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.
TMS stands for Transcranial Magnetic Stimulation. It is a safe, non-invasive, non-medication treatment for obsessive compulsive disorder using magnetic stimulation.
We really start thinking about using TMS to treat OCD when people have tried traditional medications (Serotonin Reuptake inhibitors) and Exposure-Response Prevention therapy without successful symptom reduction or when the medications cause intolerable side effects.
The patient sits in a comfortable chair while the TMS coil is properly set in place on their head. Magneitc pules are then sent to brain circuits known to be involed in OCD while simultaneously doing brief provocations or exposures, meant to activate the specific fear circuitry for a particular patient. These are planned in advance 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.
Yes. TMS therapy with the Brainsway Device was cleared by the FDA in Aug 2018 for OCD & a separate MagVenture coil was also cleared in Aug 2020. Additionally, TMS has been approved and used in depression since 2008. I would argue that 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.
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.
Each treatment lasts about 20 minutes. The full course of treatment will generally be five days a week for 4-6 weeks depending on response.
Unfortunately, OCD is often not diagnosed until someone has suffered for many years. If you think you may have OCD, it is important to be assessed by a provider familiar with OCD and its many variations so that you can get accurate diagnosis and appropriate treatment recommendations.
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. When they don’t work enough, or when these treatment cause substantial side effects that limit their ability to be used, TMS would be a reasonable alternative or more often a reasonable adjunctive treatment. In fact, in some of the research and what we see in clinical practice, is that TMS appears to enhance the effectiveness of medications and Exposure Therapy, as opposed to thinking of it as a complete alternative.
TMS is safe to use along with medications and in fact many patients tend to stay on medications during treatment. Since some medications may affect the efficacy of TMS, your doctor will fully evaluate you and discuss this with you before starting. Many patients are able to reduce their reliance on medications following a good response to TMS.
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.
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 the intrusive thoughts; some say the obsessions seem quieter; others report they are able to 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 which is clinically significant and on par with the kinds of successes we see with medications when they work for people, but usually in a faster amount of time. About 50-60% of our patients report at least a 20% reduction in symptoms