TMS Therapy for OCD: Should you try it?

TMS, or transcranial magnetic stimulation, is an alternative therapy that some obsessive-compulsive disorder (OCD) sufferers become curious about when other treatments they’ve tried don’t work. TMS is a type of brain stimulation therapy (if it sounds scary, don’t worry—it’s non-invasive). You may have even come across it in your TikTok feed, with users sharing what it’s like to have a TMS device strapped to their head, emitting small, consistent pulses. 

“The best way I can describe it, and the way my doctors described it to me before my first session—is almost how you’d imagine a woodpecker would feel—like a very intense continuous tapping for twenty or so seconds at a time,” said Hannah Shanker, a TikTok user from Chicago, Illinois, sharing her experience. “It wasn’t the most comfortable feeling in the world but it’s definitely doable.”

Keep in mind, for the vast majority of people with OCD, relief is most likely to come from what’s called “evidence-based treatment”—this means there’s decades of clinical research to prove that it works. Those treatments are Exposure and Response Prevention (ERP), which is a specialized therapy that was developed specifically for OCD, medication, or a combination of the two. But humans are variable, and there are times when evidence-based treatments do not work or provide quite enough relief. 

After having negative reactions to OCD medications, Shanker decided to begin TMS—29 sessions over the course of 6 weeks. The following year, she received 10 more sessions of TMS for OCD treatment while also doing ERP therapy—which involves gradually exposing yourself to situations or stimuli that trigger obsessive thoughts or anxiety while teaching you how to refrain from engaging in compulsive behaviors. 

“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.”

Keep reading to learn more about TMS, and whether it could be right for you.

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What is TMS and how does it work? 

Transcranial magnetic stimulation, or TMS, is a non-invasive therapy that uses electromagnetic pulses to stimulate nerve cells in the brain. TMS, which was developed in 1985, has therapeutic potential for neurological or mental health disorders. Here are some of the conditions that TMS may help:

• Treatment-resistant depression 
• OCD
• Post-traumatic stress disorder (PTSD)
• Tourette disorder 
• Chronic pain syndrome 
• Generalized anxiety disorder (GAD)
• Bipolar disorder 
• Movement disorders such as Parkinson disease 
• Smoking cessation
• Migraines 

TMS is done as an outpatient procedure that takes 30 to 60 minutes and is performed by a TMS technician or doctor. You’ll sit, awake, in a comfortable chair wearing earplugs (to minimize the clicking sound you hear during the treatment). Next, a magnetic coil is placed above the front area of your brain, while the technician customizes the settings on the TMS machine for you. Once they begin administering the treatment, you’ll feel a tapping sensation underneath the magnetic coil, on your scalp, as electric currents are passed through the coil generating a magnetic field.

“Magnetic fields go to very specific sites of your brain that are related to the areas that depression and OCD can exist,” explains Tracie Zinman-Ibrahim, a LMFT, CST, Chief Compliance Officer of NOCD. The exact length of your treatment is different for everyone, but it’s usually something that is repeated 5 days a week for 4 to 6 weeks. 

As for whether it’s painful, Some patients report pain or discomfort, though this can often be fixed by changing the setup. After each treatment session, you can resume normal daily activities (in other words: no downtime required).

Keep in mind, before a TMS session, you must be cleared for the treatment by a medical provider. This typically includes a physical exam as well as an evaluation of your mental health and discussion of any family history of diseases and mental health disorders.

What is TMS for OCD? 

OCD is a disorder in which people experience recurrent and persistent thoughts, urges or sensations (obsessions). These obsessions are unwanted and cause significant anxiety or distress, which leads to compulsions—mental or physical actions done in an attempt to escape the discomfort or make the intrusive thought go away. OCD affects around 1 in 40 adults.

Initially, the FDA approved TMS therapy for the treatment of major depressive disorder in patients who had not responded to antidepressant medications. Over the years, however, researchers began exploring whether it might be helpful for other mental health conditions, and in the process, they discovered that it could help alleviate the symptoms of OCD for some people. TMS was approved for OCD in 2018. 

Keep in mind, TMS is not a one-illness-fits-all therapy. Since different parts of the brain are involved in different mental health disorders, the protocol—and sometimes even the device being used—is adjusted based on which condition that needs treatment. Researchers are continuing to learn about the techniques and devices that can specifically work best on OCD in the brain. 

Two common types of devices used in TMS are rTMS and dTMS. Repetitive TMS, or rTMS, devices target the areas of the brain closest to the surface. Meanwhile, dTMS (deep TMS) makes it possible for pulses to reach deeper into the brain. Deep TMS has shown to be more effective in reducing OCD symptoms compared to TMS. “Deep TMS (dTMS) looks and targets the same spaces in the brain but goes even deeper,” Ibrahim said. 

It’s also worth noting 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 find out whether 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)

With that said, this does not mean that other experimental strategies are illegal or unsafe. However, they may not have been evaluated by the FDA and are less likely to be covered by insurance.

Limitations of TMS for OCD

“You use TMS for conditions specifically when medications and other therapies have failed; this isn’t usually the first option,” says Ibrahim. Not to mention, “in order to get approved for TMS, you have to show everything that you have tried that have failed including medications and therapies.”

It’s also important to note that TMS is not a stand-alone solution. Patients with OCD who are undergoing TMS are also typically engaged in other treatments including medications and ERP. 

“TMS does not teach you skills for OCD,” says Ibrahim. “You still have to do your ERP therapy since TMS doesn’t wipe out symptoms.” She also explains that “it’s not that TMS targets specific OCD symptoms. Rather, “it goes in and helps certain brain areas that are responsible for OCD symptoms. Because of that, you can have an improvement in your symptoms. Maybe you’ll have less intense or less frequent triggers.”

Simply put: “TMS may help reduce the severity of symptoms. But If you’re not doing ERP in your daily life, your symptoms will become less manageable,” notes Ibrahim.

As mentioned above, TMS is also an intensive time commitment that doesn’t work for everyone. Typically, people receive TMS five days a week, for thirty minutes, usually over several weeks. “Most people see an improvement around 20 sessions,” Ibrahim said. 

As for how long the effects of TMS for OCD last? Results have been variable, ranging from two weeks to three years.

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 

There’s also a risk of seizures, but this side effect of TMS is extremely rare.

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 and depression. “TMS and ECT are completely different,” Ibrahim said. “ECT is a last resort, and depends on the severity of OCD where other treatments have failed.” 

Here are some of the differences:

• TMS does not send electricity into the brain
• TMS is not designed to induce a seizure
• TMS does not require general anesthesia
• TMS is not associated with memory loss or other cognitive impairments sometimes associated with ECT
• TMS is much more localized, targeting specific areas of the brain associated with OCD and other mental health conditions

Costs of TMS

Typically, costs depend on treatment providers, where you’re going, where you live, or if you’re going to a local psychiatrist versus a medical 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. However, you should always check what your insurance covers. The out of pocket expenses can be around $100 with insurance.”

“Also to qualify for insurance to pay for TMS, your doctor will have to do an extensive amount of information about what has been used,” she adds.

A last word of advice from Ibrahim: Despite what you may see on TikTok or anywhere else you’re searching for people’s experiences with OCD treatment: “It’s important to not compare yourself to other people you’re finding online,” Ibrahim said. “Go find what works for you.”