TMS for OCD: FDA-Cleared Treatment Option
Learn how TMS therapy helps treat obsessive-compulsive disorder: the evidence, protocol, and what to expect.
Clinically Reviewed: Board-Certified Psychiatrist |Next Review: July 2025
Key Takeaways
- Deep TMS received FDA clearance for OCD in August 2018
- OCD protocol targets different brain circuits than depression treatment
- Success rates show 40-50% significant symptom reduction on Y-BOCS scale
- Works well alongside exposure and response prevention (ERP) therapy
- Treatment involves 29 sessions over 6 weeks with specialized coil placement
Understanding OCD and Treatment Challenges
Obsessive-Compulsive Disorder (OCD) affects about 2-3% of the population. It involves intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety.
Standard OCD treatments include medications (usually SSRIs at higher doses or clomipramine) and exposure with response prevention (ERP) therapy. However, about 40-60% of people don't achieve full symptom relief with these approaches alone.
TMS offers an additional FDA-cleared option for people with OCD who need more help.
FDA Clearance for OCD (August 2018)
In 2018, the FDA cleared BrainsWay Deep TMS™ specifically for treating OCD in adults. This clearance was based on rigorous clinical trials demonstrating safety and effectiveness.
Regulatory Milestone
This was the first FDA clearance of any TMS device specifically for OCD, recognizing Deep TMS as a proven intervention for this challenging condition.
How TMS Targets OCD: Brain Circuits Explained
OCD involves overactivity in specific brain circuits, particularly the cortico-striato-thalamo-cortical (CSTC) loop. This circuit includes:
- Anterior Cingulate Cortex: Involved in error detection and anxiety
- Orbitofrontal Cortex: Related to decision-making and doubt
- Striatum: Connected to repetitive behaviors
- Thalamus: Acts as relay station for these signals
In OCD, this circuit becomes "stuck" in a loop—generating persistent anxiety and the urge to perform rituals. TMS for OCD targets these overactive areas to help calm the circuit and reduce symptom intensity.
OCD-Specific TMS Protocol
How It Differs from Depression Treatment
- Coil placement: Positioned more anteriorly (forward) to target OCD circuits
- Session length: Approximately 29-30 minutes (vs. 20 minutes for depression)
- Stimulation parameters: Different frequency and intensity optimized for OCD
- Number of sessions: Typically 29 sessions over 6 weeks
- Bilateral stimulation: May target both hemispheres in some protocols
Clinical Evidence & Success Rates
The pivotal trial that led to FDA clearance showed promising results:
vs. 11% sham
On Y-BOCS scale
Over 6 weeks
Note: Response defined as ≥30% reduction in Y-BOCS (Yale-Brown Obsessive Compulsive Scale) score from baseline.
Combining TMS with ERP Therapy
Exposure and Response Prevention (ERP) is the gold-standard behavioral therapy for OCD. TMS doesn't replace ERP—it can enhance it.
How they work together:
- TMS reduces baseline anxiety: Makes it easier to engage with exposure exercises
- Weakens compulsion urges: You may find it less difficult to resist rituals
- Improves therapy tolerance: Reduced distress during exposures
- Addresses brain circuits: While ERP addresses behavior patterns
Many clinicians recommend continuing or starting ERP therapy alongside TMS for optimal OCD management.
What to Expect with TMS for OCD
Treatment Course
- Week 1-2: Brain mapping, adjustment to treatment; early sessions
- Week 3-4: Some people notice reduced anxiety around obsessions
- Week 5-6: Continued symptom reduction; easier to resist compulsions
- Post-treatment: Assessment of response; maintenance planning
What Improvement Looks Like
For people who respond to TMS for OCD, improvements may include:
- Reduced frequency and intensity of intrusive thoughts
- Less anxiety associated with obsessions
- Decreased urge to perform compulsions
- Ability to resist or delay rituals more easily
- More time spent on meaningful activities (less time on rituals)
- Improved quality of life and daily functioning
Frequently Asked Questions
How is TMS different for OCD vs. depression?
TMS for OCD uses a different coil placement (targeting the anterior cingulate cortex and medial prefrontal cortex) and a specialized protocol. The session is slightly longer (about 29-30 minutes) and uses different stimulation parameters specifically designed for OCD brain circuits.
Do I need to stop my OCD medications for TMS?
No, you can typically continue your medications during TMS. Many people stay on their SSRIs, clomipramine, or other OCD medications. Your psychiatrist will coordinate both treatments and may adjust medications based on how you respond to TMS.
Can TMS replace exposure therapy (ERP)?
No, TMS should not replace ERP. Research suggests TMS works best when combined with behavioral therapy. TMS may help reduce obsessions and anxiety enough to make ERP more tolerable and effective. Think of TMS as preparing your brain to better engage with therapy.
How long does it take to see OCD improvement with TMS?
Most people notice changes gradually over weeks 3-5 of treatment. Some report reduced anxiety around obsessions earlier, while compulsion reduction may take longer. Full benefits are typically assessed at the end of the 6-week course.
What if I have both depression and OCD?
Your psychiatrist will determine which condition to target first based on severity and impact on your functioning. Sometimes protocols can be adjusted to address both, or separate treatment courses may be recommended. Insurance coverage and clinical priorities guide the decision.
Is TMS covered by insurance for OCD?
Coverage varies more for OCD than for depression. Some plans cover TMS for OCD with prior authorization, while others may not yet have updated their policies. Our billing team will verify your specific benefits and help with appeals if needed.
Can TMS help with compulsions or just obsessions?
TMS can help reduce both obsessions (intrusive thoughts) and compulsions (repetitive behaviors). By targeting the brain circuits that generate anxiety and the urge to perform rituals, TMS may make it easier to resist compulsions and reduce the frequency and intensity of obsessions.
Do I need maintenance TMS for OCD?
This is still being researched. Some people maintain OCD improvements without additional TMS, especially if they continue ERP therapy. Others benefit from periodic booster sessions. Your doctor will create a maintenance plan based on your response and symptom trajectory.
What's the success rate for TMS and OCD?
Clinical studies show about 40-50% of people experience clinically significant symptom reduction (at least 30% improvement on Y-BOCS scale). About 30-35% achieve 'response' (50% or more symptom reduction). Results are best when combined with ongoing behavioral therapy.
Can TMS make OCD worse?
This is extremely rare. Some people may experience temporary anxiety increase as they become more aware of their symptoms while reducing compulsions. This is actually similar to what happens in ERP therapy and usually resolves. If you experience worsening symptoms, discuss with your doctor immediately.
Plain-Language References
- 1. FDA Clearance: FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder (August 2018)
- 2. Carmi L, et al. (2019). "Efficacy and safety of deep TMS for OCD: a prospective multicenter randomized controlled trial." American Journal of Psychiatry 176(11):931-938.
- 3. Roth Y, et al. (2021). "Real-world efficacy of deep TMS for OCD." Journal of Psychiatric Research 140:373-378.