Transcranial Magnetic Stimulation for OCD
A recent episode of the Dr. Phil titled, “Inside the World of OCD” featured the use of Transcranial Magnetic Stimulation (TMS) as a breakthrough treatment for OCD. Since then I have had several family members of individuals with OCD ask me about TMS. I was glad to hear that the individuals featured on the show got some relief from their OCD after TMS, so I decided to research its efficacy and availability.
The good news is that there are local clinics offering TMS. The bad news is that there is no scientific evidence that TMS is an effective treatment for OCD. Even the web site for the clinic featured on the Dr. Phil episode states, “Transcranial Magnetic Stimulation (TMS) is a "NEW" FDA approved treatment for depression. NO SIDE EFFECTS, NO MEDICATION, NON INVASIVE. TMS is a successful treatment for patients that have failed antidepressants and other therapies for depression.” There are no claims of FDA approval for or success with TMS as treatment for OCD.
The fact is that TMS is an approved treatment only for depression and only for adults who have failed to achieve satisfactory improvement from antidepressant medication. TMS was approved by the FDA 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.
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.
