OCD

Treatment of OCD Now Approved by FDA Using Transcranial Magnetic Stimulation

November 7, 2018

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Transcranial Magnetic Stimulation (TMS) has shown tremendous potential in treating a variety of mental health, mood disorder and neurological issues. An evolution of Electroconvulsive therapy (ECT), it uses magnetic stimulation rather than electric to boost the production of neurotransmitters in the brain. Unlike ECT, practitioners can focus on much more specific areas of the brain, enabling them to target the exact area of the brain related to various issues.  TMS is typically suggested for treatment after first line treatments like medication fail.

There is a great deal of ongoing research on the potential uses for TMS currently, and in August of 2018 the FDA approved TMS for treating Obsessive Compulsive Disorder (OCD). The FDA originally approved TMS for treatment of major depressive disorders in 2008, adding treatment for migraine headache pain in 2013.

How Does TMS Treat OCD?

OCD is chronic disorder, where individuals have reoccurring, uncontrollable thoughts or behaviors that they feel the need to repeat over and over. It is typically treated with medication, therapy or a combination of the two. TMS can now be used for patients who are not responding to typical treatment. Approximately one percent of adults in the US have OCD.

Frequent and repeated hand washing is one symptom commonly reported in patients with OCD.

There has been a great deal of research on what causes OCD, and the general consensus it it is caused by an imbalance in the brain's chemistry. This is why medications like SRIs have been helpful in treatment. More recently, this understanding has expanded into focusing on the structure and function of the brain’s neural network and how it may play a role in OCD. TMS is proving helpful when the treatment requires more than replenishing a chemical imbalance and instead focuses on the neural network and its function.

For OCD, TMS can target the Orbitofrontal Cortex (OFC), which is an area of the brain consistently tied to OCD. Three studies focused on TMS application to the OFC showed positive results.

OCD patients have lower activation in various regions of the brain, some of which (OFC) can be stimulated with TMS. Image Courtesy of Harvard Surgical Planning Laboratory

In addition to the OFC, the most promising results were seen after treating the “pre-Supplementary Motor Area” or pre-SMA, an area that has consistently been seen as overactive in patients with OCD. The first studies targeting the pre-SMA examined the use of TMS for patients with OCD and Tourette’s syndrome. At the end of treatment, patients showed general reduction in OCD symptoms in addition to improvement in functioning, as well as reductions in depression and anxiety. Importantly, the improvements held for at least three months.

“Transcranial magnetic stimulation has shown its potential to help patients suffering from depression and headaches,” said Carlos Peña, Ph.D., M.S., director of the Division of Neurological and Physical Medicine Devices in the FDA’s Center for Devices and Radiological Health. “With today’s marketing authorization, patients with OCD who have not responded to traditional treatments now have another option.”

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