Transcranial Magnetic Stimulation for OCD
Transcranial Magnetic Stimulation (TMS) is a breakthrough treatment for OCD. The FDA cleared deep transcranial magnetic stimulation (Deep TMS) for obsessive-compulsive disorder (OCD) treatment, following a double-blinded placebo-controlled multicenter trial. And there are local clinics offering TMS.
TMS is an approved treatment only for adults who have failed to achieve satisfactory improvement from medication.
TMS was approved by the FDA for treatment of depression in 2008. Studies have looked at TMS as treatment for a variety of brain based disorders such as Migraines, PTSD, Parkinson’s and OCD and have failed to find any conclusive benefit from TMS for anything other than medication resistant depression.
Different brain stimulation techniques are promising as an add-on treatment of refractory OCD, although studies frequently reported inconsistent results. TMS, DBS, and tDCS could possibly find some use with adequate testing, but their standard methodology still needs to be established.
A 2022 meta-analysis shows that r-TMS is an effective treatment for OCD, but largely for those not resistant to SSRI or failing to respond to only one SSRI trial. As a consequence, r-TMS may be best implemented earlier in the care pathway.
Pub Med is an electronic database of over 22 million pieces of research literature in biomedical topics. A search for “TMS OCD” produced nine results. (A comparable search for “ERP OCD produced 209 results). Three of the nine articles were reviews of compiled research. Five of the nine articles clearly conclude that TMS is no more effective than “sham” (placebo) treatment; this included the most recent review of the literature from 1966 to 2010 which found 12 such studies which used control groups. Two of the nine studies that Pub Med found did not use a control group, and the remaining one study of the nine did divide 21 patients into treatment and sham-control groups and concluded that their results supported “further investigation into the potential therapeutic applications of rTMS.”
A search of Pub Med for research specifically by the doctor featured in the Dr. Phil episode found that he has published research, having been a contributing author in 21 studies. Most are MRI or PET studies of the head and neck for tumors, aneurysms or other lesions or injuries. The most recent study he co-authored was published in 1996 and was a study of brain injury in soccer players. He has published no studies of TMS for the treatment of OCD (or depression).
In conclusion, my review of the research suggests that there is some evidence that TMS can be an effective treatment for medication resistant depression. Sadly, there is no scientific evidence that TMS can improve OCD any more than a placebo or “sham” treatment can. About seven of ten people with OCD will benefit from medication or CBT, with research repeatedly finding the best treatment response coming from a combined treatment of an SSRI and Exposure with Response Prevention.
Until there is a substantial collection of research finding such compelling results, I will not be recommending anything else.
TMS is an approved treatment only for adults who have failed to achieve satisfactory improvement from medication.
TMS was approved by the FDA for treatment of depression in 2008. Studies have looked at TMS as treatment for a variety of brain based disorders such as Migraines, PTSD, Parkinson’s and OCD and have failed to find any conclusive benefit from TMS for anything other than medication resistant depression.
Different brain stimulation techniques are promising as an add-on treatment of refractory OCD, although studies frequently reported inconsistent results. TMS, DBS, and tDCS could possibly find some use with adequate testing, but their standard methodology still needs to be established.
A 2022 meta-analysis shows that r-TMS is an effective treatment for OCD, but largely for those not resistant to SSRI or failing to respond to only one SSRI trial. As a consequence, r-TMS may be best implemented earlier in the care pathway.
Pub Med is an electronic database of over 22 million pieces of research literature in biomedical topics. A search for “TMS OCD” produced nine results. (A comparable search for “ERP OCD produced 209 results). Three of the nine articles were reviews of compiled research. Five of the nine articles clearly conclude that TMS is no more effective than “sham” (placebo) treatment; this included the most recent review of the literature from 1966 to 2010 which found 12 such studies which used control groups. Two of the nine studies that Pub Med found did not use a control group, and the remaining one study of the nine did divide 21 patients into treatment and sham-control groups and concluded that their results supported “further investigation into the potential therapeutic applications of rTMS.”
A search of Pub Med for research specifically by the doctor featured in the Dr. Phil episode found that he has published research, having been a contributing author in 21 studies. Most are MRI or PET studies of the head and neck for tumors, aneurysms or other lesions or injuries. The most recent study he co-authored was published in 1996 and was a study of brain injury in soccer players. He has published no studies of TMS for the treatment of OCD (or depression).
In conclusion, my review of the research suggests that there is some evidence that TMS can be an effective treatment for medication resistant depression. Sadly, there is no scientific evidence that TMS can improve OCD any more than a placebo or “sham” treatment can. About seven of ten people with OCD will benefit from medication or CBT, with research repeatedly finding the best treatment response coming from a combined treatment of an SSRI and Exposure with Response Prevention.
Until there is a substantial collection of research finding such compelling results, I will not be recommending anything else.
