TMS Therapy: Can It Cure OCD?
Putting magnets on your scalp, and receiving electromagnetic pulses delivered to your brain: this probably isn’t what you imagined when you thought about receiving treatment for your OCD symptoms. But that’s exactly how an innovative new treatment for OCD works.
It’s called transcranial magnetic stimulation, or TMS therapy, and it’s helped thousands of people recover from the most stubborn of OCD and depression symptoms.
What is TMS Therapy?
TMS, short for transcranial magnetic stimulation, sounds like something out of a science fiction movie, but it’s a legitimate treatment used for depression and other conditions, including Obsessive-Compulsive Disorder. There’s so much research supporting its efficacy that the FDA has even approved it for treating both depression and OCD.
What Is TMS Therapy Used For?
Most of the research that’s been conducted on TMS has been to study how well it works for treatment-resistant depression. Depression can be a stubborn disease, and for some people, frontline treatments like psychotherapy and psychiatric medication either don’t work, or cause too many side effects to be comfortable.
For these people, TMS therapy can be incredibly effective. Around 50 to 60 percent of people with treatment-resistant depression experience a significant improvement in their symptoms with TMS therapy, and a third of those people find that their symptoms go away altogether. For people who have tried everything else under the sun to treat their depression and haven’t found relief, this number is extremely significant.
On top of depression, research has been conducted to study the effects of TMS therapy on other mental illnesses and even physical health conditions, as well. There is evidence that supports the use of TMS therapy for:
- Depressive Disorders
- Obsessive-Compulsive Disorder
- Alzheimer’s disease
- Post-Traumatic Stress Disorder (PTSD)
- Stroke recovery
- Parkinson’s disease
- Chronic pain
- Multiple sclerosis
However, more research needs to be conducted on many of these conditions for TMS therapy to be accepted as an evidence-based treatment for them. The FDA has approved TMS for major depressive disorder and obsessive-compulsive disorder, which is great news for those of us in the OCD community.
How Does TMS Therapy Work?
During TMS therapy, electromagnetic coils (similar to the technology used in MRI scans) are placed on certain areas of your scalp. The treating physician delivers perfectly calibrated micropulses to specific brain regions that are thought to be affected by your depression, OCD, or whatever you’re receiving the treatment for. This is repeated for half an hour to an hour every day, 5 days a week for several weeks.
Scientists don’t yet know exactly how TMS therapy works or why it’s so effective. What they think is that the electromagnetic pulses stimulate the areas of the brain that are affected by depression or OCD. When your brain is sick with a mental illness, it changes: certain areas get smaller, and neurotransmitters that are present in healthy brains stop firing like they’re supposed to.
Researchers think that TMS therapy corrects these chemical imbalances in the brain and allows the brain to “rewire” itself. They also think that TMS stimulates specific regions of the brain that aren’t working properly due to depression or OCD — we’ll talk more about which specific regions in the next section.
Is TMS Therapy Safe?
TMS therapy is a non-invasive procedure: that means that no skin is broken. Since it isn’t a surgery, you won’t need to be put under any anesthesia whatsoever, so you’ll be able to drive yourself home after every session. No anesthesia also means that there are less risks associated with the procedure.
In general, TMS therapy is safe and well-tolerated by most people. People often liken TMS therapy to another brain stimulation called electroconvulsive therapy (ECT). But unlike ECT, TMS therapy doesn’t cause seizures. There is a tiny risk (.01 percent) of developing seizures after receiving TMS, but this is incredibly rare.
Some of the more common, minor side effects associated with TMS include:
- Scalp pain where the magnetic coils were placed
- Muscle twitching
- Mild headaches
These side effects are usually temporary, and most people find that fatigue and tiredness go away after the first week or two of treatment. In general, TMS therapy is considered a safe treatment for OCD.
TMS Therapy and OCD: Does it Work?
Although TMS therapy is most commonly used to treat major depressive disorder, there is emerging research that supports the claim that it can help improve symptoms of OCD, as well. If first-line treatments for OCD like SSRI medications and Exposure and Response Prevention haven’t worked for you, it might be worth looking into TMS therapy.
OCD and the Brain
In order to discuss how TMS therapy works for OCD, it’s first important to understand how exactly the disease of OCD affects the brain.
OCD, or obsessive-compulsive disorder, is a mental illness that makes people experience obsessions and compulsions. Obsessions are unwanted and intrusive thoughts that circle around in a person’s brain. People with OCD place a lot of emphasis and meaning onto these thoughts and can’t stop thinking about them.
Compulsions are the repetitive behaviors that people with OCD do to try to lessen the anxiety that their obsessive thoughts bring with them. For example, they could compulsively review their memories, act out rituals that are meant to “protect” them, ask for reassurance, or check things like locks over and over again.
Studies that have been conducted on how OCD affects the brain have found that the disease shrinks the organ’s brain matter. This means that certain areas of the brain are literally smaller with OCD. The parts of the brain that are most affected by OCD include regions that help us with impulse control, and information processing. In particular, the orbitofrontal cortex is affected by OCD.
In addition to that, the communication between different areas of the brain is affected by OCD. Research shows that the OCD brain responds too highly to errors, and so feels the need to “correct” the mistake over and over and over again.
All of these effects on specific brain functions and areas of the brain lead people with OCD to have a hard time controlling their impulses, like the urge to perform compulsions over and over again. We know that it’s illogical and we want to stop performing the repetitive behavior, but we can’t seem to help ourselves. Additionally, people with OCD process information in an “incorrect” way — leading us to give more importance to obsessive thoughts than they’re worth.
How Is TMS Used for OCD?
Although — again — we don’t know exactly how TMS therapy interacts with the brain, we do know that it stimulates certain brain regions that are affected by diseases like depression or OCD. According to the International OCD Foundation, there are three ways that TMS is typically used to treat OCD:
Targeting the Dorsolateral Prefrontal Cortex
This is the same area of the brain that’s targeted when TMS is used to treat depression. The dorsolateral prefrontal lobes are responsible for executive functioning tasks, like judgment and decision-making. Studies are mixed on whether or not targeting this area of the brain is helpful for OCD patients. More research needs to be conducted to know for sure, but it seems clear that it’s definitely not as effective to target this area of the brain in OCD patients as it is for depressed patients.
Targeting the Orbitofrontal Cortex
Like we talked about before, the orbitofrontal cortex is highly affected by OCD. One way TMS can be used for people with OCD is to target this area of the brain. Quite a few studies have found that targeting this area of the brain has resulted in an improvement in OCD symptoms. Again, though, more research is needed to be able to say for sure that this is helpful.
Targeting the Pre-Supplementary Motor Area
Targeting this area of the brain has been shown to be the most effective in using TMS for OCD. Along with the orbitofrontal cortex, this area of the brain has been shown to be overactive for people with OCD, so this is probably why TMS targeted to this area is so effective.
Overall, more research needs to be conducted to determine exactly how TMS therapy interacts with the brains of people with OCD. For now, all we have are hypotheses.
Benefits of TMS Therapy for OCD
Although we don’t yet know exactly how TMS therapy interacts with the OCD brain, we do have a lot of emerging evidence that shows us that it does work. Studies have shown that TMS therapy is more effective than no treatment for decreasing OCD symptoms. One meta-analysis found that TMS therapy that targets the orbitofrontal cortex was particularly effective for people with OCD. The research backing TMS therapy for OCD is so substantial that the FDA gave one TMS provider clearance to use TMS therapy for OCD.
Research has shown that up to 40 percent of people with OCD don’t respond to traditional front-line treatments, like psychotherapy or medications. That’s almost half of all people with OCD who continue suffering with painful symptoms. For those people, TMS therapy offers a glimmer of hope — a light at the end of the tunnel.
OCD and Depression
When talking about the use of TMS therapy for OCD, it’s also important to keep in mind the relationship that OCD and depression have with each other. OCD and depression have an incredibly high comorbidity rate — this is just a fancy way of saying that many people with OCD (up to 60 percent of us, in fact) also face depression. Knowing what a painful disorder OCD is, and how much it affects people’s everyday lives, it isn’t hard to see why so many of us are depressed.
This is important to think about when considering the benefits of TMS for people with OCD. There still needs to be more research conducted on whether or not TMS can help your OCD symptoms go away. But there is widespread evidence that suggests that TMS therapy has a good chance of helping your depression symptoms go away.
If you have a diagnosis of co-occurring OCD and depression, then TMS therapy could be especially beneficial for you.
What to Expect During TMS Therapy
Starting a new treatment, especially one that might be unfamiliar to you like TMS therapy, can be scary. Here, we’ll walk you through what to expect before, during, and after a TMS therapy session.
Before Your First TMS Therapy Session
Before you start TMS, the treatment clinic will conduct a basic assessment to make sure you’re a good candidate. This might include getting a mental health history, looking into your insurance benefits, and asking you about any metal that you might have in your body. This will make sure that you are eligible to receive TMS therapy before getting started. Many providers will ask you to come into their offices to complete the assessment.
Your First TMS Session
After you’ve been approved for TMS therapy, you’ll go in for your first session. Before the treatment is delivered, you’ll need to be fitted for your TMS cap. This is the device that actually delivers the electromagnetic pulses to your skull. Your doctor will make sure that all of the coils are placed where they need to be in order to reach your brain.
They will also calibrate the TMS machine for you. The goal is to deliver the strongest pulses possible to your brain without causing you any pain. Your TMS physician will deliver pulses to your brain and watch for any reactions, like a twitch of your pinky finger.
In some situations, you might receive your first TMS treatment right away, during your first appointment. After the cap is fitted and the machine is calibrated, the therapy safely can begin.
You’ll be asked to remove any metal, like jewelry, from your body. You’ll also be given earphones so that the loud noises from the TMS machine don’t cause any damage to your hearing. Once the treatment begins, you’ll feel the small pulses being delivered to your skull, along with a tapping sound every few minutes. These pulses are painless.
The treatment will last between 20 minutes to an hour. During this time, you can use your earphones to listen to a meditation, soothing music, a podcast, or anything else that feels relaxing for you.
After a TMS Session
After your TMS session ends, you will be able to drive yourself home. Remember that TMS therapy is a non-invasive procedure, so you don’t need to stay overnight in a hospital or undergo any anesthesia whatsoever. You might feel some mild pain or sensitivity on your skull where the coils were placed, but in general, you shouldn’t be in any pain. You might also feel fatigued, have a slight headache, or experience slight twitches in your body.
You’ll come back the very next day for another session. Sessions usually take place from Monday to Friday, and you’ll have the weekends to take a break.
Is TMS Therapy for Me?
Although there is growing research that says that TMS therapy is effective for OCD, it might not be for everyone. Like any treatment, there are pros and cons to TMS that you should consider when thinking about whether or not to try it. Any physician you choose will conduct a complete assessment to make sure you’re eligible for TMS treatment.
You might be a good candidate for TMS therapy if:
You have treatment-resistant OCD or depression.
You’ve tried other treatments for OCD or depression, and they haven’t worked for you — or they’ve caused too many side effects to be worth continuing. You’ve experienced multiple episodes of OCD and/or depression, and you’re reaching the end of your rope. After trying so many different types of treatment, you’re starting to feel hopeless. If you’re finding yourself in this scenario, then TMS therapy may be for you.This is also important on a logistical level because some insurance companies have stringent requirements that make you try several antidepressant medications before approving you for TMS.
You don’t have any metal in your head or body.
This could include anything from metal plates in your skull to metallic ink tattoos. Metal is contraindicated with the electromagnetic field that TMS uses. Receiving TMS therapy if you have any metal implants could be dangerous.
You don’t have and aren’t at high risk for a seizure disorder.
Although it’s incredibly small, especially compared to other brain stimulation therapies like electroconvulsive therapy, there is a 0.1 percent risk of developing seizures after receiving TMS therapy. You should tell your doctor if you have a seizure disorder, or if you’re at risk for developing one.
You’re willing to make the time commitment.
You don’t need to be hospitalized or stay overnight to receive TMS therapy, and sessions usually only last between 30 and 60 minutes. However, TMS still requires a pretty large time commitment: you’ll need to receive treatment 5 days a week for up to 6 weeks. Usually, your treating physician will have you come in every day between Monday and Friday. If you’re unable to make that kind of commitment at this time, then TMS therapy might not be for you.
There is a TMS clinic near you.
One of the biggest disadvantages of TMS therapy is that most clinics that deliver this treatment are located in large metropolitan areas. If you live in a remote or rural area, you might not have easy access to a provider that’s able to deliver TMS. For obvious reasons, TMS therapy can’t be delivered through telehealth platforms, so you’ll need to have a TMS clinic near you to be able to receive treatment.
The only person who can tell you for sure whether or not you’re a good candidate for TMS therapy is a TMS provider. If you’re fortunate enough to have a TMS clinic in your area, give them a call and ask for an assessment.
Other Evidence-Based Treatments for OCD
Although TMS is a good option for those who haven’t benefited from other OCD treatments, it still isn’t usually people’s first choice when thinking about treating their OCD. Many other treatments for OCD have much more evidence backing their claims of efficacy than TMS therapy does so far. Some of these evidence-based OCD treatments include:
Exposure and Response Prevention
This form of Cognitive-Behavioral Therapy is considered the gold standard in OCD treatment, and there is an impressive amount of research that supports the fact that it’s effective. ERP is based on an understanding that you can’t beat OCD with logic. Instead of focusing on defeating irrational thoughts, like traditional CBT, ERP helps people to intentionally trigger obsessions by exposing themselves to their fears, and then resist the urge to react to them with a compulsion.
This trains the OCD brain to place less and less meaning on obsessions, and learn that thoughts are just thoughts, and don’t need to be reacted to. Many people have found recovery through ERP, and we at Impulse Therapy use ERP principles in our self-guided program.
A class of antidepressant medication called SSRI (short for Selective Serotonin Reuptake Inhibitors) has been proven to be effective for treating both OCD symptoms and any depression that you might be experiencing on top of it. SSRIs have few side effects compared to other types of psychiatric medications. With that said, the side effects are still too much for some people, and those people might choose to go through TMS therapy instead.
Using self-help programs like Impulse Therapy and educating yourself can go a long way in helping you learn about your OCD and what treatments are available to you. Our self-guided audio program uses evidence-based philosophies like ERP to help people start getting a handle on their OCD symptoms.
If one thing’s for sure, it’s that OCD is a serious psychiatric illness that’s not likely to go away on its own. If you think you’re suffering from OCD, then it’s critical that you seek treatment right away. Learn more about our self-guided OCD program here. Recovery from OCD is within reach.