TMS for Depression and OCD: An Evidence-Based Treatment Worth Considering

By Shirli H. Libet, MS, LMFT

Depression and Obsessive-Compulsive Disorder (OCD) can significantly affect a person’s emotional well-being, relationships, and daily functioning. While psychotherapy and medication are effective for many people, some continue to struggle despite treatment.

As a psychotherapist with over 20 years of experience, I believe it is important to explore additional treatment options when traditional approaches are not providing sufficient relief.

One treatment I recommend considering is Transcranial Magnetic Stimulation (TMS), a noninvasive, FDA-cleared treatment supported by clinical research.

What Is TMS?

Transcranial Magnetic Stimulation (TMS) uses magnetic pulses to stimulate specific areas of the brain involved in mood regulation and other psychological processes. Unlike medication, TMS targets specific brain regions rather than circulating throughout the body. It does not require surgery or anesthesia, and patients remain awake during treatment.

The FDA first cleared TMS for major depression in 2008 and authorized a specific deep TMS system for OCD in 2018.

How Effective Is TMS for Depression?

Research has demonstrated that TMS can significantly reduce depressive symptoms, particularly in individuals who have not responded adequately to antidepressant medications.

A 2024 systematic review and meta-analysis of five randomized controlled trials involving 507 patients with treatment-resistant depression reported:

45.3% experienced a significant reduction in depressive symptoms, compared with 24.2% in control groups.

38.3% achieved remission, compared with 14.4% in control groups. (Lan et al., 2024)

These findings are encouraging, especially for individuals who have tried multiple treatments without sufficient improvement. However, results vary, and not everyone responds to TMS.

Can TMS Help With OCD?

OCD involves intrusive, unwanted thoughts and repetitive behaviors or mental rituals that can interfere with daily life. The most established psychological treatment for OCD is Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP). Medication is also commonly recommended.

For individuals who continue experiencing significant symptoms, certain TMS protocols may provide additional benefits. In a randomized controlled trial published in the American Journal of Psychiatry, researchers reported:

38.1% of patients receiving deep TMS showed a clinically meaningful improvement, compared with 11.1% receiving sham treatment.

At a one-month follow-up, response rates were 45.2%, compared with 17.8% in the sham group. (Carmi et al., 2019)

Although these findings are promising, research supporting TMS for OCD is less extensive than research for depression. TMS is generally considered an additional option rather than a replacement for ERP.

Why I Recommend Considering TMS

In my clinical practice, I see how persistent depression and OCD can affect a person’s motivation, relationships, confidence, and overall quality of life. I believe mental health treatment should be individualized and informed by current scientific evidence.

Evidence-based: Clinical trials support its effectiveness, especially for treatment-resistant depression.

Noninvasive: No surgery or general anesthesia is required.

Different side-effect profile: It avoids some systemic side effects associated with medication, although headaches and scalp discomfort can occur.

Compatible with psychotherapy: Individuals can generally continue therapy while receiving TMS.

TMS is not appropriate for everyone. Screening is necessary because rare but serious adverse effects, including seizures, can occur.

My Clinical Perspective

When someone continues to struggle with depression or OCD despite appropriate treatment, I believe it is important to explore other scientifically supported options.

TMS is not a guaranteed cure, but it may offer meaningful improvement for individuals who have not found sufficient relief through conventional treatment. For depression, the evidence is well established. For OCD, certain deep TMS protocols offer a promising additional approach.

My recommendation is to discuss TMS with a qualified psychiatric provider to determine whether it may be appropriate as part of a comprehensive treatment plan. There is no single treatment that works for everyone, and meaningful improvement may require exploring more than one approach.

References

Carmi, L., et al. (2019). Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder. American Journal of Psychiatry, 176(11), 931–938. https://doi.org/10.1176/appi.ajp.2019.18101180

Lan, X.-J., et al. (2024). Deep transcranial magnetic stimulation for treatment-resistant depression: A systematic review and meta-analysis of randomized controlled studies. Asian Journal of Psychiatry, 96, 104032. https://doi.org/10.1016/j.ajp.2024.104032

U.S. Food and Drug Administration. (2018). FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder

Disclaimer: This article is for educational purposes and does not replace individualized medical advice or psychiatric assessment.

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Shirli H. Libet, MS, LMFT | Educational Blog Article