OCD

TMS for OCD: Everything You Need to Know

November 4, 2020

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Photo Courtesy of  Osmosis.org

Obsessive Compulsive Disorder or OCD is a disorder that affects millions of people. The most recent studies have shown that 1.2% of adults met the clinical criteria for a diagnosis of OCD during the year leading into the study. And 2.3% of participants in the study had met the requirements for an OCD diagnosis at some point in their lives. That would be about one in every forty people experiencing the symptoms of OCD at some point in their life at a level severe enough to qualify for a clinical diagnosis.  If those numbers are extrapolated across the entire population of the United States that comes out to about seven and a half million individuals who meet the criteria for a diagnosis at some point in their lives. Additionally, the same study also indicates that over a quarter of people experience either compulsions or obsessions but didn’t rise to the level of a clinical diagnosis of Obsessive Compulsive Disorder. That would mean over 60 million Americans suffer from some form of obsession or compulsive behavior.

Studies also indicate that OCD has the third highest rate of seriously disabling cases of all mental health disorders. The only disorders that surpass OCD in seriously disabling cases are bi-polar disorder and drug addiction.

chart of ocd symptoms
OCD has one the highest rates of all mental health disorders of seriously debilitating cases.Photo Courtesy of PulseTMS.com

How Do Clinicians Handle Compulsions Currently?

Modern Medicine Commonly Relies On Medication

Thankfully there are effective treatments available for those who suffer from Obsessive Compulsive Disorder. The most common treatments for OCD involve psychotherapy or medication. Typically the psychotherapy involves Cognitive-behavioral therapy. CBT involves exposure and response prevention techniques to alter a person's behaviors and thoughts. Oftentimes the behavioral therapy is often assisted with a type of medicine known as selective serotonin reuptake inhibitors (SSRIs). SSRIs are more commonly called antidepressants. They treat depression by increasing the level of serotonin in the patients brain. However not every person who has OCD finds these treatments to be as effective as they would like.

It is not uncommon for OCD patients to not respond to the initial treatments that their doctors and psychiatrist try. In fact almost one half of OCD patients fail to respond to the first treatment that is tried. Even in the patients that do respond to treatment it is rare to see complete remission of the symptoms of OCD.

The patients with OCD that respond to SSRIs effectively are only about 20 out of every 100 patients that are prescribed them. And for those that do show an effective response, there is still the danger of significant negative effects from the prescription of SSRIs. So although the drugs have been shown to help with the symptoms of OCD, the side effects can be drastic enough to cause some patients to outright quit the medication.

The effects of the drug are not only affecting the part of the brain that causes the symptoms of OCD. They can have drastic effects all across the body. This fact, combined with the fact that sufferers of OCD typically require a higher dosage of SSRIs than those suffering from other disorders such as depression, means that a patient incurs a lot of risk with the SSRIs without the guarantee they will serve as an effective treatment for their OCD. And while pharmaceuticals and psychotherapy are the most common forms of treatment for OCD, there are new promising treatments for the disorder on the horizon.

chart of types of ocd
OCD can manifest itself in a variety of different places in a person's life. Photo Courtesy of Very Well Mind.

Alternative Types of Treatment Are Available

Transcranial Magnetic Stimulation for OCD

In August 2018 the FDA approved the use of Transcranial Magnetic Stimulation as a treatment option for OCD. But what is Transcranial Magnetic Stimulation (TMS) and how is it used to treat those who suffer from OCD symptoms? Well the science behind TMS has a long history but the technique relies on the underlying physical connection between electricity and magnetism and the electrical impulses in the human brain. 

Transcranial Magnetic Stimulation is a painless  treatment that is often used in addition to, or as a replacement for, psychotherapy and medication when they have shown to be ineffective. TMS isn’t an overly complex process. It is the use of magnetic waves to stimulate particular areas and structures in the brain. This is done in a unique way thanks the advances of modern science.

 Scientists have long understood that there is an underlying physical connection between electricity and magnetism. Additionally scientists and clinicians know that the human nervous system, and by extension the human brain runs on electricity. As such scientists realized the mind could be influenced by the introduction of new electrical currents. In the 1980s P. A. Merton & H. B. Morton first successfully stimulated the motor cortex of the brain using transcranial electrical stimulation (TES). 

However, the use of actual electrical currents was known to cause quite a bit of discomfort and pain when it was applied to patients.. In 1985 underlying physical connection between electricity and magnetism was used to create the first functional and stable Transcranial Magnetic Stimulation device. This new machine meant that the electrical impulses in the human mind could be observed and altered by doctors without the patient undergoing the painful process of having electrical currents run through their heads.

By realizing that magnetic fields could be harnessed to influence the electricity in the human brain, a new non invasive technique was discovered. By targeting magnetic fields at certain parts of the brain the amount of activity and excitability in the neurons can be altered. And this can all be done with painful electrical shocks or any kind of invasive procedure 

Unfortunately, Transcranial Magnetic Stimulation devices weren’t initially thought of as treatment tools. Doctors didn’t realize the devices could be used as a way to treat mental health disorders for several years. The devices were primarily used only as diagnostic tools that would allow scientists to monitor the electrical activity in neurons in the different structures of the brain.

Being able to observe the electrical activity in different portions of the brain was no small feet though. This advancement was what allowed scientists to look at the devices as a way to treat mental health disorders. By observing that certains areas of the brain had less neural activity than other portion in patients with mental health disorders, doctors were able to determine that low activity in certain parts of the human brain corresponds with the symptoms of different disorders. The first time TMS was used as a tool for treatment was in the early 1990s. The journal Neurology published an article title Induction of Speech Arrest and Counting Errors With Rapid-Rate Transcranial Magnetic Stimulation by Alvaro Pascual-Leone. This article, and the findings presented therein, excited the curiosity of the clinical and scientific community. Which led to a significant amount of  research, clinical experiments, and conferences over the next two decades. 

The research continued to pile up over the years and the United States Federal Government approved the Transcranial Magnetic Stimulation devices for treatment in psychotherapy in 2008. The government approved the devices after the scientific community had proven that TMS devices could be used as an effective therapeutic application in the fields of physical rehabilitation, neurology,  and psychiatry. 

However, the devices weren’t approved for use as a treatment for Obsessive Compulsive Order until August of 2018. At the time Dr. Carlos Peña, the director of the Division of Neurological and Physical Medicine Devices in the Food and Drug Administration’s Center for Devices and Radiological Health, said “With today’s marketing authorization, patients with OCD who have not responded to traditional treatments now have another option.”  But how effective of a treatment for OCD has TMS shown to be?

chart of how tms treats ocd
TMS relies on stimulating different structures in the brain to increase or decrease the neural excitability and encourage the production of neurotransmitters. Photo Courtesy of Slide Player.com

Magnets Mitigate the Adverse Effects of Medication

Focusing the Treatment Prevents Undesired Consequences

Well for those patients who have responded poorly, or haven’t responded to traditional forms of treatment, TMS can be an effective treatment. Unlike SSRIs which cause a litany of different side effects,  TMS has been shown to be well tolerated by most people. The side effects of TMS are typically reported as being in the mild to moderate range and tend to decrease as the patient adjust to the therapy in additional sessions. The most common side effects are a mild headache, a mild discomfort at the scalp, light tingling or spasms in face muscles that are near the area the treatment was administered and some lightheadedness. The most serious side effects of TMS treatment are hearing loss if proper ear protection isn't worn, feelings of mania after the treatment, and in rare cases, seizures so make you sure you discuss things thoroughly with your doctor before deciding on trying the treatment.

Typically during a TMS treatment portions of the patient's brain are targeted by magnetic fields generated by an electromagnetic coil placed near the patient's head. The magnet is turned on and off by the attending physician. The doctor will need to determine the best area to target the magnetic pulse during the first session. As such the first session should last around an hour with future sessions lasting around 40 minutes.

When a patient is suffering from symptoms of OCD the doctor will target the magnet wave at a few potential places. The most likely area will be the Dorsolateral Prefrontal Cortex (DLPFC). Which is a region of the brain that is located toward the front of the head in the frontal lobe. Another region that may be targeted is the Orbitofrontal cortex (OFC). The OFC generally shows overactivity in patients who suffer from OCD. And the final area that would be targeted in the Pre-Supplementary Motor Area (pre-SMA). Just like the OFC this area of the brain also shows overactivity in patients who are suffering from OCD. The studies thus far have shown the best results in using TMS as a treatment for OCD.  

However, the bottomline is that TMS is a brand new treatment for OCD. And while it has shown promising results for a variety of different mental health disorders, there is much research left to be completed. However, doctors and clinicians  have committed to completing additional research on the use of TMS as a treatment for a variety of disorders including OCD. But the findings thus far with TMS have been promising. And although the treatment is still in the early stages of its development as an effective tool for treating OCD it is likely an increasing number of studies are published on how the treatment can be refined and developed into a more effective treatment option.

chart showing the cycle of ocd symptoms
Left untreated OCD can trap those who suffer from it in a cycle that consumes their life. Photo Courtesy of  oshoclinicpanchkula.com.

At the end of the day, if you or somebody you know are suffering from Obsessive Compulsive Disorder, TMS is a treatment that is worth considering. Especially if traditional treatments like medication and behavioral therapy have been shown to be ineffective. The side effects from TMS are less drastic than the side effects most commonly listed from SSRIs and the treatment is more specifically targeted than medication. However, that doesn’t mean the treatment is entirely risk free. In rare instances some patients have suffered seizures so it’s important to have an in depth discussion with a healthcare professional before changing your treatment routine.

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