OCD Treatment In Tampa

OCD Treatment Tampa FL

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Transcranial Magnetic Stimulation For Obsessive Compulsive Disorder (OCD)

Tampa, FL's Leading OCD Treatment Specialist ✔

What IS OCD?

Obsessions

Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the patient feels driven to perform in response to an obsession or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

What Is The Treatment For OCD?

Does TMS Work For OCD?

What Is TMS For OCD?

Does insurance cover TMS for OCD?

Which TMS devices are FDA-cleared for OCD?

Transcranial Magnetic Stimulation For Obsessive Compulsive Disorder (OCD)

Tampa, FL's Leading OCD Treatment Specialist ✔

TMS had been cleared by the FDA for the treatment of OCD in 2017. In particular, that clearance was a specific form of TMS called deep Transcranial Magnetic Stimulation or dTMS. Recently in August 2020, the FDA cleared Magventure TMS therapy using D-B80 coil for the treatment of OCD. This was great news for those suffering from OCD, a debilitating mental illness that is one of the most challenging to treat. In this article, we will look at the currently available treatment options for OCD. Then, we will take a deeper dive into the option of TMS therapy for OCD.

What IS OCD?

OCD stands for Obsessive Compulsive Disorder. The best description of OCD is explained by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Below is a summary of it. OCD is a chronic mental illness characterized by the presence of obsessions or compulsions or both

Obsessions

Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted that cause marked anxiety or distress.

The patient attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action.

(i.e., by performing a compulsion).

Compulsions

Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the patient feels driven to perform in response to an obsession or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Typically, The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Patients with mild OCD usually have good insight: meaning that the patient recognizes that obsessive-compulsive disorder beliefs are not true. Patients with severe OCD might have poor (limited) insight: meaning that the patient thinks obsessive-compulsive disorder beliefs are probably true. The most severe cases could be associated with delusional beliefs: meaning that the patient is completely convinced that obsessive-compulsive disorder beliefs are true.

What Is The Treatment For OCD?

The best first-line treatment for OCD is Cognitive Behavior Therapy (CBT). More specifically, the most effective cognitive behavioral therapy for OCD is a type of CBT called Exposure and Response Prevention (ERP). Exposure and Response Prevention is typically done by a mental health professional (psychiatrist, psychologist, social worker, or mental health counselor) in an outpatient setting. ERP is a type of behavioral therapy that exposes the patient to situations that provoke their obsessions and the resulting distress while helping them prevent their compulsive responses. Response prevention is the key to ERP. This process of getting used to the provocation of obsessions is what we call habituation.

In addition to psychotherapy, medication antidepressants are also considered first-line treatment, Usually, psychopharmacological treatment is done with ERP CBT mentioned above. Pharmacotherapy options include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and fluvoxamine (Luvox) and the mostly serotonergic tricyclic antidepressant clomipramine (Anafranil). These treatments help some patients with OCD have some reduction of OCD symptoms, but they do not usually result in full remission. About 30% of OCD patients wouldn’t have satisfactory results from CBT +/- medications. Now, these patients have an alternative treatment option.

Learn more about the success rate of TMS

Does TMS Work For OCD?

The answer is; Yes. A specific form of TMS called deep TMS is a safe, effective, and FDA-cleared treatment option for OCD. Let’s look at the details of TMS for OCD.

What Is TMS For OCD?

Transcranial Magnetic Stimulation (TMS) utilizes an electromagnetic field on the skull and directing it to specific brain regions. This will activate certain circuits of the brain, returning the normal sync of the brain circuits.

In a typical TMS session, patients are awake and sit in a comfortable treatment chair, while the operator places a magnetic coil over a given region of the head. Then, magnetic pulses will be applied that travel through hair, skin, muscle, and bone until they reach the brain. The magnet intensity is close to magnets uses in an MRI brain scanner but more focal. When magnetic pulses reach the targeted brain circuits, they turn into micro-electrical currents and activate neurons (brain cells), which then affects the related brain circuits. The magnetic pulses and location of stimulation are always specific for each patient according to an initial assessment of the person’s brain “brain mapping”. A typical TMS session takes about 20 minutes, and most treatments require daily sessions Monday to Friday for a few weeks (typically 6 weeks). Because there aren’t any systemic side effects, Patients drive to the TMS clinic on their own, receive the treatment, and then continue with regular daily activities.

In 2008, the FDA approved the use of TMS for the treatment of depression. In 2013, the FDA approved the use of “deep TMS” (using TMS H1-coil) also for depression. In 2017, the FDA approved the use of “deep TMS” (using TMS H7-coil) for OCD. In August 2020, the FDA approved MagVenture TMS therapy (using D-B80 coil) for the treatment of OCD.

OCD treatment with TMS delivers magnetic stimulation to the frontal brain structures and networks, targeting the dorsal medial Prefrontal Cortex (dmPFC) and the Anterior Cingulate Cortex (ACC) bilaterally.

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A multicenter blinded randomized controlled trial published in the American Journal of Psychiatry in 2019 described the positive results. After six weeks of TMS treatment, the study showed significant improvement for the active treatment group when compared to sham (placebo). To be more specific, 38.1% of patients in the active group achieved a response of more than 30% reduction in symptom severity. Moreover, 54.8% of patients in the active group achieved a partial response of more than 20% reduction in symptom severity.

Does insurance cover TMS for OCD?

Unfortunately, not yet. Despite the clear evidence of safety and efficacy of TMS for OCD and despite the FDA-clearance, insurance companies are still claiming that TMS for OCD is still investigational. Interestingly enough, insurance companies will happily pay for non-proven psychopharmacological medications for OCD but they won’t pay for a proven treatment. The obvious reason is saving money and spending it on “big pharma” instead of doing what’s best for patients. This hopefully will change soon as more advocacy is being pushed to improve access to mental health services.

Please note that the cost of TMS therapy for depression is covered by most commercial insurance companies and all federal medical plans like Medicare and Tricare.

Which TMS devices are FDA-cleared for OCD?

Currently, in the United States of America, there are two TMS devices cleared for the treatment of OCD.

Brainsway Deep TMS System. The Brainsway Deep Transcranial Magnetic Stimulation System is intended to be used as an adjunct for the treatment of adult patients suffering from Obsessive-Compulsive Disorder. De Novo FDA-clearance in 2017. Then a 510(k) FDA-clearance for an improved version with better user interface in 2019.

MagVenture TMS Therapy for adjunctive treatment of OCD. The MagVenture TMS Therapy System is intended to be used as an adjunct for the treatment of adult patients suffering from Obsessive-Compulsive Disorder (OCD). This is a 510(k) FDA-clearance granted in 2020.