November 08, 2019

By Steven Ryan Vidrine, M.D.

Many patients struggling with Obsessive Compulsive Disorder (OCD) are familiar with the go-to treatment approaches: medication (usually SSRIs) and exposure-response prevention (ERP) therapy, which was developed specifically for the treatment of OCD. For many patients, these first-line treatments work. Unfortunately, many other patients struggle to feel better with medication or struggle to tolerate the side effects. 
Additionally, ERP therapy can be difficult to find and to afford. If one is able to get a therapist specialized in OCD treatment, the therapy itself is often quite difficult and uncomfortable. The idea behind ERP is for the individual to face their fears and learn to refrain from engaging in compulsions. For many patients, there are just too many hurdles, or the process is too long and difficult. For some “treatment resistant” individuals, they do everything as recommended and are still left with significant symptoms. 
For those patients, there are additional treatment options available. And we’re starting to understand how one of these treatment options, deep transcranial magnetic stimulation (dTMS), can work with therapy and medication to reduce symptoms more effectively. 

What is dTMS? 

At my practice, one treatment modality that we offer is non-invasive deep transcranial magnetic stimulation (dTMS). dTMS is the first new therapy in over a decade to be FDA-cleared for treating OCD. This outpatient treatment is intended for patients who have not found success with medication and therapy and are looking for another option. 
dTMS works by targeting parts of the brain known to be involved in OCD with temporary magnetic fields. Patients go in for daily 20-minute sessions, Monday through Friday, for five to six weeks. And often continue to improve after the treatment period ends. 
One way that dTMS for OCD differs from depression treatment is that the treatment is most effective when paired with a brief “provocation” or “exposure” personally designed for the patient based on their OCD fears. The belief is that by activating the OCD circuitry at the time of stimulation, we can better target their specific symptoms and better help their brain recalibrate its response.
A trial, that led to the FDA clearance of the treatment, has shown that dTMS can be highly effective in reducing OCD symptom severity. The treatment is non-invasive, and the only common side effects are mild scalp discomfort and minor headaches that usually go away after the first couple weeks of treatment.

How Can dTMS Be Used with Therapy? 

While the clinical trial data is promising, the dTMS approach has only been FDA approved for the treatment of OCD since August 2018. So many psychiatrists and patients still have questions about how it works and how it might be used in addition to other treatment approaches. 
As one of the first psychiatrists to begin using the device in routine clinical practice, I’ve treated several OCD patients since the treatment was approved. The severity of these cases has ranged from moderate (significant impact on function but still maintaining expected work/social activities) to severe (on disability, requiring residential treatment or hospitalization). I have seen this treatment fail for some and work wonders for others. 
In my experience, dTMS reduces symptom severity seemingly through increasing patients’ ability to resist compulsions and engage more effectively with ERP therapy, even when overall obsessions may not have drastically changed. I have worked with several patients who tried medications and ERP with OCD specialists several times in the past, and didn’t see improvements. But once they paired their treatment with dTMS, they were able to progress and feel better at much a greater rate. Patients often describe feeling that they have more control over the behaviors they choose, that obsessions are quieter or easier to ignore, and that they feel they can fight the obsessions and compulsions more successfully. 
As a clinician who believes in ERP as the cornerstone of OCD treatment, this anecdotal evidence is an opportunity to take what we already know to work in most cases, and boost its effects with dTMS. I’m excited about this new treatment option for patients, and as a provider, I have enjoyed being able to have another tool to use against OCD. I encourage you to ask your psychiatrist about dTMS if you feel like it might be the right approach for you. 
Dr. Vidrine is a Board-Certified Psychiatrist who specializes in treating patients with OCD, Body Dysmorphia, Anxiety Disorders, and Treatment-Resistant Depression. He is a member of TMS Health Solutions, a practice which specializes in caring for the 40% of patients who don’t respond to medication and providing innovative and effective therapies. 

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