ocd Archives - Heading Health

October 11, 2022

Obsessive-compulsive disorder (OCD) is a condition characterized by recurrent, unpleasant intrusive thoughts and repetitive behaviors aimed at reducing anxiety or preventing some undesirable event. It currently afflicts between two to three million U.S. adults.

The condition is typically treated with some combination of cognitive-behavioral therapy (CBT) and a type of oral antidepressant called selective serotonin reuptake inhibitors. However, studies indicate that around half of OCD patients fail to respond adequately to the standard treatments. Moreover, many that respond to SSRIs discontinue due to undesirable side effects (e.g., weight gain, sexual dysfunction, emotional numbness, etc.).

Because of this, researchers began to search for novel treatments. Many focused on finding new applications for a non-invasive procedure called transcranial magnetic stimulation (TMS), initially approved by the FDA for treatment-resistant depression in 2008. In 2018, TMS became FDA-approved for OCD.

Here are answers to common questions about this new intervention.

What is TMS?

TMS is a drug-free and noninvasive procedure used to treat various brain disorders, including several mental health conditions. It uses magnetic coils placed just above the scalp to send magnetic pulses into specific regions of the brain associated with symptoms of the conditions it is being used to treat. For example, in the case of treatment-resistant depression, the pulses are sent toward regions of the brain associated with mood regulation.

By sending repeated pulses to these specific areas of the brain, TMS “trains” neurons in those areas to fire differently and create new, healthier connections.

How Does TMS for OCD Work?

TMS for OCD works in much the same way as TMS for treat-resistant depression, except for two key differences. First, the magnetic pulses are directed at deeper structures in the brain, which are more closely associated with OCD. For example, one of the primary targets is the right orbitofrontal cortex, which studies have found is hyperactive in adults with OCD. It is also thought to be partially responsible for the unending urge to repeat compulsive behaviors that individuals with OCD experience. Other targeted areas include the supplementary motor cortex, medial prefrontal cortex, and anterior cingulate cortex.

Unlike treatment-resistant depression, which is associated with underactive neurons in parts of the brain related to mood regulation, OCD is connected with brain regions firing too much. As a result, in addition to targeting different areas of the brain, technicians utilize another type of stimulation called low wave stimulation, which inhibits, rather than activates, regional brain activity.

What are the Advantages of TMS for OCD

TMS has several advantages compared to the first-line oral medications used to treat OCD.

One of the problems with oral medications is that they are often imprecise, spreading throughout the brain and targeting many more areas than are directly implicated in the conditions they are meant to treat. This causes many unwanted side effects, such as weight gain, sexual dysfunction, emotional numbing, and more. TMS can deliver incredibly localized treatments, targeting the very source of the symptoms and avoiding unwanted side effects.

Aside from lacking precision, first-line oral medications often must be taken continuously to cause and maintain their therapeutic effects. After a round of TMS treatments, the benefits can last for a substantial period of time. On average, results last between four to fourteen weeks and can easily be sustained with quick maintenance sessions.

How Heading Does TMS for OCD Differently

In many cases, TMS is offered as a standalone treatment. While it can be very effective on its own, studies have found its effects can be amplified when combined with other interventions. For example, one experiment found that patients who underwent TMS and CBT experienced nearly a 60 percent drop in their OCD symptoms and that for 80 percent of the subjects, their symptoms decreased by at least 40 percent.

At Heading, patients have access to our integrated team of mental health specialists with wide-ranging expertise to complement their TMS and enhance its therapeutic effects. By combing TMS with other therapies, our patients benefit from the synergistic effects of a holistic approach to mental health.

Talk with your doctor to determine whether this treatment is right for you or schedule an appointment with one of our psychiatrists or therapists to advise you on this or any other potential treatments, including ketamine, Spravato, and TMS. Call us at 805-204-2502 or request an appointment here.

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What To Expect At Your First Psychiatrist Appointment

January 28, 2022

Whether it is over the phone or in person, seeking help for your mental health can be daunting if you do not know what to expect. This article will give you some useful pointers to empower you to work in collaboration with our psychiatrists on starting your journey to recovery.

1. Come prepared

Before your appointment, it might be useful to take some time to think about the reason for your visit. What symptoms or struggles are impacting you the most? How and when did they start? If possible, keep a diary of your symptoms over a couple of weeks. This is helpful to monitor their frequency, intensity, identify a particular time of day, potential triggers, and things that make you feel better, etc. Sleep patterns, appetite, and weight fluctuations are equally valuable sources of information for your doctor.

It is also useful to gather some details about your childhood from your family, including your birth, your developmental milestones (at what age did you start walking, talking, etc.), your behavior as a child and how you did in school. Ask your relatives if there is a history of mental illness in your family – this may be a sensitive subject but can be relevant as you might be more susceptible to certain conditions.

If you have been referred by another healthcare provider, bring your consultation letters including previous diagnoses, treatments, and medications you have been on. Make sure to bring hospital discharge letters if you had previous admissions or inpatient treatment.

2. What you are likely to talk about
If this is your first contact with a psychiatrist, the appointment is likely to take about an hour.

At first, your healthcare provider may give you the opportunity to talk freely about your presenting complaint. After that, you will be asked a series of more detailed questions on your childhood, education, family, current situation, medical history, etc. They might ask you questions on some of the more intimate aspects of your life, including relationships, sexuality, illicit drugs, or if you ever had trouble with the law. This enables your psychiatrist to make a 360° assessment of your mental health and how it affects you in your daily life. If you feel uncomfortable answering certain questions, do not hesitate to let your doctor know. Do not forget that professionals are bound by confidentiality and none of the information you disclose will be shared with your relatives or the authorities.

Depending on the reason for your visit, they might ask very detailed questions about treatments and therapies you have already tried, including over the counter and herbal or non-conventional treatments – did they help? What side effects did you suffer from? Why did you stop? This will allow your doctor to tailor his approach to give you the best chance of positive outcomes. Finally, give your psychiatrist any information that has not come up in questions, but you believe to be relevant to your circumstances – you know yourself best.

3. Outcome of your consultation
For someone suffering from debilitating symptoms, getting to put a name on your illness might feel therapeutic. It enables you to give an identity to the enemy you are battling, and to connect with other individuals going through the same journey. However, it is important to understand that your provider might not be able to give you a diagnosis at the time of the first consultation. Many diagnostic criteria rely on temporality, i.e., length of time you have been suffering from symptoms, and sometimes a positive diagnosis can only be made retrospectively, many months down the line. Whilst this might be frustrating, it is paramount not to rush as being given a certain label can have long-lasting consequences in terms of treatment you will be offered or will not qualify for.

However, your psychiatrist might still be able to provide you with a working diagnosis or provisional diagnosis to allow treatment planning whilst waiting for all the diagnostic criteria to be filled.

Coming to the end of your consultation, you will make a plan in conjunction with your psychiatrist about how to go forward. You might be offered a combination of therapy, medication, and other treatments such as TMS or novel agents. Remember you are the main actor of your recovery, and the decision on what treatment modality you believe will suit your circumstances is ultimately yours, guided by the advice of your psychiatrist. They will explain in detail the modalities, side effects, and evidence behind every option, to allow you to make an informed decision. You might wish to take more time to read through patient leaflets, do your own research, or talk about it with your next of kin. Other things to discuss are the frequency of follow-ups and monitoring and making a contingency plan for you to refer to in case your mental health deteriorates, such as urgent helplines and contact numbers.

If you have further questions about scheduling with a psychiatrist, another mental health provider, or how to best prepare for your appointment, give us a call at 512-777-2591 and we would be happy to assist you.

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