Obsessive-compulsive disorder (OCD) is a unique kind of anxiety disorder. However, it is one of the disorders that have the most understood neurocircuitry. By knowing what causes OCD to occur in the brain, treatment options can target those areas to help alleviate symptoms. But, of course, everyone’s brain is different. While some people can find relief through therapy and medication, other people may need alternative treatments to move beyond their OCD symptoms. One alternative treatment that can help with treatment-resistant OCD is dTMS. In this blog post, let’s chat about what dTMS is, how it’s different from regular TMS, how it treats OCD, and more.
What is dTMS?
dTMS stands for deep transcranial magnetic stimulation. It is very similar to regular TMS, but with one important difference that is indicated in its name: the magnetic pulses go deeper into the brain. The average TMS coil can penetrate a magnetic field about 2 to 2.5cm into the brain. However, dTMS coils can penetrate about 3.5 to 4cm. While a 2cm difference may not seem like much, it is a lot when it comes to the brain. And the reason why we need to go deeper into the brain for treating OCD with TMS is that the circuitry we’re aiming for is just a bit of a deeper target compared to that of depression.
How OCD works in the brain
When someone has OCD, we want to focus on treating the dorsal medial prefrontal cortex. This is the part of the brain involved in helping to focus your attention where it needs to go and ignore stimuli or information that is not helpful to you.
The dorsal medial prefrontal cortex is also helpful in behavior switching. For example, say you keep washing your hands but realize that repetitive hand washing actually isn’t helpful to you. You will switch your behavior and stop washing your hands too much. However, a person with OCD has a harder time switching behaviors even when they know it isn’t helpful and is even harmful to them.
Additionally, the dorsal medial prefrontal cortex is sometimes called “the watchtower” of the brain because it is involved in threat appraisal. Because OCD thrives on fear-based decision-making and behaviors, the metaphorical guard of “the watchtower” might end up needing overtime as they are on a constant lookout for improbable threats.
How dTMS treats OCD
dTMS targets and sends magnetic pulses to the dorsal medial prefrontal cortex, which strengthens that part of the brain. The stimulation of the magnetic pulses increases your cognitive control. Our OCD Program Director, Dr. Ryan Vidrine, says that dTMS is basically “bicep curls for your brain circuits that resist obsessions and compulsions.”
Day 1 of dTMS treatment
When starting with dTMS treatments, as well as regular TMS treatments, the first session is a bit more time-intensive than the rest of the sessions you’ll have. On that first day, your provider will measure your head and customize the amount of magnetic energy to your brain shape and sensitivity. To customize it all just right, your provider will test a motor function on a hand or foot. They will then determine the lowest dose needed to make that target move 50% of the time, which is your motor threshold. Your dosage will be based on your motor threshold and should give you enough treatment to help you but not enough to overstimulate the brain and cause a seizure.
After determining your measurements and dosage on your first day, you will begin treatment. Treatment will look like you sitting in a comfortable chair with the dTMS headpiece positioned over your head. You will feel a tap like a woodpecker on your scalp as the pulses are sent to your brain as the machine is working. However, nothing is touching you. “Your scalp is a muscle,” explains Dr. Vidrine, “and when the magnetic field goes through the scalp, it causes the scalp to contact.” The sensation can be a little uncomfortable but is generally tolerable. You will likely desensitize yourself to it as you continue treatment. Treatment sessions only last about 20-25 minutes, and you can drive yourself home and resume your regular activities afterward.
Another difference when using dTMS for OCD compared to regular TMS for depression is that your provider may want to try provoking your OCD symptoms while you’re undergoing TMS treatment. Ongoing research indicates triggering those anxieties could result in slightly better outcomes. An example of what this could look like is, say, a patient has contamination OCD and they get anxious when exposed to germs. Their provider might ask them to touch the floor and then touch their cheek, having them sit with their anxieties during the dTMS treatment. However, this method may not be suitable for every patient, and your provider will work with you to determine what is appropriate.
Success with dTMS for OCD
Success looks different for each patient going through a dTMS course of treatment for OCD. Your response can vary due to how severe your symptoms are and how long you’ve been experiencing them, as well as your willingness to improve.
It is important to note that patients don’t usually say “My OCD is totally gone,” or “I never have intrusive thoughts anymore.” Instead, they typically say things like:
- “I still get that stuff, but I can ignore it much more easily.”
- “I have the urge to compulse, but I can resist more and wait longer before I give in.”
- “The thoughts are still there but quieter.”
It’s impossible to get you to a place with zero intrusive thoughts, obsessive thinking, disgust reactions, or moments of fear because those things are simply a part of being human. However, dTMS treatment can help you resist the compulsions and get you to a place where you don’t avoid your fears. If you can do that, then you are able to move beyond your OCD.
dTMS, like regular TMS, doesn’t come with many side effects. Unlike medications that work globally throughout all your organ systems, TMS is applied locally. As a result, having mild headaches or scalp tenderness where the TMS is applied is common, However, these sensations usually stop as you continue treatment.
Every once in a while, patients will say they are a little tired after treatment, but some say they actually feel more energized afterward. After the whole course of treatment, some patients report feeling sharper and having less brain fog.
Importantly, during TMS treatment, there is a very small risk of seizure. Less than 1% of cases experience one, and no one develops a seizure disorder. If a seizure were to occur, treatment is stopped and the patient is taken care of. The provider will adjust the dosage to help ensure it doesn’t happen again. “It’s scary,” says Dr. Vidrine, “but generally not consequential outside of that moment. We’ve had people who have had seizures come back and finish their treatments in the past.”
How to get treated with dTMS for OCD
To get dTMS for OCD, you should meet with a physician that offers it and do a consultation and evaluation. Together, you can see if it is appropriate.
The tricky part with getting dTMS treatments is, of course, payment. The out-of-pocket cost for a full course of 6 weeks of TMS is costly. Currently, as of this post, Cigna in California will cover the costs if you have treatment-resistant OCD. To indicate that you have treatment-resistant OCD, you’ll have to have tried at least two or more medication trials that are appropriate as well as some amount of appropriate behavioral therapy.
If you’re interested in learning more about dTMS for OCD, connect with us! We’d love to see if we can help you move beyond your OCD. Our expert providers are specially trained in OCD. Contact us today and get the support you deserve.