BrainsWay’s deep transcranial magnetic stimulation (TMS) device was approved for the treatment of obsessive-compulsive disorder (OCD) by the FDA in August 2018, opening the door for a new form of treatment to be both officially approved by the country’s regulatory body on medication and therapy, and in time, the country’s biggest insurance providers.
Deep transcranial magnetic stimulation is no miracle drug, but it is an innovative new treatment that can help the thousands to millions of Americans who are affected by OCD, yet do not respond to the current gold standard for treatment. While TMS has previously been used for the treatment of depression, the treatment of OCD through TMS requires a different kind of TMS technology that reaches deeper into the brain affects portions of the brain previously left untapped due to certain technical limitations. This opens the door for research on TMS’ as-of-yet unexplored or not quite properly explored potential in the treatment of anxiety, migraines, and other neurological issues and mental health problems.
For now, TMS remains primarily prescribed as an alternative treatment option for patients with treatment-resistant depression, and as of late, treatment-resistant OCD. But how effective is the treatment really? And how widespread is its availability? While a great number of the country’s biggest insurance providers provide coverage for the treatment of depression through TMS given certain prerequisites, it will take a little longer for the same companies to update their policies and offer the same coverage for patients with OCD. But the research is promising, and it’s likely that many Americans who don’t experience relief through typical OCD treatment methods will soon have another promising option to explore on their quest to overcome this condition.
What is TMS?
Transcranial magnetic stimulation is a form of neuromodulation that targets the brain with magnetic waves through a special coil built into a helmet. Sitting comfortably in a chair, TMS therapy sets itself apart from other forms of neuromodulation by requiring no medication, no invasive procedures, no anesthesia, and no lasting risk. The only drawback? The treatment takes time to work.
TMS therapy is split into dozens of sessions, with the exact dosage depending on the patient’s condition and other factors. Typically, the sessions occur five times a week over the course of at least four weeks (and up to six weeks), mirroring the dosage used to treat depression. This may change as research continues into fine-tuning the perfect amount of TMS for OCD treatment.
Each session only takes about 20 minutes, and each session is spent comfortably sitting in a chair reading, listening to music, or holding a pleasant conversation with the TMS technician present at the procedure. Complaints include the physical feeling of the procedure, which is likened to a pencil tapping gently at one’s scalp.
Afterwards, patients are free to get up and leave, or stay a while if they happen to experience any fatigue or headaches. Headaches do occur, typically in the first few sessions, often as a result of scalp discomfort from the helmet. Patients may drive themselves home or arrange for someone to pick them up.
TMS is effective, safe, and non-invasive. However, it isn’t free. The devices used to apply TMS therapy are specially built and often expensive, and treatment can be quite costly. Because insurance is critical to help cover the costs for TMS therapy, insurance coverage is important. Thankfully, most insurance providers provide coverage for TMS therapy for depression and are likely to follow suit for OCD.
TMS and Insurance
TMS for Major Depressive Disorder is covered by a wide list of different insurance providers, including:
- Fallon Health
- Harvard Pilgrim
- Masshealth PCC Plan
- One Care
- And more.
If treatment for OCD is to be covered similarly to treatment for MDD, then it’s likely that many of the prerequisites will be quite similar. For MDD, TMS becomes an option in many people’s insurance policies provided they have attempted first line treatments including pharmacology (antidepressants) and psychotherapy (CBT or DBT). ‘Additional augmentation strategies’ are also listed, referring usually to different antidepressants (non-SSRI antidepressants, from SNRIs to TCAs), different forms of psychotherapy, as well as dietary supplements.
The gold standard for OCD treatment involves the use of SSRIs and specialized talk therapy, including behavioral therapies like CBT, and ‘acceptance-commitment therapy’, which makes use of trauma treatment therapies like exposure therapy to help patients deal with their obsessions and compulsions. In the event that these treatments do not appreciably affect a patient’s mental health, it’s likely that deep TMS will become an option.
How Does TMS Treat OCD?
To understand why deep TMS is used to treat OCD in the first place, it’s important to understand how TMS works, and how it treats other conditions (such as depression). TMS involves the use of magnetic waves, aimed at a specific portion of the brain. These waves disrupt the communication between cells in the brain, essentially forcing a restart of certain pathways where different regions of the brain connect and communicate. The brain is mapped out into different regions, all of which have their own roles in helping the conscious and subconscious function, automatically executing many of the functions that keep us alive and allow us to think, process, and respond to stimuli.
In cases of mental illness, it’s sometimes possible that the communication in the brain is messed up. Certain signals aren’t doing what they should be doing, resulting in problems with mood, cognition, and behavior. For OCD, several different portions of the brain have been identified as potential targets for TMS therapy in a bid to help treat the disease. These include the dorsolateral prefrontal cortex (DLPFC), the pre-supplementary motor area (pre-SMA), and the orbitofrontal cortex (OFC). Because some of these regions are located deeper inside the brain and most TMS machines only penetrate a few centimeters past the skull, BrainsWay’s deep TMS machines are the first to be approved by the FDA for the treatment of OCD due to their ability to better target the portions of the brain that may affect OCD.
As for how effective deep TMS is for the treatment of OCD, studies show that it’s a very promising option when other treatments fail. However, it’s also a young treatment. More research is needed to determine certain things, like how often the treatment is necessary, and why certain individuals respond better when different parts of the brain are targeted with TMS.