Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation treatment that uses magnetic pulses to target areas involved in obsessive-compulsive disorder (OCD). The U.S. Food and Drug Administration (FDA) cleared TMS for treatment-resistant OCD in 2018. It is typically considered when people do not respond to first-line treatments, such as exposure and response prevention (ERP) therapy and medication.
How does TMS work for OCD?
TMS delivers focused pulses to specific brain regions, including the prefrontal cortex and supplementary motor area. “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. By modulating brain activity, TMS can help reduce the intensity of OCD symptoms. Treatments are typically conducted in outpatient sessions, five days a week, for four to six weeks.
Types of TMS devices and treatments
Several FDA-approved devices can be used to deliver TMS for OCD. While they all use magnetic pulses to stimulate targeted brain areas, they differ in intensity, depth, and delivery method:
- Repetitive TMS (rTMS): The most common type, delivering repeated pulses to modulate brain activity.
- Deep TMS (dTMS): Uses specialized coils (such as the BrainsWay H7 coil) to reach deeper brain regions linked to OCD.
- Theta-burst stimulation (TBS): A newer, faster approach that delivers bursts of stimulation in shorter sessions.
Your care team will determine which device and protocol are best for your specific needs.
How effective is TMS for OCD?
TMS can provide meaningful symptom relief for some people with treatment-resistant OCD. Studies suggest that about 40-60% of patients experience a significant reduction in OCD symptoms. However, response rates vary, and not everyone improves. TMS can be a viable alternative if first-line treatments, such as ERP therapy and medication, have been unsuccessful.
Who is a candidate for TMS therapy?
TMS is typically recommended for people who:
- Have tried ERP therapy and medication without sufficient improvement.
- Cannot tolerate the side effects of medication.
- Are seeking a non-invasive alternative to more intensive procedures, such as deep brain stimulation (DBS).
A psychiatric evaluation is required to determine if someone qualifies for TMS.
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.
How long does it take to see results from TMS?
Many patients notice improvement within two to three weeks of starting treatment, while others may require up to six weeks before experiencing benefits. Some people continue to see improvement after completing their sessions. In some instances, maintenance sessions may be recommended to sustain results.
How does TMS compare to other OCD treatments?
As mentioned, several other treatments may be considered before trying TMS. Here are the first-line treatments for OCD:
Exposure and response prevention (ERP) therapy
ERP is a specialized form of cognitive behavioral therapy (CBT) proven to be effective for OCD. General CBT, if not tailored for OCD, can sometimes be unhelpful or even worsen symptoms. ERP involves gradually facing triggers head-on while resisting the urge to engage in compulsions.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Medications
Medications, such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and atypical antipsychotics, may be used in conjunction with ERP or as standalone treatment to reduce the intensity of OCD symptoms.
Other approaches that may be done in addition to ERP therapy include mindfulness-based strategies and acceptance and commitment therapy (ACT).
TMS is not a first-line treatment but can play an important role for people who have not responded to traditional approaches.
If TMS is not effective, there are other options you can explore for severe or treatment-resistant OCD, such as:
- Deep brain stimulation (DBS)
- Intensive outpatient programs (IOPs)
- Partial hospital programs (PHPs)
- Residential treatment centers (RTCs)
- Gamma knife radiosurgery (GKRS)
Can TMS be combined with ERP therapy?
Yes. TMS is often used alongside ERP therapy rather than as a replacement. Since ERP directly helps people face fears and reduce compulsive behaviors, and TMS works by modulating brain activity linked to OCD, the two can complement each other.
“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.
Cost and availability of TMS
“Costs vary, but it is an expensive treatment,” says Ibrahim. “You’re looking at $6,000 to $20,000 for a set of sessions without insurance.” Insurance coverage varies and often requires documentation of prior treatment attempts. While availability is expanding, access remains limited compared to ERP therapy and medications, which are more widely available.
Bottom line
TMS therapy is an FDA-approved, non-invasive option for people with treatment-resistant OCD. While it doesn’t replace ERP therapy or medication as first-line treatments, it can reduce symptoms for some individuals who haven’t found relief elsewhere. If you’re considering TMS, consult with a mental health professional to determine if it’s a suitable option for your needs.
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 expenses may be as low as $100.
- TMS is typically considered when first-line treatments, such as ERP therapy and medication, haven’t provided sufficient relief.
