is the only new therapeutic approach for treating OCD that the FDA has cleared in the past decade. Patients that have not improved using medications and psychotherapy alone may qualify to receive TMS for OCD. Trials conducted by the FDA documented symptom relief for patients that received TMS therapy.5

What Is TMS?  

TMS therapy is an FDA-approved treatment approach for patients diagnosed with obsessive-compulsive disorder. [5] Read on to explore the process of TMS treatment and what a patient can expect.  

EEG Evaluation

Researchers have discovered the benefits of pairing TMS and electroencephalography (EEG) to learn more about the pathophysiology of the brain. This concurrent approach is non-invasive and provides essential information about the patient’s brain activity and pathways.6

Magnetic Pulses

During TMS treatment procedures, the provider will hold an electromagnetic coil against the patient’s forehead. Brief magnetic pulses are conducted through the coil and then pass through the patient’s skull. Understandably, this sounds a bit scary. However, the magnetic pulses are simply tiny electrical currents produced to stimulate nerve cells in different parts of the patient’s brain. To put the magnetic pulses into perspective, they are very similar to what a patient would experience when having an MRI.  

rTMS

The two terms, transcranial magnetic stimulation (TMS) and repetitive transcranial magnetic stimulation (rTMS) are interchangeable. Researchers have studied rTMS or TMS to treat mental health conditions including depression, psychosis, anxiety, and OCD.  

What To Expect In TMS Therapy?

Transcranial magnetic stimulation therapy is non-invasive. Patients generally report feeling a tapping sensation on their forehead during the administration of pulses. 

How Long Is This Therapy? 

When patients receive TMS for OCD, daily treatment sessions continue for approximately six weeks. Although this seems like a time commitment, each session is only twenty to forty minutes.  

How To Prepare for TMS? 

To get ready for TMS treatment, individuals should always have a physical exam and psychiatric evaluation. Your chosen TMS provider will provide instructions about preparation.

Physical Exam

The physical exam portion is essentially a medical provider clearing you to receive TMS for OCD. Exams may include lab testing and additional testing as recommended by your physician. It is imperative to inform your doctor or mental health provider about any pre-existing conditions, substance use, and prescribed medications.

Psychiatric Evaluation

A trained mental health provider will evaluate you to ensure TMS for OCD is appropriate and safe. TMS providers use physical and psychiatric assessments to assess whether this form of therapy is the best course of action for each patient.

Who Administers TMS? 

Professionally trained and certified transcranial magnetic stimulation technicians provide TMS for OCD. For the duration of treatment, the technician is present to monitor the patient.7

Who Cannot Get TMS Therapy? 

TMS for OCD is not appropriate for patients experiencing concurrent depression and psychosis or bipolar disorder. Patients at high risk of suicide are also not good candidates for TMS therapy. If a person has metal devices within their body, TMS for OCD may not be possible. During the physical exam portion of preparation, patients and providers should discuss this.8

Benefits of TMS Therapy

Research has shown that personalized TMS provides targeted OCD treatment and relief. TMS for OCD is non-invasive, highly successful, relatively quick, and has minimal side effects compared to other treatment approaches such as ECT.9

Structural 

Unlike ECT, rTMS can electrically stimulate specific sites within the brain. Structurally, TMS for OCD maximizes the therapeutic benefit while minimizing the risk of side effects.  

Physiological  

TMS therapy uses innovative magnetic stimulation technology to improve physiological processing in the patient’s brain. The physiological impacts of TMS can provide relief for various mental health diagnoses, including OCD.10

High-Success Rate 

Before approving TMS as a treatment therapy for OCD, research completed by the FDA demonstrated that repetitive transcranial magnetic stimulation could be highly effective in reducing the severity of symptoms.  

Non-Invasive

For patients, a key benefit of TMS therapy is that it is non-invasive, and they do not have to undergo anesthesia. The patient is alert and oriented throughout the therapeutic procedure. Additionally, the patient can request to stop at any time during TMS.

No-Side Effects 

If patients experience any side effects from TMS therapy, they are usually mild and short-lived. Possible side effects can include muscle contractions, tingling sensations, headaches, and light-headedness. Seizures are only a concern if the patient has a history. As a reminder, it is critical to be transparent with your medical provider or mental health professional about any pre-existing physical health conditions.  

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