Quick facts
- What it is
- Non-invasive magnetic stimulation of brain circuits involved in OCD.
- FDA-cleared for
- Adults with OCD who have not improved enough with therapy and medication.
- Alongside treatment
- TMS can be used with therapy and medication.
- Insurance
- Many insurers still consider TMS for OCD investigational; we tell you where your plan stands first.
- Led by
- Dr. Khaled Bowarshi, dual board-certified psychiatrist.
- Locations
- Wesley Chapel and Tampa, Florida.
What is OCD?
Obsessive Compulsive Disorder is a chronic mental illness characterized by obsessions, compulsions, or both, as described in the DSM-5.
Obsessions are recurrent, persistent and unwanted thoughts, urges or images that cause marked anxiety or distress. Compulsions are repetitive behaviors, such as hand washing, ordering or checking, or mental acts, such as praying or counting, that a person feels driven to perform to reduce anxiety. They are typically time-consuming (more than an hour a day) or cause significant distress or impairment.
Patients with mild OCD usually have good insight, while those with severe OCD may have limited insight, and the most severe cases can involve delusional beliefs.
How common is OCD?
The annual prevalence of OCD is about 1.2% and the lifetime prevalence is 2.3%, about 1 in 44 Americans. According to the National Institute of Mental Health, about half (50.6%) of those with OCD had a serious impairment. OCD can also co-occur with anxiety disorders and depression.
What causes OCD?
The exact cause is not fully understood. A chemical imbalance was long considered the leading explanation, but as neuropsychiatry advances we are learning that imbalances in the cortical-striatal-thalamic-cortical (CSTC) pathway are present in patients with OCD. This pathway consists of parallel interconnected loops between cortical and subcortical areas that determine which actions are selected as important and which are ignored.
What is the treatment for OCD?
The best first-line treatment is Cognitive Behavior Therapy, specifically Exposure and Response Prevention (ERP), which exposes the patient to situations that provoke obsessions while helping them avoid compulsive responses. Antidepressants such as fluoxetine, paroxetine, sertraline, fluvoxamine and clomipramine are also first-line and are usually combined with ERP.
These treatments help some patients reduce symptoms, but they do not usually result in full remission. About 30% of OCD patients don't get satisfactory results from CBT with or without medications. For them, there is now another option.
Does TMS work for OCD?
Yes. TMS is a safe, effective and FDA-cleared option for adults with OCD.
In a typical session you are awake in a comfortable chair while a magnetic coil is placed over the head. Pulses travel through hair, skin, muscle and bone to the targeted brain circuits, with an intensity close to an MRI but more focal. Pulses and stimulation location are specific to you, based on an initial brain mapping. A session takes about 20 minutes, with daily sessions Monday to Friday for a few weeks, typically six. You can drive yourself and continue your normal day.
OCD treatment delivers magnetic stimulation to the dorsal medial prefrontal cortex and the anterior cingulate cortex on both sides.
FDA clearance and results
TMS is FDA-cleared for the treatment of OCD in adults who have not improved enough with therapy and medication.
In a multicenter, blinded, randomized controlled trial published in the American Journal of Psychiatry, 38.1% of patients in the active group had a response of more than 30% reduction in symptom severity after six weeks, and 54.8% had a partial response of more than 20% reduction, with significant improvement compared to sham.
Does insurance cover TMS for OCD?
Not yet in most cases. Despite the evidence of safety and efficacy and the FDA clearance, many insurers still consider TMS for OCD investigational. Advocacy to improve access is ongoing, and we will tell you where your plan stands before you start.
TMS for depression is covered by most commercial insurers and by federal plans such as Medicare and Tricare.
In summary
Patients with OCD have one more treatment option that is safe, effective, non-invasive and FDA-cleared.
Next steps
Start with a psychiatric evaluation. Call (813) 867-2378 to schedule in Wesley Chapel or Tampa.
Frequently asked questions
Sources and further reading
- Obsessive-Compulsive Disorder (OCD). National Institutes of Health / NIMH
- Obsessive-Compulsive Disorder (OCD): statistics from the National Comorbidity Survey Replication, 2001–2003. National Institute of Mental Health
- FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. August 17, 2018. U.S. Food and Drug Administration
- MagVenture TMS Therapy for treatment of OCD. 510(k) K193006. Cleared August 9, 2020. U.S. Food and Drug Administration
- Carmi L, et al. Efficacy and safety of deep TMS for obsessive-compulsive disorder: a prospective multicenter randomized placebo-controlled trial. Am J Psychiatry. 2019;176:931–938. American Journal of Psychiatry
- Brain Stimulation Therapies. National Institute of Mental Health
Medical information on this page is educational and not a substitute for professional advice. Individual results vary.