TMS for OCD: Effectiveness, Protocols, and Patient Selection

TMS for OCD: Effectiveness, Protocols, and Patient Selection

TMS for OCD is more than just using the same treatment protocol as depression. In this episode, Dr. Harvey and Dr. Malzberg discuss how transcranial magnetic stimulation is used for obsessive-compulsive disorder, including FDA-cleared protocols, the H7 coil, symptom provocation, dorsomedial prefrontal cortex and anterior cingulate targets, and what patients can realistically expect. They also cover why TMS for OCD is less commonly used than TMS for depression, how insurance coverage affects access, and why clinicians need to be careful not to overdiagnose OCD when intrusive thoughts may fit a different formulation. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com [https://psychofarm.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

Chestnut Lodge: The Psychiatry Case That Still Matters (for TMS)

TMS gets a historical frame in this episode, using the Chestnut Lodge case and Rafael Osheroff’s lawsuit to explore how psychiatry changes when old assumptions fail patients. Dr. Steve Harvey and Dr. Greg Malzberg discuss psychoanalysis, medication, neuromodulation, and the danger of treating any one approach as the only legitimate answer. The conversation connects a famous psychiatry history case to today’s patients who cycle through depression medications without hearing about TMS, while also warning against turning TMS or any newer treatment into hype. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com [https://psychofarm.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

What Are the Safety Risks of TMS? (Seizures, Hearing Loss, and Metal)

TMS safety risks are the focus of this episode, with a balanced look at why transcranial magnetic stimulation is considered very safe while still requiring thoughtful precautions. Psychiatrists explain the rare but serious concerns patients should understand before treatment, including hearing damage without earplugs, seizure risk during stimulation, and metal-related issues near the magnetic field. The discussion also covers practical clinic safety steps, why medication changes can matter during a TMS course, and why “no side effects” is not the right way to describe any treatment. It is a clear, grounded overview for anyone considering TMS or educating patients about it. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com [https://psychofarm.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

How TMS Works for Depression: Brain Networks, Neuroplasticity, and the Left DLPFC

How TMS works is the focus of this episode, which moves beyond the idea that depression is simply a chemical imbalance. Dr. Harvey and Dr. Malzberg explain why TMS targets the left dorsolateral prefrontal cortex, how that surface region may influence deeper connected brain networks. They also discuss neuroplasticity with appropriate caution, emphasizing that it is not magical brain fertilizer but one possible part of how treatments for depression create change. The result is a clear, honest psychiatry conversation about TMS, depression, brain networks, and what science still cannot fully explain. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com [https://psychofarm.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

Serotonin Hypothesis of Depression: Why Low Serotonin Is Too Simple

Serotonin hypothesis of depression is the center of this episode, as two psychiatrists unpack why the low serotonin “chemical imbalance” story became so popular and why it falls short. They trace the monoamine hypothesis, discuss serotonin, norepinephrine, and dopamine, and review evidence that challenges a simple serotonin deficiency model. The conversation also explains why this does not mean SSRIs or antidepressants stop working, using clear analogies and clinical examples like delayed medication response, serotonin syndrome, tryptophan depletion, TMS, and depression research. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com [https://psychofarm.substack.com?utm_medium=podcast&utm_campaign=CTA_1]