For years OCD was treated almost entirely with medication and exposure therapy. In 2018, deep
TMS became the first non-invasive brain-stimulation
device cleared for OCD, based on a multicentre randomised trial.
The pivotal trial
The key study was a prospective, multicentre, randomised, double-blind, sham-controlled trial of deep TMS using the H7 coil, which reaches the medial prefrontal and anterior cingulate cortex. Stimulation was typically delivered after a brief symptom provocation to engage the relevant circuits.
The results
Response, defined as at least a 30 percent reduction on the Yale-Brown Obsessive Compulsive Scale, was 38.1 percent with active deep TMS versus 11.1 percent with sham. The advantage in symptom scores persisted at the one-month follow-up.
A regulatory first
On the strength of this trial the FDA granted clearance in August 2018, the first ever for a non-invasive device in OCD. Sessions were relatively brief, about 25 minutes, five times a week over six weeks.
Deep TMS with the H7 coil is an FDA-cleared, evidence-based option for OCD, roughly tripling the response rate versus sham in the pivotal trial, and a meaningful addition for patients who have not responded to standard care.
References
- Carmi L, et al. (2019). Efficacy and safety of deep TMS for OCD: a prospective multicenter randomized double-blind placebo-controlled trial. American Journal of Psychiatry.
- US FDA De Novo clearance of deep TMS for OCD, August 2018.
This article is for general information and is not medical advice. TMS suitability is decided by a psychiatrist on an individual basis. Speak to our team about your own situation.