Obsessive compulsive disorder
OCD treatment when therapy and medication have not been enough
Deep TMS is cleared specifically for obsessive compulsive disorder, using a different coil from the one used for depression. It is given alongside whatever else you are doing, not instead of it.
Treatment resistance
You have probably already done the hard part
The recommended treatments for OCD are a course of CBT with exposure and response prevention, and an SSRI, often at a higher dose than would be used for depression.
If you are reading this, there is a reasonable chance you have done both. ERP asks more of a patient than almost any other psychological treatment, and finishing a course of it is an achievement in itself. Being told afterwards that the next step is a higher dose of the same medication, or another round of the same therapy, is a difficult thing to hear.
Not responding adequately to standard treatment is common, and it is not a reflection of how hard you worked at it.
What we can offer
Two things we can offer
Deep TMS with the H7 coil
OCD is treated with a different helmet from the one used for depression, targeting the medial prefrontal cortex and anterior cingulate cortex rather than the network involved in mood.
Sessions follow a brief symptom provocation, which is deliberate: the treatment works on the circuit while it is active.
A consultant assessment
An hour with Dr Nabavi to review what you have tried, confirm the picture, and work out whether Deep TMS is a reasonable option.
£400, credited against treatment if you go ahead.
Cleared for OCD on its own evidence
In a multicentre trial, 99 people with OCD were randomly assigned to six weeks of daily Deep TMS or a sham version of it. Response, defined as a reduction of at least 30% on the Yale-Brown Obsessive Compulsive Scale, was 38.1% with active treatment against 11.1% with sham. A month after treatment finished, the figures were 45.2% and 17.8%.
Two things worth saying about those numbers. The response threshold in OCD trials is a 30% reduction rather than the 50% used in depression, so they are not directly comparable with figures you may have read elsewhere. And more people did not respond than did.
Carmi et al. (2019), American Journal of Psychiatry 176(11): 931-938.
The protocol
29 sessions over six weeks
A short symptom provocation
An individually agreed exercise before each session, to bring the relevant thoughts to mind so the circuit being treated is active during stimulation. It is discussed with you in advance, and it is brief.
Around 20 minutes of stimulation
Five a week over six weeks, 29 sessions in total. You sit in a chair, awake, and go home afterwards.
Y-BOCS at set points
Scored before treatment, partway through, at the end and again at follow-up. It is the standard measure used in OCD research, so your result can be compared against something.
Brain mapping is repeated weekly at no extra cost, and sessions are £250 each, whichever coil is used. We set out the full cost of your course in writing before you start. If the treatment is not working, that will be visible to both of us, and we will say so.
Alongside
Deep TMS is an addition
You do not stop your medication and you do not stop therapy. If you have an ERP therapist, keep seeing them.
You also stay under your existing psychiatrist or GP, and we write to them with what we find and what we do.
Your medication continues
Any change to your prescription is a decision for you and whoever prescribes it.
Your therapy continues
If you are working with an ERP therapist, carry on. We are providing a specific treatment, not taking over your care.
Who it is not for
A history of seizures, or metal implants in the head or ears. Ordinary dental fillings are not a problem.
Common questions
That is the usual position of people who come to us for this. Having completed ERP without enough improvement is one of the main reasons Deep TMS gets considered.
A short, individually agreed exercise before each session to bring the relevant thoughts to mind, so that the circuit being treated is active during stimulation. It is discussed and agreed with you in advance, and it is brief.
The trial included a range of presentations. Whether it is appropriate for yours is one of the things the assessment establishes.
No. You can contact us yourself, and we will usually ask to keep your GP informed.
Then we will tell you. Depending on your history there may be other options worth discussing, or a clear recommendation to take back to your own team.
Find out whether it applies to you
The assessment covers your OCD history, what ERP and medication have done so far, and whether a six-week course with the H7 coil is worth doing.