The current, first line/gold standard treatments for OCD continue to be Serotonin Reuptake Inhibitors and a very specific type of behavioral therapy known as Exposure-Response Prevention or ERP. For most patients, these two types of treatment will generally work.
However, TMS therapy can be a great option to consider for people who have OCD but have not had success with traditional medications and Exposure-Response Prevention therapy. It can also be a treatment option for patients who are concerned about experiencing the side effects of medications.
In fact, in some of the research, and what our providers see in clinical practice, is that TMS appears to enhance the effectiveness of medications and exposure therapy. This means that TMS can be an addition to traditional treatment methods as opposed to thinking of it as a complete alternative.
It’s not that OCD magically disappears completely. Often, patients will still report intrusive thoughts or obsessions after treatment, but they tell us that their brain is better at dealing with them. They are better at ignoring intrusive thoughts; some say the obsessions seem quieter; others report they can stay present with things they care about more easily, and many describe a much greater ability to resist the urge to engage in compulsive behaviors that we know perpetuate OCD.
In our practice, just over 1/3 of patients meet the full response criteria of 30% or greater improvement in the YBOCS, which is the standard measurement of OCD symptoms. On average, our patients see about a 6-7 point decrease in their YBOCS score. This point decrease is clinically significant and on par with the kinds of successes we see with traditional medications when they work for people, but these results usually occur in less time. About 50-60% of our patients report at least a 20% reduction in symptoms.
TMS is a safe treatment. While it is a relatively new mental health treatment, it was FDA-approved for the treatment of depression in 2008. In 2018, TMS therapy with the Brainsway Device was cleared by the FDA for OCD, and a separate MagVenture coil was also cleared for OCD treatment in 2020.
Because TMS is a local or focal treatment, it is probably as safe, if not safer, than many of the medications used which can have systemic effects throughout the entire body.
Also, we want you to know that our clinicians who administer TMS treatments are professionally trained and put each patient’s comfort first.
TMS treatments do not hurt during or after each session. There are very few side effects of TMS therapy. Most side effects are mild and short-lasting, and can include:
- Headaches
- Sleepiness
- Lightheadedness
- Scalp discomfort
- Twitching or tingling of the facial muscles
Many patients find it to be uncomfortable on their scalp and mild headaches are common during the first few treatments, but these generally go away within the first two weeks as people get used to the sensation. It is rare that anyone drops out of TMS because of side effects.
More serious side effects happen very rarely, but can consist of:
- Seizures
- Hearing problems from the loud clicking noise that occurs during treatment
- Mania, which is more likely to occur if an adolescent has bipolar disorder
However, our expert providers will use their professional knowledge to further help avoid serious side effects like the ones listed above. It is most likely that some adolescents may experience a mild headache.
Generally, patients will feel just like their normal selves. They will be able to drive and go back to their regular activities. Some people report feeling a little tired or having a mild headache, but that usually goes away after the first week or two. Other people report more energy and better focus, as well as the ability to ignore obsessive, anxious thoughts after treatment.
TMS delivers localized electromagnetic pulses to the prefrontal cortex, which is the area of your brain that regulates mood. These electromagnetic pulses stimulate neurons, which release neurotransmitters and hormones such as serotonin and dopamine. Depression and other mental health conditions are linked to an imbalance of these neurotransmitters. TMS works to restore that balance and can provide a more lasting impact on relieving depression symptoms than other treatments, such as antidepressants.
During a TMS treatment, the patient sits in a comfortable chair while the TMS coil is properly set in place on their head. (While this may sound intimidating, it really isn’t!) After the headpiece is in place, electromagnetic pulses are sent to the prefrontal cortex, which is the area of the brain responsible for mood and is known to be involved in OCD.
However, undergoing TMS treatment for OCD is a slightly different process than using TMS therapy to treat clinical depression. When being treated for depression, patients have the option to watch tv, listen to music, or chat with staff or a family member. For OCD treatments though, patients do brief provocations or exposures that are meant to activate the specific fear circuitry for a particular patient. These provocations or exposures are planned with the treating clinician and personalized to each patient. With this protocol, we believe we are strengthening brain circuits responsible for dealing with obsessions and resisting the urge to engage in compulsions.
Each treatment lasts about 20-30 minutes. The full course of treatment will generally be five days a week for four to six weeks. We know that coming in five days a week for weeks on end is a commitment, but the results could impact your mental well-being for a lifetime.
TMS stands for Transcranial Magnetic Stimulation. It is a safe, non-invasive, non-medication treatment for clinical depression that uses magnetic fields to stimulate the specific part of the brain known to control mood. It has proven to be effective for people with OCD.
TMS is used on people with mental health conditions that have not seen success with medications and/or antidepressants. TMS has extremely limited side effects, especially when compared to traditional medications and antidepressants, so it is also a treatment option for people who may be suffering from side effects while trying to experience relief from their condition.
Many patients find that TMS is an amazingly effective treatment option. The FDA labeled TMS therapy to be marketed as a treatment for clinical depression in 2008. In 2018, TMS therapy with the Brainsway Device was cleared by the FDA, and in 2020, the MagVenture Coil was also cleared. Both the Brainsway Device and MagVenture Coil are intended for OCD treatment.
TMS therapy is often administered in conjunction with other types of treatment, such as psychotherapy or (possibly continuing) medication management. At Mindful Health Solutions, our expert providers will work with you to create the best treatment plan for your specific needs.
TMS therapy can be a great option to consider for people who have OCD but have not had success with traditional medications and Exposure-Response Prevention therapy. It can also be a treatment option for patients who are concerned about experiencing the side effects of medications.
OCD is characterized by excessive thoughts and compulsions that may lead to repetitive behavior. These thoughts and compulsions may be unreasonable and fear-based, often triggering intense distress that gets in the way of everyday functioning and managing the tasks of everyday living.
Unfortunately, OCD is often misdiagnosed, or not diagnosed until someone has suffered for many years. If you think you or someone you care about may have OCD, it is important to be assessed by a provider intimately familiar with OCD and its many variations to get an accurate diagnosis and appropriate treatment recommendations.
Mindful Health Solutions’ OCD program focuses on offering comprehensive evaluation and evidence- based treatment approaches. Our treatment plans include discussion of various medication approaches, brain stimulation options such as TMS, reading or self-learning recommendations, lifestyle modifications, education to you and your family about the diagnosis, as well as helping to connect you to other OCD specialized individual therapists or groups.
We want to help patients to rise above their OCD. Our certified and professional doctors want to work with patients to free them from the burden of OCD with the most innovative, effective, non-invasive, and evidence-based therapies available.
If you think that you or a loved one is struggling with OCD, let us help. Go to our Contact Us page and reach out to us in a way that is comfortable for you. Together, we can find a path forward.
Unfortunately, OCD is often not diagnosed until someone has suffered for many years. If you think you or someone you care about may have OCD, it is important to be assessed by a provider intimately familiar with OCD and its many variations so that you can get accurate diagnosis and appropriate treatment recommendations. Our program focuses on offering comprehensive evaluation and evidence-based treatment approaches. Our treatment plans include discussion of various medication approaches, brain stimulation options such as TMS, reading or self-learning recommendations, lifestyle modifications, education to you and your family about the diagnosis, as well as helping to connect you to other OCD specialized individual therapists or groups.
Many patients find it to be uncomfortable on their scalp and mild headaches are common during the first few treatments, but these generally go away within the first two weeks as people get used to the sensation. It is rare that anyone drops out of TMS because of side effects. You’ll be able to drive and go back to your regular activities after treatment, as there are no known cognitive side effects.
OCD is a type of anxiety disorder that is characterized by excessive unwanted thoughts, concerns, and fears (obsessions) that may lead to repetitive behavior (compulsions). These thoughts and behaviors may be unreasonable and fear-based, and often trigger intense distress that gets in the way of everyday functioning and managing the tasks of everyday living.
OCD is typically a lifelong disorder that may start in childhood but more likely begins during the teen or young adult years. With it being a lifelong disorder, the severity of the symptoms and the types of obsessions and compulsions one might have can fluctuate. Overall, symptoms usually get worse during times of stress. Severe symptoms are often so distressing and time-consuming that you aren’t able to perform necessary functions. However, even if symptoms aren’t severe, they may still be excessive and take a great deal of time and energy as well as impact your daily life and relationships.
The obsessions and compulsions that may be experienced when having OCD usually revolve around a theme. For example, one theme could revolve around the fear of a tragedy. An obsessive thought that might center around this theme is a fear of causing harm to loved ones, others, or yourself by accidentally causing your house to catch on fire. Because of this obsessive thought, you compulsively and repeatedly check that the stove is off. There are a wide variety of themes present within OCD, and these themes, like obsessions and compulsions, can fluctuate throughout your life.
The symptoms of OCD typically include having obsessive thoughts that result in compulsive actions surrounding themes such as:
- Contamination Fears / Washing Compulsions
- Body Dysmorphic Disorder (BDD / appearance-related obsessions)
- Social Anxiety
- Phobias (fear of animals, flying, vomiting, leaving home, freeways, etc.)
- Panic Disorder (fear of panic attacks)
- Hyper-Responsibility OCD / Checking (fear of making a mistake or causing a tragedy)
- Hypochondria (fear of having/getting illnesses)
- Harm OCD (violent obsessions, hit-and-run OCD, fear of causing harm)
- Sexual Orientation OCD (fear of being in denial about sexual orientation)
- Pedophile Obsessions (fear of inappropriate sexual thoughts about children)
- Relationship OCD (obsessions about love and fidelity)
- Religious or Moral Obsessions (Scrupulosity)
- Sensorimotor OCD (fear of consciousness of blinking, swallowing, breathing, etc.)
- Perfectionism
It’s important to note that not all themes are listed above, and it is very possible to struggle with a theme that isn’t present. Also, it is possible to have OCD if you only have obsessive thoughts or only do compulsive, repetitive actions. You do not have to do both in order to be diagnosed with OCD.
It is important to get an OCD diagnosis from a trained professional. Only once a diagnosis has been made should you work with your doctor to determine an appropriate and comprehensive treatment plan that works for you.
If you think that you or a loved one is struggling with OCD, let us help. Go to our Contact Us page and reach out to us in a way that is comfortable for you. Together, we can find a path forward.
TMS should not impact the medications themselves. However, as TMS treatments continue, there may no longer be a need for the medications that were being used as part of the original mental health treatment plan.
Unlike traditional medications that work through the bloodstream, TMS stimulates the brain and delivers localized electromagnetic pulses to the prefrontal cortex, which is the area of your brain that regulates mood and behavior. These electromagnetic pulses stimulate neurons, which release neurotransmitters and hormones. Many experts believe that OCD and other mental health conditions are linked to an imbalance of these neurotransmitters. TMS works to restore that balance and can provide a more lasting impact on relieving OCD symptoms than other treatments, such as medication.
However, mental health treatments are not one-size-fits-all situations. Because of this fact, treatment plans will vary depending on each patient’s unique needs and concerns. Treatment plans could follow these paths:
- If a person was already taking medications before beginning TMS treatments, they may or may not continue to take them.
- If a person was not already taking medications before beginning TMS treatments, they may or may not be prescribed medications to supplement their TMS treatment plan.
Overall, patients will work closely with their providers to collaborate on a treatment plan that works best for them. And as treatments continue, the plan will be adjusted as needed to make sure patients are continuing on their path to wellness.
Generally, you will feel just like your normal self. You’ll be able to drive and go back to your regular activities as you normally would. Some people report feeling a little tired or having a mild headache, but that usually goes away after the first week or two. Other people report more energy and better focus and ability to ignore obsessive, anxious thoughts after treatment.
Most insurances cover TMS for Major Depression and coverage for OCD at this time can be less consistent or straight-forward but access does appear to be increasing. Our team will advocate on your behalf for coverage, and do the hard work of the back and forth with your insurance company before you get started with treatment so that you know exactly what you are expected to pay. Additionally, as much as 30% or more of OCD patients struggle with depression as well, and certainly this is more common by the time symptoms of gotten signiifcant enough that we are talking about TMS, and if we are able to obtain coverage for your co-occurring depression, your doctor may be able to adjust the treatments to address your OCD symptoms as well. You’re doctor can talk about the various options and protocols with you in your assessment.
