Obsessive-Compulsive Disorder (OCD) remains a significant challenge in psychiatric practice, with a substantial portion of patients showing resistance to conventional treatments. As clinicians, we continually seek evidence-based interventions to address this treatment gap. In recent years, Transcranial Magnetic Stimulation (TMS) has emerged as a promising adjunctive therapy for OCD, particularly in cases where traditional approaches have proven insufficient.
To kick off this series, we will consider the state of TMS in OCD treatment, focusing on its efficacy, mechanisms, and potential to expand our therapeutic toolkit.
The Science Behind TMS for OCD
Subsequent studies have shown even more promising results:
To kick off this series, we will consider the state of TMS in OCD treatment, focusing on its efficacy, mechanisms, and potential to expand our therapeutic toolkit.
The OCD Challenge
Obsessive-Compulsive Disorder affects 1-3% of the global population, causing significant distress and functional impairment (Ruscio et al., 2010). Despite available treatments, up to 40% of patients remain treatment-resistant (Howes et al., 2022). This is where TMS enters the stage, offering new hope for those who've exhausted conventional options (Bermudes et al., forthcoming).
Enter TMS. TMS, particularly using the innovative H7 coil system, has emerged as a promising adjunctive treatment for adults with moderate to severe OCD. But what makes it so special?
Key Benefits of TMS for OCD:
1. Non-invasive: Unlike deep brain stimulation, TMS is non-invasive and doesn't require surgery.
2. Targeted approach: The H7 coil allows for precise stimulation of deeper brain structures implicated in OCD (Roth & Zangen, 2014).
3. FDA-cleared: In 2018, the FDA cleared Brainsway's H7 coil system for OCD treatment, marking a significant milestone (U.S. Food and Drug Administration, 2018).
The Science Behind TMS for OCD
TMS works by modulating the activity of neural circuits involved in OCD, particularly the cortico-striatal-thalamo-cortical (CSTC) circuits. The H7 coil targets the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC), key areas implicated in OCD pathophysiology (Goodman et al., 2021).
Groundbreaking Research
A pivotal multicenter, randomized, double-blind study by Carmi et al. (2019) demonstrated the efficacy of deep TMS for OCD:
- 38.1% of patients in the active TMS group showed a response (≥30% reduction in YBOCS scores) compared to 11.1% in the sham group.
- Symptom improvement was maintained 4 weeks post-treatment.
Subsequent studies have shown even more promising results:
- In a post-marketing study, 72.6% of patients achieved a positive response after an average of 18.5 sessions (Roth et al., 2021).
- Treatment effects were durable, with many patients maintaining improvements for 1-2 years (Harmelech et al., 2022).
Is TMS Right for Your Practice? Integrating TMS into your psychiatric practice could revolutionize your approach to treatment-resistant OCD. It's not just about adding a new treatment option – it's about offering renewed hope to patients who've long struggled with debilitating symptoms. As psychiatric practitioners, staying informed about this innovative therapy could be the key to transforming lives and elevating our practice.
Ready to explore how TMS could enhance your OCD treatment arsenal? Stay tuned for our next post (and forthcoming course!), where we'll delve deeper into the neurocircuitry of OCD and why TMS is so effective.
References:
Bermudes, R. A., Lanocha, K. I., & Janicak, P. G. (Eds.). (forthcoming). Transcranial Magnetic Stimulation: Clinical Applications for Psychiatric Practice, 2nd Ed. American psychiatric pub.
Carmi, L., Tendler, A., Bystritsky, A., Hollander, E., Blumberger, D. M., Daskalakis, J., Ward, H., Lapidus, K., Goodman, W., Casuto, L., Feifel, D., Zangen, A., & Roth, Y. (2019). Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: A prospective multicenter randomized double-blind placebo-controlled trial. American Journal of Psychiatry, 176(11), 931-938.
Goodman, W. K., Storch, E. A., & Sheth, S. A. (2021). Harmonizing the neurobiology and treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 178(1), 17-29.
Harmelech, T., Tendler, A., Arikan, M. K., Tarhan, N., & Zangen, A. (2022). Long-term outcomes of a course of deep TMS for treatment-resistant OCD. Brain Stimulation, 15(1), 226-228.
Howes, O. D., Thase, M. E., & Pillinger, T. (2022). Treatment resistance in psychiatry: state of the art and new directions. Molecular Psychiatry, 27(1), 58-72.
Roth, Y., Tendler, A., Arikan, M. K., Vidrine, R., Kent, D., Muir, O., MacMillan, C., Casuto, L., Grammer, G., Sauve, W., Tolin, D., Harvey, P. O., Borges, H., Rifkin, R., Shofty, B., Zangen, A. (2021). Real-world efficacy of deep TMS for obsessive-compulsive disorder: Post-marketing data collected from twenty-two clinical sites. Journal of Psychiatric Research, 137, 667-672.
Roth, Y., & Zangen, A. (2014). Reaching deep brain structures: The H-coils. In A. Rotenberg, J. C. Horvath, & A. Pascual-Leone (Eds.), Transcranial Magnetic Stimulation (pp. 57-65). Humana Press.
Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15(1), 53-63.
U.S. Food and Drug Administration. (2018). De Novo Classification Request for Brainsway Deep Transcranial Magnetic Stimulation System. Retrieved from https://www.accessdata.fda.gov/cdrh_docs/reviews/DEN170078.pdf