Yes, TMS is FDA-cleared for obsessive-compulsive disorder (OCD), with two conditions that matter. It is cleared for adults, and it is cleared as an adjunct, meaning an add-on to the OCD treatment you are already getting, not a replacement for it. The clearance covers specific devices and coils, and MagVenture, the brand of TMS equipment in our TMS therapy program in Folsom and Rocklin, holds one of them.
Anxiety is a different story. We found no FDA clearance for TMS as a treatment for an anxiety disorder on its own. What the FDA has cleared, for MagVenture and others, is reducing anxiety symptoms in adults being treated with TMS for depression. Here is what the records say and what an OCD course involves.
What is OCD, and what is usually tried first?
OCD is marked by obsessions, which are unwanted, intrusive, recurring thoughts, urges, or images, and compulsions, which are repetitive behaviors or mental acts a person feels driven to perform in response to an obsession. The American Psychiatric Association estimates it affects 1 to 2 percent of people in the United States.
Two treatments come first. The APA names exposure and response prevention (ERP), a specific type of cognitive behavioral therapy, as the first-line therapy for OCD, and selective serotonin reuptake inhibitors (SSRIs) as the other first-line treatment; severe OCD should get both at once. The National Institute of Mental Health adds a detail that explains why many people feel stuck: antidepressant treatment for OCD can take 8 to 12 weeks before symptoms begin to improve, and may need higher doses than are used for depression.
TMS enters after those steps, and NIMH describes it the same way: used along with medication, psychotherapy, or both, for severe OCD that did not respond to other treatments.
Is TMS FDA-cleared for OCD?
Yes. The record, in order:
- August 2018. The FDA granted the first OCD clearance to the BrainsWay Deep TMS System (De Novo DEN170078). The indication reads: "intended to be used as an adjunct for the treatment of adult patients suffering from Obsessive-Compulsive Disorder."
- August 2020. The FDA cleared the MagVenture TMS Therapy system for the same adjunctive OCD indication (510(k) K193006), using its Cool D-B80 coil. The clearance states that the indication, target population, protocol, and treatment location are identical to the BrainsWay device.
Two details in that labeling shape treatment. It is for adults: safety and effectiveness were established in people aged 22 to 68, not outside that range. And it is an add-on: the pivotal trial required participants to stay on their SSRI, other OCD medication, and/or therapy at a stable dose, and the labeling says patients should be maintained at their current dosages during TMS.
How is TMS for OCD different from TMS for depression?
If you have read about TMS for depression, set those numbers aside. OCD uses a different protocol, spelled out in the MagVenture clearances (K193006 and the 2025 update, K251119) and the BrainsWay trial summary.
- A different target. Depression protocols aim at the left dorsolateral prefrontal cortex, as our article on how TMS works for depression describes. The OCD protocol stimulates the dorsomedial prefrontal cortex on both sides, deeper and closer to the midline, using coils cleared for that purpose.
- A different schedule. The labeling specifies 29 sessions over six weeks: one a day, five days a week for five weeks, then four in week six. There is no taper.
- Shorter stimulation. Each session delivers about 18 minutes of 20 Hz pulses; in the trial, the full visit ran about 30 minutes.
- Symptom provocation. Before each session, a clinician briefly brings up your specific obsession, for up to five minutes, until you feel moderately anxious, so the OCD circuit is active while it is stimulated. It is uncomfortable by design, and it is part of the cleared protocol.
The figures on our TMS page (20 to 30 minutes, five days a week for four to six weeks) are general estimates, not the OCD labeling. Ask our office what an OCD course would look like for you before you plan around either.
Does TMS work for OCD?
The FDA's first OCD decision rested on one randomized, sham-controlled trial of the BrainsWay device in 100 adults with at least moderate OCD who stayed on their medication or therapy during the study. MagVenture's clearance relied on that evidence by showing its device and protocol are equivalent, not on a separate pivotal trial. The De Novo summary reports, in its modified intent-to-treat analysis, that at six weeks 38.1 percent of people on active treatment had a response, defined as at least a 30 percent drop on the Yale-Brown Obsessive Compulsive Scale, versus 11.1 percent on sham. Remission, a score under 10, was rare in both groups, at about 5 percent.
Read that honestly. About four in ten people on active TMS met that response bar, versus about one in ten on sham. Others improved by less or not at all. Few reached remission at six weeks, and the trial does not show a cure or lasting remission. That is a reason to ask about it, not a promise. Our article on TMS success rates for depression explains how response and remission are measured.
Is TMS FDA-cleared for anxiety?
Not for an anxiety disorder on its own, based on the FDA records we reviewed. Here is the exact wording, because this is easy to overstate.
The MagVenture system's current indication (K251119, cleared August 2025) is "for the treatment of depressive episodes and for decreasing anxiety symptoms for those who may exhibit comorbid anxiety symptoms in adult patients suffering from Major Depressive Disorder" who did not improve on antidepressants in the current episode. BrainsWay received an equivalent clearance in 2021 (K210201). In plain terms: if you are being treated with TMS for depression and you also have anxiety symptoms, the device is cleared to help with those too. This is sometimes called anxious depression.
Generalized anxiety disorder, panic disorder, and social anxiety without depression are not covered by those clearances, so treating them with TMS is off-label. Off-label use is legal, and your psychiatrist can discuss whether it is reasonable for you, but you should hear it described that way, and insurers generally treat it that way.
Who is a candidate for TMS for OCD?
Usually, an adult whose OCD is still at least moderate after a fair trial of ERP, an SSRI, or both, and who can keep a weekday schedule for six weeks. A psychiatric evaluation decides the rest. Expect questions about:
- Which medications and therapies you have tried, for how long, and at what dose
- Any metal or implanted device in or near your head, which can rule TMS out
- Seizure history, head injury, or other neurological conditions
- Every medication you take, including clomipramine and others that can lower the seizure threshold
- Pregnancy, and recent substance use
In the trial, the most common side effect was headache, reported by 37.5 percent of people on active treatment and 35.3 percent on sham, a similar rate. Jaw, face, or scalp discomfort usually faded as people got used to the sessions. Our TMS myths article covers the safety questions people worry about most.
One rule above all: do not stop or change your medication or therapy to start TMS. The clearance assumes you stay on them. If you are not in treatment for OCD yet, that is often the first step, and our medication management team can see you in person or by video.
Does insurance cover TMS for OCD or anxiety?
Sacramento NeuroPsych Associates accepts many commercial, Medicare, and Medi-Cal plans. Whether yours covers TMS for OCD depends on your specific benefits and on prior authorization, and plans vary more for OCD than for depression; for anxiety without depression, off-label status can make coverage harder to get. Our guide to whether insurance covers TMS therapy explains authorization and denials. Ask our office to check your benefits before you plan around a course.
TMS in Folsom and Rocklin
We provide TMS on MagVenture equipment at our Folsom and Rocklin offices, both open Monday through Friday, 8:00 AM to 5:00 PM. Dr. Harjot Sekhon and Dr. Abhijit Ramanujam are certified in TMS and both list OCD among the conditions they treat. There is no sedation, so most people drive themselves and go back to work after a session. Evaluations can be done by telehealth from anywhere in California; treatment is in person. Our Natomas office is opening soon.
The OCD clearance is tied to specific coils and a specific protocol, so ask our office whether that protocol is available at your location before you plan around it. Your evaluation settles the rest. Our week-by-week TMS timeline covers the depression course and still helps with planning rides and work.
If you are in crisis or thinking about harming yourself, call or text 988 or call 911.
Frequently asked questions
Can I get TMS for OCD if I am not on medication?
The clearance is for TMS as an add-on to existing OCD treatment, and the trial required a stable medication or therapy plan. If you are not in treatment, your psychiatrist will likely talk with you about starting ERP, an SSRI, or both first. Do not start or stop anything on your own.
How many TMS sessions does OCD take?
The FDA labeling for the OCD protocol is 29 sessions over six weeks. Your psychiatrist may recommend something different based on your situation, and insurers approve a specific number, so confirm both before you start.
Does TMS treat anxiety?
TMS is cleared to reduce anxiety symptoms in adults being treated for depression. It is not cleared for anxiety disorders on their own, so that use is off-label. Ask your psychiatrist which applies to you.
Take the next step
If OCD has not eased with therapy and medication, or you have depression with heavy anxiety, a psychiatric evaluation is where the answer starts. We will review what you have tried, screen for safety, and tell you plainly whether TMS fits. Schedule an appointment or call (916) 473-2235.
