1. are hyperactive at rest in people with OCD compared to healthy patients
2. become overly active when symptoms are provoked
3. resume their normal activity after successful treatment with either medical or behavioral therapy

Normally, these regions are intimately connected to the basal ganglia — a cluster of nerve cells responsible for movement and regulating emotions and behavior. The basal ganglia receive the input from the cerebral cortex. These signals are then conveyed to another brain region called the thalamus, which then relays this information back to the cortex.

However, hyperactivity in the frontal lobes of OCD patients breaks the communication between the basal ganglia and thalamus. This causes the thalamus to get out of control. This failure of the frontal lobes to inhibit the thalamus is what triggers unrelenting intrusive thoughts and behaviors.

The usage of dTMS in tweaking brain activity in OCD is contingent upon the maladaptive behavior of neurons in these networks. It either excites or suppresses these target regions based on the frequency of magnetic pulses applied.

dTMS therapy has optimized the odds for people with OCD to finally receive treatment that will benefit them.

A 2019 clinical study published in the American Journal of Psychiatry showed a statistically significant (30%) improvement in OCD symptoms in the dTMS group after 6 weeks of daily sessions, as measured by the Yale-Brown Obsessive-Compulsive Scale. The treatment was as effective as the medications available for treating OCD. Nonetheless, dTMS achieved quicker results relative to medical therapy.

This study was a rare one because it entailed provoking OCD symptoms in the participants prior to each treatment session. The idea behind provoking OCD symptoms was to activate the relevant brain circuitry.

A 2019 scientific survey compiled about 32 studies to evaluate the effects of rTMS on anxiety. Though this survey suggested the need for more studies to determine the effects of TMS on anxiety, it did reveal the beneficial impact of TMS on anxiety symptoms.

According to this survey, one of the clinical trials conducted on participants with a generalized anxiety disorder (GAD) showed a clinically substantial reduction in anxiety symptoms after receiving 25 rTMS sessions.

Another 2016 study conducted by Dr. Diefenbach and fellows showed improved outcomes in patients with GAD after a 3-month rTMS treatment. Six of nine patients in the active group achieved remission during the 3-month follow-up period.

Patients with anxious depression particularly appear to benefit from rTMS sessions. A 2019 study evaluated and compared the outcomes of 172 patients with comorbid anxiety disorders with patients who did not have comorbid anxiety. At the end of the TMS session, 39.5% of patients showed 50% improvement in their symptoms of depression. In addition, 23.3% of patients with depression and comorbid anxiety achieved remission.

Another condition that often follows anxiety symptoms is Restless Legs Syndrome (RLS). In fact, stress and anxiety are major triggers of RLS. A study done on patients with RLS who received TMS therapy revealed significant improvements in the symptoms of restless legs, anxiety symptoms, and sleep quality.

Though OCD is a treatable illness, not all patients respond to the currently available treatments. Even when patients do respond, it is rare to see them completely recovering from the condition.

Thanks to novel treatments like deep TMS that hold more promise for refractory OCD. Being a non-invasive therapy with minimal adverse effects, dTMS is considered a good alternative for people who fail to respond to first- or second-line therapies.

Two companies now offer FDA-cleared TMS devices for the treatment of OCD, namely Brainsway and MagVenture.