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rTMS for Obsessive-Compulsive Disorder

ocd obsession germs

Obsessive-compulsive disorder (OCD) involves experiencing repetitive, intrusive thoughts, urges, or images that cause fear and anxiety. These unwanted and uncomfortable thoughts and feelings are typically recognized as irrational but are still perceived as uncontrollable. In an effort to neutralize or decrease discomfort, we are often compelled to engage in physical or mental rituals. As these rituals tend to consume a large portion of the day, individuals with OCD often experience significant impairment in many aspects of their life.

OCD is a multifactorial disorder linked to abnormalities in brain circuits, genetic
predisposition, and environmental factors. In individuals with OCD, there can
be abnormalities in brain circuits responsible for recognizing and responding
to threats (1).

Standard first-line treatments for OCD include pharmacotherapy with serotonin reuptake inhibitors (SSRIs) as well as cognitive behavioural therapy (CBT) with
exposure-response prevention (ERP). However, approximately 40–60% of individuals
do not respond to these treatments (2,3). Unlike these treatments, RTMS is
another therapy that has the advantage of targeting specific brain areas
associated with OCD.

Studies have shown that more than 60% of individuals treated with rTMS experience a significant reduction in unwanted, distressing, and intrusive thoughts (obsessions) as well as repetitive or ritualized behaviors (compulsions) (4). These benefits often begin
within several days of treatment. Further, up to 90% of individuals maintain
the benefits for more than one year, which can be extended further with regular
(monthly) maintenance sessions. In addition, individuals treated with rTMS have
reported improvement in symptoms of co-morbid anxiety, depression, and tic
disorders (5). Finally, RTMS is also considered an effective adjunct to other
treatments including pharmacotherapy (i.e., SSRIs) and psychotherapy (i.e., CBT
with ERP) (2,3).

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, highly effective treatment that uses electromagnetic impulses that pass easily through the skull to stimulate abnormal brain activity without any systematic side effects or downtime.

  1. Liang, K., Li, H., Bu, X., Li, X., Cao, L., Liu, J., … & Huang, X. (2021). Efficacy and tolerability of repetitive transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Translational psychiatry, 11(1), 1-10.
  2. Grassi, G., Moradei, C., & Cecchelli, C. (2023). Will Transcranial Magnetic Stimulation Improve the Treatment of Obsessive–Compulsive Disorder? A Systematic Review and Meta-Analysis of Current Targets and Clinical Evidence. Life, 13(7), 1494.
  3. Fitzsimmons, S. M., van der Werf, Y. D., van Campen, A. D., Arns, M., Sack, A. T., Hoogendoorn, A. W., … & van den Heuvel, O. A. (2022). Repetitive transcranial magnetic stimulation for obsessive-compulsive disorder: A systematic review and pairwise/network meta-analysis. Journal of affective disorders, 302, 302-312.
  4. Harmelech, T., Tendler, A., Arikan, M. K., Çetin, H. L., Esmeray, M. T., Ilhan, R., … & Roth, Y. (2022). Long-term outcomes of a course of deep TMS for treatment-resistant OCD. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 15(1), 226-228.
  5. Thatikonda, N. S., Vinod, P., Balachander, S., Bhaskarpillai, B., Arumugham, S. S., & Reddy, Y. J. (2023). Efficacy of repetitive transcranial magnetic stimulation on comorbid anxiety and depression symptoms in obsessive-compulsive disorder: a meta-analysis of randomized sham-controlled trials. The Canadian Journal of Psychiatry, 68(6), 407-417.