If you’ve tried medication for OCD and still feel stuck, you’re not alone. SSRIs help a lot of people, but they don’t work for everyone. And there’s a reason for that: they don’t reach the specific part of the brain where OCD actually starts.
That’s where deep TMS comes in. Deep TMS (deep transcranial magnetic stimulation) is a non-invasive treatment that uses magnetic pulses to stimulate brain areas that sit too far below the surface for standard treatments to reach. For OCD, deep TMS targets the circuit driving obsessive thoughts and compulsive behaviors. The first device to earn FDA clearance for OCD was BrainsWay’s H7 coil, and most of the published research uses that device. In clinical studies, anywhere from 38% to 63% of people responded to treatment, depending on the protocol. Newer deep TMS systems, including the Ampa One used at Nushama, target the same brain regions using coils that the FDA considers substantially equivalent to BrainsWay’s technology.
Here’s what you should know about how it works, what the research says, and what to expect if you’re considering it.
Why medication only goes so far
SSRIs are the standard first-line treatment for OCD. They do help. But the bar for what counts as “responding” to medication is lower than most people think. In clinical research, a response usually means a 25-35% reduction on a standard symptom scale. That means someone can technically respond to an SSRI and still have OCD running their daily life.
According to the National Institute of Mental Health, about 1.2% of U.S. adults (roughly 2 to 3 million people) had OCD in the past year. For the 40-60% who don’t get enough relief from their first medication, the next steps aren’t great: higher doses with more side effects, adding a second medication, or starting the whole process over with a different SSRI.
The core issue is that SSRIs work by adjusting serotonin levels across the entire brain. They’re not precise. They don’t zero in on the specific circuit where OCD symptoms originate. Deep TMS takes the opposite approach: it delivers magnetic pulses directly to that circuit.
The brain circuit behind OCD
OCD isn’t a personality quirk or a lack of willpower. It’s a brain circuit that gets stuck.
Researchers have identified a specific loop in the brain called the CSTC circuit (short for cortico-striato-thalamo-cortical). Here’s the simple version of how it works: a worry pops up in one part of your brain (“Did I turn off the stove?”). Normally, another part of your brain would filter that thought out, recognizing it as unimportant. But in OCD, the filter doesn’t work. The thought gets sent to a region that amplifies it and loops it right back to the beginning. Now the worry is louder, more urgent, and harder to ignore. Compulsions, like checking, counting, or washing, are the brain’s attempt to quiet a signal that the circuit won’t let go of.
SSRIs can dial down the intensity of these signals. But they don’t repair the circuit itself. Deep TMS goes after the circuit directly.
What makes deep TMS different from standard TMS
Not all TMS is the same, and the difference matters a lot for OCD.
Standard TMS coils can reach about 1.5 to 2 centimeters below the scalp. That’s enough to treat conditions like depression, and some standard TMS devices have recently received FDA clearance for OCD too. But the brain areas most involved in OCD, the anterior cingulate cortex and medial prefrontal cortex, sit deeper than that.
Deep TMS coils were designed to solve this problem. BrainsWay’s H7 coil, the first FDA-cleared device for OCD, generates a wider, deeper magnetic field that can reach these areas directly. Research measuring its electric field found that the H7 stimulates roughly 40 cm3 of brain tissue at therapeutic strength, far more than a standard coil can reach. Newer systems like the Ampa One use an M Coil that targets the same dorsomedial prefrontal region and was FDA-cleared with BrainsWay’s deep TMS system as its predicate device, meaning the FDA found the two substantially equivalent in design and function.
So when a clinic says they offer “TMS for OCD,” the type of coil and the evidence behind it matter. Reaching deeper isn’t just a technical detail; it’s the difference between targeting the right circuit and missing it.
What the research actually shows
There are three key studies worth knowing about, each adding a different piece to the picture.
The study that got FDA clearance
The trial that led to FDA clearance in August 2018 was published in the American Journal of Psychiatry (Carmi et al., 2019). It was the real deal: 99 patients across multiple centers, with neither the patients nor the clinicians knowing who was getting the real treatment and who was getting a placebo version.
The results: 38% of people receiving active deep TMS responded, compared to just 11% in the placebo group. In real-world clinical practice across 22 sites, that number climbed to about 58%.
What does “responded” actually mean in daily life? For many people, it was the difference between OCD dictating every hour of their day and being able to manage their symptoms well enough to hold down a routine, show up to work, and engage with the people around them.
A faster option: 10 days instead of 6 weeks
One of the biggest barriers to any treatment is time. The standard deep TMS protocol runs five days a week for six weeks. That’s a lot to ask of someone with a job, kids, or other commitments.
A 2024 study published in Cureus (Mudunuru et al.) looked at a compressed version: twice-daily sessions over just 10 days. They tracked 239 people with OCD across multiple clinics.
Even with a stricter definition of improvement than the original trial used, nearly 63% of people responded. The changes were large and clinically meaningful, not borderline. If time is a major concern for you, this is worth discussing with your care team.
Combining TMS with medication
A 2025 trial in the American Journal of Psychiatry (McGirr et al.) tested whether pairing TMS with a specific medication, D-cycloserine, could improve outcomes. D-cycloserine helps the brain form new connections, which may make it more receptive to the effects of stimulation.
The combination more than doubled the improvement compared to TMS alone (39% symptom reduction vs. 17%). Worth noting: this study used a slightly different type of TMS than the H7 coil, but the underlying idea, that treatments can amplify each other, is the bigger takeaway.
A note on the research: BrainsWay, the company that makes the H7 coil, funded or co-authored some of the studies above. That’s standard in medical device research, but worth knowing. Also worth noting: the published clinical trials used BrainsWay’s H7 coil specifically. The Ampa One’s M Coil targets the same brain region and was FDA-cleared as substantially equivalent, but it has not been tested in its own OCD-specific trials yet.
How deep TMS compares to other OCD treatments
Here’s a quick comparison to help you think through your options with your care team.
| | Deep TMS | Standard TMS | ERP therapy |
|---|---|---|---|
| FDA-cleared for OCD? | Yes (first clearance, 2018) | Yes (since 2024), less OCD data published | N/A (behavioral therapy) |
| What it targets in the brain | Deeper areas tied to OCD (ACC, mPFC) | Shallower areas (1.5-2 cm depth) | Works through behavior change, not direct brain targeting |
| How often people improve | 38-63% in published studies | Still building an OCD evidence base | 60-80% (depends on therapist skill and patient engagement) |
| How long it takes | 6 weeks or 10 days (accelerated) | Usually 6 weeks | 16-20 weekly sessions |
| Dropout rate | Low | Low | About 15-19% |
| Works with other treatments? | Yes | Yes | Yes |
The important thing to understand is that these aren’t either/or choices. ERP (exposure and response prevention) is the gold-standard talk therapy for OCD, and it has a strong track record. Deep TMS doesn’t replace it. They actually work well together. During each deep TMS session, you briefly face one of your OCD triggers right before stimulation. This “lights up” the target circuit so the magnetic pulses hit it while it’s active, which mirrors the core principle behind ERP.
What treatment actually looks like
If you’re curious about the day-to-day experience, here’s what to expect.
Before you start
You’ll have a psychiatric evaluation where your clinician measures your current symptoms, reviews your medication and treatment history, and checks for overlapping conditions like depression or anxiety. This helps your team figure out whether deep TMS makes sense for you and what a realistic outcome looks like.
During each session
Every session follows the same three steps:
- A brief exposure to your triggers. Your clinician will guide a short, personalized exercise related to your specific OCD patterns. If contamination is your main issue, it might involve touching a surface that activates your obsessive thinking. The point is to activate the brain circuit so the pulses can target it while it’s engaged.
- The stimulation itself. You’ll wear a cushioned helmet that houses the deep TMS coil. It delivers magnetic pulses for about 20 minutes. Most people describe the sensation as a tapping or knocking on the scalp.
- The schedule. Either five sessions a week for six weeks, or the accelerated route of twice-daily sessions over 10 days.
You don’t need anesthesia or sedation. Most people go straight back to their day afterward.
Tracking your progress
Your care team will re-measure your symptoms around week 3 and again at the end of treatment. These check-ins are where adjustments happen if needed.
If you also deal with depression
This is more common than people think. According to the International OCD Foundation, somewhere between a quarter and half of people with OCD also experience major depression. It makes sense when you think about it: living with relentless intrusive thoughts is exhausting in a way that can pull you into depression all on its own.
The problem is that depression makes everything harder to treat. It drains the motivation you need for ERP therapy. And managing both conditions usually means stacking medications with overlapping side effects.
There’s some encouraging data here. A clinical report on 59 people with both OCD and major depression (Tendler et al., 2021, published in Brain Stimulation) found that the same deep TMS protocol used for OCD also improved depression scores. OCD symptoms dropped by about 30%, depression scores dropped by 38%, and roughly 71% of people got better in both areas. One treatment course, both conditions.
How Nushama approaches OCD treatment
A lot of clinics offer TMS for OCD as a one-and-done procedure. At Nushama’s Manhattan clinic, we use the Ampa One system, which delivers deep TMS through its M Coil to the same brain regions targeted in the clinical research described above. The Ampa One is FDA-cleared for depression; its use for OCD is off-label, meaning the FDA has not specifically reviewed it for that purpose. Off-label prescribing is common and accepted in medicine (many psychiatric medications are used off-label), and the M Coil was FDA-cleared with BrainsWay’s deep TMS system as its predicate device.
But deep TMS is just one piece of how we approach OCD. At Nushama, it fits into a larger treatment plan that also includes medication management, coordinated referrals to therapists who specialize in ERP, and care for overlapping conditions like depression, all handled by the same team.
This matters because the research keeps pointing to the same conclusion: OCD improves most when treatments reinforce each other rather than working in isolation. The McGirr study showed that combining brain stimulation with the right medication more than doubled improvement rates. That’s the philosophy behind how we structure care: neuromodulation, medication, and behavioral therapy working together.
If you’ve been living with OCD and medication hasn’t been enough, deep TMS is an FDA-cleared, evidence-backed option worth exploring. At Nushama, it’s part of a care plan designed around you, not a one-size-fits-all protocol. For more on what’s available, see our guide to emerging OCD treatments in 2026 or learn about ketamine-assisted therapy for OCD.
Book an OCD evaluation to find out whether deep TMS is a good fit.
FAQs
Is TMS for OCD the same as TMS for depression?
Not exactly. Depression TMS typically uses a standard coil that reaches relatively shallow brain areas. Deep TMS for OCD targets deeper regions, the anterior cingulate cortex and medial prefrontal cortex, that are more directly involved in obsessive-compulsive behavior. BrainsWay’s H7 coil was the first device FDA-cleared for OCD and has the most published research. Newer systems like the Ampa One target the same deep brain regions using coils the FDA considers substantially equivalent, though their current clearance is for depression.
How long does it take to work?
The standard protocol runs six weeks (five sessions per week). There’s also a 10-day accelerated option that showed a 63% response rate in a study of 239 people. Some patients notice improvement as early as day 10. Your care team will track your progress throughout.
Can I keep taking my OCD medication?
Yes. Deep TMS is designed to work alongside your current medication. The original clinical trial included patients already on stable OCD medications. Some research even suggests that combining TMS with certain medications can improve results.
Does insurance cover it?
It depends on your plan. Because deep TMS has FDA clearance for OCD, more insurers are starting to cover it. Nushama’s team can help you check your coverage and walk through payment options.
What does it feel like?
Most people describe it as a tapping or knocking sensation on the scalp. No needles, no sedation. Some people feel mild scalp discomfort in the first few sessions, but it usually fades quickly. You can drive yourself home and go about your day right after.
