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TMS for OCD: An Effective Treatment Option to Relieve Symptoms
Laurence Lippsett
Medically reviewed on 11/20/2020 by
Dr. Steven Harvey
St. Louis Regional Medical Director
Obsessive-Compulsive Disorder (OCD) is a more common condition than you might think, affecting approximately 2.2 million Americans. People with OCD experience recurring intrusive obsessions (thoughts or images) and/or compulsions (urges to carry out certain repetitive behaviors). These symptoms can cause considerable disability and suffering. In 2018, the FDA approved Transcranial Magnetic Stimulation (TMS) as a treatment for OCD. A 2019 American Journal of Psychiatry study showed that TMS therapy for OCD significantly improved patient symptoms. If you're struggling with this disabling disorder, you may want to consider TMS for OCD.
What Are the Symptoms of OCD?
For people with OCD, obsessions and compulsions are part of their daily lives and consistently consume a great deal of their time and energy. OCD isn't just a personality quirk; it's more than wanting your pencils arranged just so or habitually locking and unlocking the front door. The obsessions and compulsions of those who suffer from OCD can be extreme, and can get in the way of everything in your life, including work, school, social activities, and relationships.
One familiar example of OCD is an obsession with contamination. Unfounded fears of germs or disease might trigger overpowering feelings of fear, disgust, or doubt. Those with OCD may try to ensure they are germ-free by compulsively washing their hands until they bleed. Or, cleaning their house repeatedly. Other common obsessions include the fear of losing control, not getting things perfect, or causing harm by failing to do something. As a result, individuals with OCD may repeat behaviors again and again to try to maintain a feeling of control. They may compulsively organize things in particular, precise ways to create a sense of orderliness. Or they may hoard items they think might come in handy in emergencies. They may constantly check if they turned off the stove or if their children are still in bed. Other well-documented obsessions include having unwanted sexual or violent thoughts, or feeling guilty of moral failure.
How Is OCD Treated?
We don't know exactly what is the cause of OCD, but we do know that certain medications are often a big help. About 40 to 60 percent of patients with OCD experience relief from their symptoms when using these medications. If they do help, the medications typically take many weeks before they start alleviating symptoms. They are known to cause side effects in some people as well. Among these are insomnia, weight gain, headaches, sedation, high blood pressure, sexual dysfunction, and gastrointestinal problems as such nausea and diarrhea. Another treatment for OCD is a type of cognitive behavioral therapy called exposure and response prevention (ERP). ERP involves systematically exposing a patient to whatever triggers their obsessions and compulsions under the guidance of a trained therapist or psychologist, teaching the patient incrementally how to mitigate their anxieties and to better tolerate the exposure.
What Is TMS for OCD?
TMS therapy for OCD is another treatment proven to be effective. While it can complement other treatments, TMS fills a crucial gap for people who don't see results from medications. TMS therapy is a non-invasive, drug-free outpatient treatment in which patients sit in a comfortable chair, awake and alert, while a device near their scalp delivers gentle magnetic pulses, similar to those in an MRI scan. The pulses stimulate changes in brain chemical signaling that can alleviate OCD symptoms. Although TMS for OCD has been approved by the FDA, it is not yet covered by most health insurance providers. To learn more about whether TMS therapy could be right for you, schedule a no-cost consultation. You deserve to break that exhausting cycle of obsessions and compulsions, so take the time to find a treatment that gets you back on track.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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