For people with obsessive-compulsive disorder (OCD), finding effective treatment can feel overwhelming, especially if first-line options like exposure and response prevention (ERP) therapy aren’t effective on their own. Transcranial magnetic stimulation (TMS), a non-invasive brain stimulation therapy, can complement other treatments.
Transcranial magnetic stimulation (TMS), is a non-invasive brain stimulation therapy that has been shown to reduce symptoms of obsessive-compulsive disorder (OCD) in some individuals, particularly when other treatments haven’t provided enough relief. TMS works by using electromagnetic pulses to target specific areas of the brain associated with OCD symptoms, helping to regulate brain activity and alleviate distress.
While TMS can be an option for treatment, most people with OCD experience the greatest relief through exposure and response prevention therapy (ERP). However, when ERP isn’t enough, TMS may offer additional support. Keep reading to learn more about how TMS works and whether it might be a good fit for you.
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What is TMS?
Transcranial magnetic stimulation, or TMS, is a non-invasive therapy that uses electromagnetic pulses to stimulate nerve cells in the brain. It was developed in 1985, and has therapeutic potential for many neurological or mental health conditions, including:
- OCD
- Treatment-resistant depression
- Post-traumatic stress disorder (PTSD)
- Tourette disorder
- Chronic pain syndrome
- Generalized anxiety disorder (GAD)
- Bipolar disorder
- Movement disorders such as Parkinson’s disease
- Smoking cessation
- Migraines
How does TMS work?
TMS is an outpatient procedure, typically lasting 30 to 60 minutes. During the session, you’ll sit awake in a comfortable chair while wearing earplugs to help soften the clicking sound from the machine.
A magnetic coil will be placed above the front area of your brain, and your technician will adjust the TMS machine to fit your unique needs based on your condition and symptoms. “Magnetic fields go to very specific sites of your brain that are related to the areas where depression and OCD can exist,” explains Tracie Ibrahim, LMFT, CST, Chief Compliance Officer of NOCD. Since different parts of the brain are involved in different mental health disorders, the protocol—and sometimes even the device used—is customized for each individual.
What does TMS feel like?
Before starting TMS, you’ll need to be cleared by a medical provider. This process typically includes a physical exam, a mental health evaluation, and a discussion about your medical history to determine whether you have any metallic implants that could interfere with the magnetic fields used during treatment. Additionally, individuals with a history of seizures or epilepsy may not be suitable candidates.
During the procedure, some people report mild discomfort, such as headaches or scalp sensitivity, but others say it just feels like an unusual sensation. “The best way I can describe it [is] like a very intense continuous tapping for twenty or so seconds at a time,” said Hannah Shanker, a TikTok user from Chicago, Illinois. While this might feel strange at first, most people find they adjust quickly.
Any discomfort is usually temporary and tends to lessen over time as your body adjusts to the treatment. Your TMS team will work with you to ensure the process is as comfortable and manageable as possible, and can adjust the stimulation levels if needed. After each session, you can immediately return to your daily activities.
What are the side effects of TMS?
The side effects of TMS are usually short-lived and mild. When complications or side effects do occur, they may include the following:
- Headaches
- Neck pain
- Scalp pain
- Tinnitus, or ringing in the ear
- Hyperacusis, or increased sensitivity to sound
- Anxiety
- Tingling
- Facial twitching
- Sleepiness
- Altered cognition during treatment
The most serious, but rare, side effect associated with TMS is seizures, though the risk is extremely low.
Types of TMS devices
Two common types of devices used in TMS are rTMS and dTMS. Repetitive TMS (rTMS) targets areas of the brain closest to the surface, while deep TMS (dTMS) allows pulses to reach deeper into the brain. Research shows that dTMS is more effective in reducing OCD symptoms compared to rTMS. “Deep TMS (dTMS) looks and targets the same spaces in the brain but goes even deeper,” explains Ibrahim.
How long does treatment take?
The length of treatment varies, and depends on factors like the condition being treated, the severity of symptoms, and how you respond. Most people receive TMS five days a week for four to six weeks. While most people notice improvements after about 20 sessions, results vary—some experience relief lasting several years, while others may find it only lasts a few weeks.
How much will TMS cost?
Typically, costs depend on treatment providers, where you’re going, where you live, or if you’re going to a local psychiatrist versus a specialty TMS clinic. “Costs vary but it is an expensive treatment,” Ibrahim said. “You’re looking at $6,000 to $20,000 for a set of sessions without insurance.” With insurance, payments can be around $100 with insurance.” It’s also important to note that many insurance providers require documentation that more traditional treatments haven’t been effective before approving coverage for TMS therapy.
Is TMS the same as electroconvulsive therapy?
Electroconvulsive therapy (ECT) is another non-invasive procedure that has been used to treat psychiatric conditions like anxiety, depression, and OCD—but according to Ibrahim, “TMS and ECT are completely different.” She explains that ECT is a last resort, used only for extremely severe cases of OCD where other treatment options have failed to provide relief.
TMS is much more localized than ECT, targeting specific areas of the brain associated with OCD and other mental health conditions. In contrast to ECT, TMS does not send electricity into the brain, is not designed to induce a seizure, does not require general anesthesia, and is not associated with memory loss or other cognitive impairments.
TMS for OCD
OCD is a mental health condition in which people experience intrusive thoughts, sensations, images, feelings, or urges that become obsessions. In response, people with OCD perform compulsions—mental or physical actions performed in an attempt to escape discomfort or make intrusive thoughts go away. OCD affects around 1 in 40 adults and is typically treated with ERP therapy and/or medication.
The FDA approved TMS therapy for OCD in 2018, but it is most often used for people who haven’t found sufficient relief with ERP or medication. According to Dr. Patrick McGrath, Chief Clinical Officer at NOCD, the FDA only approves treatments that are backed by research and clinical evidence, ensuring their efficacy. It’s worth noting, however, that when the FDA permits the marketing of TMS for a particular condition, they do so for specific combinations of machines and protocols. Before beginning TMS with a treatment provider, be sure to confirm that they’re following guidelines for OCD specifically.
When it comes to TMS for OCD, the FDA permitted the marketing of it for:
- A dTMS device, specifically either the BrainsWay, dTMS H7 coil, or the MagVenture cool DB80 coil devices
- Using high-frequency stimulation (20 Hz)
- Targeting two specific brain areas: the dorsomedial prefrontal cortex (dmPFC) and the anterior cingulate cortex (ACC)
Other experimental strategies may not necessarily be illegal or unsafe, but they may not have been evaluated by the FDA, and are thus less likely to be covered by insurance.
TMS and ERP therapy
ERP, or exposure and response prevention, is a type of cognitive behavioral therapy (CBT) specifically designed for OCD. It works by gradually exposing individuals to the intrusive thoughts, feelings, sensations, urges and images that cause them anxiety (known as obsessions), while helping them resist engaging in compulsions that provide only temporary relief. This process works to break the OCD cycle, reducing distress over time and building long-term strategies for managing symptoms.
After having negative reactions to OCD medications, Shanker embarked on 29 sessions of TMS over the course of 6 weeks. The following year, she received 10 more sessions of TMS for OCD treatment while also doing ERP therapy. “For the first time in my life, my intrusive thoughts were manageable, I was able to control myself from giving into compulsions, and I was able to do things that seem so normal to other people but always felt impossible for me,” Shanker said. “My OCD was still there but it wasn’t totally debilitating and all consuming, which was something I’d never thought was possible.”
TMS may help reduce the intensity or frequency of triggers, but if you’re not doing ERP in your daily life, your symptoms will become less manageable.
Tracie Ibrahim
While TMS and ERP target OCD in different ways—TMS addresses brain mechanisms, and ERP focuses on behavioral patterns—they complement each other effectively. If you’re considering TMS, combining it with ERP therapy is the best way to ensure a comprehensive and lasting approach to managing OCD. That’s because TMS can help reduce the severity of symptoms by targeting specific brain areas linked to OCD, but it doesn’t teach the essential skills needed to manage OCD effectively.
“TMS may help reduce the intensity or frequency of triggers,” says Ibrahim. “But if you’re not doing ERP in your daily life, your symptoms will become less manageable.” In other words, TMS can ease symptoms, but ERP provides the necessary tools for lasting relief.
Bottom line
TMS is an option for managing OCD, especially for those who haven’t found relief with first-line treatments. However, ERP therapy remains the most effective approach for managing OCD symptoms. If you’re considering TMS, it’s best to use it alongside ERP, to ensure you’re addressing your symptoms comprehensively.
Whatever treatment path you choose, make sure to consult a professional who can guide you through the process and tailor it to your needs. There are many ways to manage OCD, and progress is possible with the right support.
Key takeaways
- TMS is a non-invasive treatment that uses electromagnetic pulses to target brain areas linked to OCD symptoms.
- TMS requires a significant time commitment and the cost can range from $6,000 to $20,000 without insurance; with coverage, out-of-pocket costs may be as low as $100.
- TMS is typically considered when first-line treatments like ERP therapy and medication haven’t provided sufficient relief.
- TMS works best as part of a comprehensive treatment plan; combining it with ERP therapy is most effective, as TMS doesn’t teach skills for managing symptoms.