Obsessive-Compulsive Disorder (OCD) affects approximately 1 in 100 Americans and can significantly disrupt daily life. Characterized by repetitive, intrusive thoughts (obsessions) and repeated actions, OCD is difficult to manage, especially in treatment-resistant forms that are unresponsive to traditional treatments like medications or cognitive-behavioral therapy (CBT).
In recent years, Transcranial Magnetic Stimulation (TMS) has been established as a safe and potent treatment for OCD. And now accelerated TMS protocols are offering even more hope, particularly for those individuals who have not benefited much from traditional treatments.
TMS is a painless brain stimulation therapy that uses magnetic fields to control neural activity in targeted areas of the brain. Approved by the FDA for depression in 2008, TMS was approved by the FDA for OCD in 2018, with clinical trials showing spectacular symptom reduction.
The treatment involves the delivery of quick magnetic pulses to regions of the brain engaged in OCD, such as the dorsomedial prefrontal cortex. The pulses interfere with brain circuits believed to be overly active in OCD patients.
Compared to conventional TMS treatment, where a patient takes one session per day for 4–6 weeks, accelerated protocols of TMS cut treatment time. Patients are given several sessions per day for days or weeks—cutting the total time of treatment without loss and in others with an increase in efficacy.
Very powerful accelerated protocols such as SAINT-TMS and HOPE-TMS employ Intermittent Theta Burst Stimulation, a newer offshoot of TMS that delivers trains of fast pulses in patterns that mimic the brain’s natural rhythms. Treatment is thought to boost neuroplasticity—the brain’s ability for reorganization and the creation of faster, longer-term improvements.
Different research has proven the efficacy of accelerated TMS protocols for the treatment of OCD. The 2023 work by Ozer et al. used accelerated iTBS in the treatment of people with treatment-resistant OCD. The therapy was delivered via several daily sessions over a period of four days and was directed towards the dorsomedial prefrontal cortex. The sham and active treatment groups were distinguishable in that the latter were significantly improved.
Active TMS trials have response rates of 40% to 60%, and sham trials have response rates of 10% to 20%.
Also, in a 2019 study by Lior Carmi et al., it was found that 45% of the patients experienced remarkable improvement of symptoms after one month of TMS, as per the International OCD Foundation.
OCD presents itself differently in all individuals. There are some who experience contamination fear, while there are others with intrusive thoughts or compulsive checking. That is the reason why individualized TMS treatment protocols are administered.
Personalized protocols adjust stimulation parameters, target brain regions according to patient-specific brain activity and symptomatology, and time sessions based on patient-specific requirements. The mPFC and ACC are the primary brain regions that are primarily targeted for OCD treatment, as these regions regulate emotions and decision-making.
To reach these deeper structures, clinicians may use double cone coils, a recently introduced TMS coil design that penetrates more deeply into brain tissue than figure-8 coils. These coils allow for more precision and effectiveness of modulation of OCD circuits.
Emerging technologies like intelligent neuromodulation are further easing TMS personalization. Treatment strategies like HOPE-TMS integrate patient response and analysis of brain function in real time with the help of machine learning and data analysis to adjust treatment parameters based on patient response and brain function.
This adaptive process can potentially maximize acceleration and maintenance of symptom improvement, individualizing each session based on shifting needs of an individual patient.
Treatment-resistant OCD is diagnosed when the patients do not respond to at least two standard treatments, usually SSRIs and CBT. They are among the most difficult cases, and rapid TMS offers a much-welcomed second option.
A 2022 Hamelech et al. study recognized 38% of treatment-resistant OCD patients with symptom reduction via rapid TMS. It is not a cure-all, but this is significant for those that have already exhausted all else.
Maintenance sessions, though, may be required to sustain those improvements, particularly in severe, chronic patients. For most, OCD is a chronic condition, and ongoing maintenance can prevent relapse and ensure long-term success.
Accelerated TMS is a thrilling new development in OCD treatment, particularly for therapy failure or medication failure. By condensing treatment into a shorter time frame, it delivers faster relief without forfeiting effectiveness—salvation to those so desperately in need.
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