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TMS In OCD

brainstimulation_iStock-925426264People with obsessive-compulsive disorder (OCD) who don’t achieve adequate relief from medication and cognitive-behavioral therapy may benefit from deep transcranial magnetic stimulation (dTMS), a study in AJP in Advance suggests.

During dTMS treatment, a cap containing coils delivers magnetic pulses to stimulate nerve cells in the brain. The study compared active dTMS treatment with sham (inactive) treatment in 87 people with OCD, with participants in the active treatment group experiencing greater improvement in symptoms at the end of treatment and at a follow-up assessment four weeks later.

The study, led by Lior Carmi, Ph.D., of Tel Aviv University, included participants aged 22 to 68 years who were receiving outpatient treatment at 11 centers in the Canada, Israel, and the United States. All participants had a baseline score of 20 or higher on the Yale-Brown Obsessive Compulsive Scale (YBOCS), indicating that they were experiencing at least moderate symptoms of OCD despite treatment. Participants received 29 treatment sessions of active or sham treatment over a span of six weeks. The caps worn by those in the sham treatment group caused sensations in the participants’ scalps but delivered no magnetic pulses.

Before each treatment, the researchers guided the participants through a list of ideas that would provoke obsessive thoughts to activate the parts of the brain involved in OCD. A few minutes into treatment the researchers reminded participants to keep thinking those thoughts (for example, “Please keep thinking about the dirty handle”).

At the end of six weeks, YBOCS scores dropped an average of 6 points in the active treatment group, compared with 3.3 points in the sham treatment group. At the four-week follow-up, YBOCS scores were 6.5 points lower than baseline in the active treatment group, compared with 4.1 points in the sham treatment group. At both study’s end and the follow-up assessment, more participants in the active treatment group had achieved a full response, defined by a reduction of at least 30% in YBOCS score, than in the sham treatment group.

Participants in both groups experienced adverse events. The most common adverse event was headache, experienced by 37.5% in the active treatment group and 35.3% in the sham treatment group. The researchers noted that similar adverse effects were reported in prior studies.

“Although [triggering patient’s symptoms prior to the intervention may be] considered brief exposure therapy, the fact that both groups underwent the same exposure procedure suggests that the observed clinical effects were due only to stimulation,” the researchers wrote.

For more information, see the Psychiatric News article “FDA Clears Deep TMS Device for Treatment of Obsessive-Compulsive Disorder.”