Transcranial Magnetic Stimulation and OCD

Obsessive-compulsive disorder, or OCD, causes considerable anxiety and has also been implicated in depressive illness.  People with OCD struggle with persistent unwanted thoughts.  Alongside this, they often experience a compulsion to repeatedly carry out behaviors to reduce the amount of anxiety they feel around their obsessions.  Many people with OCD are distressed by the condition and find that it interferes with their ability to carry on with day-to-day life.

There are longstanding treatments available for obsessive-compulsive disorder which include medication and talking therapies.  The most widely used psychological intervention is cognitive-behavioral therapy (CBT), which has proved effective for many people.  However, not everyone responds well to these methods.  Over the last decade, Transcranial Magnetic Stimulation (TMS) has been incorporated into the treatment options for this debilitating condition.

How do people experience OCD?

OCD is an ongoing cycle of obsessions which create anxiety.  This anxiety is temporarily relieved by compulsive behaviors.  However, the intrusive obsessions soon resume, restarting the cycle.  There are many different types of obsessions and compulsions.  The table  below shows some of the more common ones:

Although the compulsions work in relieving the anxiety to some extent, this is only temporary.  The  distress always returns and often increases over time, leading to the increase of the intensity and frequency of the compulsive behavior and the addition of new compulsions over time.

As with any other disorder, OCD can present in a mild, moderate or severe form.  For those with a mild form of the disorder, compulsions do not intrude into large parts of their day.  However, at the other end of the spectrum, people often find that their ability to function normally is significantly impaired. OCD is often first noticed in the teenage years.  Although it is often a lifelong issue, symptoms can be dramatically improved if the proper treatment is received.

Traditional Treatments for OCD

The two traditional treatments for OCD are:

Medication – selective serotonin reuptake inhibitors (SSRIs) help reduce symptoms of OCD by increasing the levels of the neurotransmitter serotonin, which helps regulate mood.  The most used SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox).  However, some people have unwanted side effects from these medications or find that they do not work well.  SSRIs are often given alongside talking therapy.

Psychotherapy – people with OCD often receive a specialized form of Cognitive Behavioral Therapy known as Expose and Response Prevention.  This therapy aims to reduce anxiety by gradually exposing the individual to the intrusive thoughts that trigger compulsive behavior.  At the same time, they are encouraged to resist and to find distractions from their usual compulsions.  Over time, this weakens the symptoms of OCD.  It is often effective but requires a lot of time, commitment, and effort, and some people find this too challenging.

Transcranial Magnetic Stimulation – A New Approach

It is thought that around 40% of people with OCD cannot manage to complete the therapy or have difficulty with side effects from the SSRIs.  In these cases, TMS can offer a new hope for an improved quality of life.  Licensed initially for major depressive disorders, Transcranial Magnetic Stimulation (TMS) is beneficial to people with a wide range of mental health disorders, including anxiety and OCD.

How can TMS help with OCD?

Research indicates that TMS works by influencing the patterns of brain activity.  One of the critical areas in which a person with OCD has overactivity is the orbitofrontal cortex.  This area is believed to play a vital role in the formation of intrusive thoughts and compulsive behavior.  Additionally, there may be disruption in the activity in the prefrontal cortex, which helps regulate mood, increases the ability to make decisions and controls behavior.

TMS targets these brain areas and works with its natural ability to form new pathways.  It can, therefore, work with the brain to return the neural activity to more normal levels, which can help reduce obsessions and compulsions over time.  Good results have been shown in several studies over the last decade.

TMS offers key benefits that make it a viable option for people with OCD:

• Long-lasting effects – benefits can last for some months once treatment is finished. In some patients, further sessions may be needed to maintain stability.
• Few side effects – people with OCD can avoid the side effects associated with SSRIs. For example, some people experience weight gain, sexual problems, and fatigue.   With TMS, the most common side effect is a mild headache that subsides quickly once the session ends.

What to expect during a TMS Treatment for OCD

If you would like to try TMS treatment, your first step is to contact us at the Southern Colorado TMS Center, where our staff will be happy to discuss your options.

The treatment will likely involve sessions every weekday over several weeks and will be carried out over several weeks.

What happens in the session?

A small device containing an electromagnetic coil will be placed against your scalp.  Its location depends on the exact condition, but in most cases, this is over the prefrontal cortex.  The coil will deliver magnetic pulses that aim to stimulate the brain cells in the area, and this encourages them to change their activity to reduce distressing symptoms such as those experienced in depression, anxiety or OCD.  TMS is almost entirely painless, although some people may experience a slight tapping sensation on the scalp or a mild headache.  Therapy is delivered as an outpatient; there is no need for sedation, and you can sit comfortably for the duration of the appointment.  Afterwards, you can carry on with your usual daily routine.

TMS and the future

As research continues, it is clear that TMS can provide significant benefits for many people with a variety of mental health disorders.  Often, by combining TMS with traditional therapies, an individual whose progress was stagnant can start to move forward towards better mental health.  TMS represents a promising new treatment option for individuals with OCD who have not found relief from traditional methods.

Is it suitable for me?

Most people contact the Southern Colorado TMS Center because they have already tried the traditional therapies but have not had good results.  Some may have had difficulties tolerating the medication due to the side effects.  In this case, TMS can offer them a viable option.

In a few rare cases, TMS is not suitable.  The detailed assessment will examine your medical history to ensure TMS is right for you.  We always tailor treatments to the individual, and our assessment plays a key role. If you are considering TMS please contact us today, we are happy to discuss your needs in detail.