Medication vs. Psychotherapy vs. TMS: Which OCD Treatment is Right for You?

Obsessive-compulsive disorder (or OCD) can be a challenging condition for those living with it. Its symptoms may include fixating on a constant state of fear and agitation, as well as the compulsion to carry out repetitive motions to the point of exhaustion. These characteristics wear out an individual facing OCD, as they try to rid themselves of this disorder. Luckily, several OCD treatment options have been shown to help alleviate symptoms, specifically psychopharmacology (medication), psychotherapy, and transcranial magnetic stimulation (TMS). Each form of treatment come with their own set of advantages and drawbacks, but how do you choose which one will likely work for you? The following information can help you make a more informed decision.

person washing hands

OCD: Some Basic Facts

Obsessive-compulsive disorder is an anxiety-based condition characterized by obsessive thoughts and compulsive actions, both of which contribute to the patient’s level of distress. 

OCD thoughts normally revolve around themes of concern over cleanliness, organization, intrusive taboo thinking, or the idea of a catastrophe befalling themselves or a loved one. 

OCD actions are repetitive and tend to take on a ritualistic form of behavior. They can be incredibly diverse and can include anything from continuously scrubbing every dish long after it is spotless to turning one’s phone on and off as a way to protect someone from getting hurt or experiencing some kind of disaster.

2.3% of US adults and 1%-2.3% of US children and adolescents contend with OCD. OCD symptoms commonly arise between age ten and early adulthood, though it can appear at any age. Unfortunately, OCD many times goes undiagnosed, as its symptoms are explained as idiosyncratic behavior. On average, it takes 14-17 years from the first manifestation of OCD symptoms before patients begin receiving treatment.

Despite anxiety being a key symptom, OCD was eventually separated from other anxiety conditions and given greater visibility. This was due to more recent scientific discoveries that managed to identify the neural pathways and brain structures associated with the development of OCD. Genetic research was also able to find certain common genes among those facing OCD and OCD-related disorders, which distinguished them from other anxiety-based conditions. These discoveries led to the introduction of certain treatments that have been proven to offer symptom relief and increase the quality of life of patients with OCD. These treatments include a specific type of psychopharmacology, a form of psychotherapy called cognitive-behavioral therapy (CBT), and an advanced form of TMS called Deep TMS.

A person arranging items in an array using a ruler

Psychopharmacology

Several types of psychopharmacology have been found to successfully treat OCD. These medications target different neurotransmitters, which are chemical compounds secreted by the brain to relay messages between neurons. Out of the different medications to offer OCD symptom alleviation, only one family of medications is considered a first-line treatment for this condition: selective serotonin reuptake inhibitors, also known as SSRIs.

What are SSRIs? SSRIs have been shown to keep the neurotransmitter serotonin active for a longer period of time. According to research, SSRIs likely work by binding with the presynaptic neuron, thereby blocking the serotonin’s reuptake and maintaining its active state for longer. A proven mood elevator, higher levels of serotonin helps alleviate the detrimental symptoms of OCD, as well as other disorders such as depression.

SSRIs for OCD: SSRIs are FDA-approved to treat OCD for good reason. This treatment option has been found to effectively reduce symptom frequency and severity among patients battling this condition, is generally well-tolerated and is a safe form of therapy. That said, while they are considered safe to use, SSRIs can cause a number of unpleasant side effects, some of which may prove to be adverse enough to cause patients to stop the treatment altogether. Among SSRI side effects are weight gain, sexual dysfunction, and nausea. Additionally, some 40%-60% of patients show little-to-no improvement from first-line OCD medication. For these reasons, monitoring your improvement and communicating any adverse side effects to your doctor are important when starting on this treatment course.

Female patient taking medication

Psychotherapy

Psychotherapy, or talk therapy as it is sometimes called, uses the power of verbal communication to achieve greater understanding of one’s personal experiences as well as a greater sense of well-being. Among the available forms of psychotherapy, cognitive-behavioral therapy (CBT) is considered the only first-line treatment to offer significant OCD symptom alleviation. It is also the only type of psychotherapy to be FDA-approved to treat this condition.

What is CBT? Compared to other forms of talk therapy, such as psychoanalysis or psychodynamics, CBT takes a more targeted look at the condition’s symptomatology. Rather than diving into the patient’s formative experiences or key relationships, this more recent branch of therapy aims to understand in what ways the patient’s condition manifests itself. 

CBT for OCD: CBT helps patients acknowledge and describe the thoughts, feelings, behaviors, and physical reactions they associate with their OCD. Through this process of illumination, the patient will hopefully gain a greater awareness of their condition. As the treatment progresses, the patient will hopefully be able to choose a more beneficial reaction to triggering stimuli, instead of the automatic and compulsive responses they have been used to carrying out. While relatively effective in treating this condition, CBT does require a certain level of motivation on the side of the patient, a willingness to monitor their OCD symptoms, and the willpower needed to react differently to triggering stimuli. Not all individuals facing a mental health disorder have the emotional and mental reserves to follow through or stick with this form of therapy, which can affect its overall efficacy.

A therapist administering BrainsWay deep TMS treatment for OCD to a patient

Transcranial Magnetic Stimulation

Transcranial magnetic stimulation, or TMS, utilizes a series of electromagnetic pulses to reach and regulate different brain regions. The treatment has been shown to offer relief from symptoms of OCD, as well as those of other conditions. Deep Transcranial Magnetic Stimulation (or Deep TMS for short) is an advancement of TMS and presently the only non-invasive medical device to be FDA-cleared with clinically proven data to treat OCD.

What is Deep TMS? Deep TMS’s patented technology is able to simultaneously reach wider areas of the brain. This allows it to avoid any targeting issues that sometimes arise with traditional TMS. It is also able to reach deeper areas of the brain directly, which has been shown to increase treatment efficacy. As a non-invasive treatment, Deep TMS does not cause any long-lasting or adverse side effects. It does not require anesthesia and can be incorporated into the patient’s daily schedule.

Deep TMS for OCD: Deep TMS’s received its FDA clearance status due to its safety and efficacy. It has been shown to offer symptom relief to treatment-resistant patients and can also be combined with other treatments, such as medication and psychotherapy.