Deep transcranial magnetic stimulation (dTMS) was first cleared for the treatment of obsessive-compulsive disorder (OCD) by the FDA in 2018, when Brainsway’s deep TMS machines brought promising data to the table about TMS’s role in the treatment of other mental disorders.
Previously cleared by the FDA for the treatment of major depressive disorder in 2008, TMS and other forms of neuromodulation have been hailed as the potential future of psychiatric therapy. However, to many who are currently struggling with managing OCD, it’s likely that the letters TMS don’t mean much at first glance.
What is TMS?
Transcranial magnetic stimulation sounds complex, but the practical application is quite simple. There’s no mess, no pain, no use of medication or invasive strategies – all that a patient has to do in TMS therapy is sit back, try to relax, and wear a special head device that sends finely-tuned magnetic waves into the brain to affect certain portions of the brain and improve a person’s mental health.
Different conditions require different approaches, and the technology surrounding TMS has made leaps and bounds in just a few decades. While first developed in the 80s, the idea for transcranial magnetic stimulation is much older, linking back to the medical discovery of electrical brain stimulation and the first links between electricity and magnetism. Since then, neuromodulation has become much safer and much simpler for patients, although the technology has become increasingly complex.
While other forms of deep brain stimulation require direct access to the brain or the nerves around the spine to affect a person’s mood, as through vagus nerve stimulation, TMS works without the need for surgery or the use of a special medical device constantly attached to the patient.
While these therapies all apply different methods, they largely aim to achieve the same thing: utilize energy to disrupt certain pathways in the brain associated with the disorders that people suffer from. By disrupting and affecting these signals, psychiatrists can effectively reduce or even eliminate certain symptoms, depending on the effectiveness of the therapy. This targeted approach also yields fewer to no side effects, and because TMS specifically is non-invasive, there are no risks associated with anesthesia or the potential for an infection.
Unique in that way, TMS is a form of neuromodulation that requires neither anesthesia nor induced seizures, acting on the brain with magnetic waves. Most patients report that the worst side effect they suffered was a headache, and some experience an unpleasant tingling sensation on the scalp. TMS has no lasting side effects. However, its main drawback is the necessary time investment. When treating depression, for example, treatment lasts up to six weeks, with four to five weekly sessions requiring frequent visits to the TMS clinic. After treatment ends, the therapeutic effects last anywhere from several months to over a year. While total remission is possible, most people report significantly reduced symptoms instead.
TMS for Managing OCD
While TMS has been approved for the treatment of depression for over a decade, and research surrounding the use of TMS for managing OCD has been ongoing for years, it’s only recently that TMS has been officially approved for the treatment of OCD.
The concept is the same – treating the condition by affecting pathways in the brain – but the details differ. OCD is tackled through TMS via three different areas in the brain: the orbitofrontal cortex (OFC), the pre-supplementary motor area (pre-SMA), and the dorsolateral prefrontal cortex (DLPFC). In contrast, the treatment of depression primarily centers around affecting the dorsolateral and ventromedial sectors of the prefrontal cortex (DLPFC & VMPFC).
The orbitofrontal cortex is the portion of the brain developed for decision-making. As the name implies, it’s right above the eye sockets, and it is part of the brain’s prefrontal cortex. Deep TMS treatment can affect the OFC, which is significant, as the OFC has been identified as a ‘primary region’ affected by OCD.
The DLPFC is a major portion of the brain in the treatment of depression but is not as promising in the long-term treatment of OCD. Researchers found that targeting the DLPFC can reduce compulsions, but not obsessions. An improvement in mood was marked as well.
Finally, the pre-SMA has been researched for managing OCD and Tourette’s. Research shows notable reduction in OCD symptoms after just four weeks of treatment. The pre-SMA is a small portion of the brain located near the top of the brain, close to the top of the scalp.
What TMS Sessions Are Like
A typical TMS session for managing OCD lasts anywhere from under half an hour to just over half an hour, although new protocols are being researched and tested requiring only about six minutes per session. For now, though, treatment closely mirrors the current protocol used for depression treatment, usually requiring a daily session from Monday to Friday for 4-6 weeks.
Each session builds on the changes made in the previous session, which is why regular frequency is an important part of the treatment. TMS sets itself apart from other forms of neuromodulation by not requiring the constant use of a personal device. Instead, the changes made over the course of a TMS session compound over time, as the effects of more sessions take root in the brain.
TMS does not cause drastic or unforeseen changes – all sessions pinpoint the same areas of the brain and affect them with mild magnetic waves, eventually allowing the brain to essentially ‘correct’ itself by disrupting irregularities in the existing pathways between different neurons. As explained above, OCD is a condition that may occur for a variety of reasons – and these irregularities in the brain aren’t always a major factor in the development of OCD. Medication and talk therapy can be just as effective in treating certain cases of OCD, while others respond best to neuromodulation through alternative therapies like TMS.
Not the Only Treatment
TMS is one option for managing OCD, but because it’s only recently received approval – and only through a limited number of TMS equipment manufacturers – it’s still largely an alternative treatment for OCD, reserved for when other first line treatments have failed, however it is definitely a powerful and effective tool to be used.
It’s important to remember that the psychiatric community has not completely explored the therapeutic potential for TMS. While we are slowly becoming more aware of what TMS can and cannot do, there is more to research and explore. While approved by the FDA for the treatment of different conditions, TMS is still a developing technology. Improvements are being made in determining the exact dose and schedule for each disorder, and newer technology is allowing for significantly reduced treatment times.