OCD: FDA Approved TMS Treatment Update

by Isabel Leming, TMS Technician

In her latest expert blog post, Isabel Leming explores how rTMS could help sufferers of obsessive-compulsive disorder (OCD).

What is OCD? How is it treated?

The term OCD gets thrown around a lot, however Obsessive–Compulsive Disorder (OCD) is a serious anxiety-related condition that affects 1.2% of the population.

Whilst there are a range of treatment options available: Cognitive behavioural therapy (CBT), Exposure and Response Prevention (ERP), hypnotherapy and medication, up to 60% of people experience persistent symptoms despite medications and pharmacotherapy.

In recent years a neurostimulatory technique, repetitive transcranial magnetic stimulation (rTMS) has been increasingly used as an effective treatment method for OCD and has been listed under NICE guidance for the treatment of depression since 2015.

We, at Smart TMS, opened the doors to our first clinic in Kensington, London soon after the NICE approval was achieved and have continued to develop increasingly successful protocols for treating OCD.

But how does rTMS work?

rTMS is a non-invasive method of brain stimulation that uses a magnetic coil to generate magnetic pulses which are then repetitively passed through the skull, to a focused area of the brain.

Research conducted both globally and by Smart TMS suggests, rTMS treatment for OCD to be effective in roughly 50% of patients.

What other types of TMS are there?

Since Smart TMS has been successfully treating OCD using rTMS, amongst other mental health disorders, another form of TMS known as deepTMS (dTMS) has also begun to be used as a method of neurostimulation.  Deep TMS, like rTMS, uses a coil placed directly on the skull, which creates a magnetic field penetrating the brain.

What’s the difference between rTMS and dTMS?

The biggest difference between the two types is that the coil used with dTMS, called an H-coil, allows the pulse to penetrate more deeply into the brain. The figure 8 coil used in rTMS allows stimulation at a limited and clearly defined location, is the most widely used for research and therapeutic purposes. It activates cortical area of 2-3cm and depth of 2-3cm. Comparatively, the H-coil stimulates 4cm beneath the surface of the skull over a large area reaching 17cm3 of neuronal tissue.

Much like rTMS, dTMS has also shown a lot of potential for effectively treating mental health disorders. The Food and Drug Administration (FDA) in USA has recently reviewed results from a study using a Brainsway dTMS device. The results revealed that 38% of patients responded to the Brainsway device (i.e., greater than 30% reduction in symptoms as measured by a psychometric test referred to as Yale Brown Obsessive Compulsive Scale), whereas 11% of patients responded when using the sham device.

Following these results, the U.S. Food and Drug Administration permitted marketing of the Brainsway Deep Transcranial Magnetic Stimulation System for treatment of OCD. They have stated:

“With today’s marketing authorization, patients with OCD who have not responded to traditional treatments now have another option”.

What does this mean for OCD sufferers?

This formal introduction of dTMS marks a big step towards improving the treatment options available for those with OCD and consequently, TMS’ continued use in the treatment of mental health disorders can only have more positive repercussions in the future.

For the time being, Smart TMS will continue using rTMS to treat OCD, whilst continually reviewing developments in research. Watch this space!