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Richmond Brain & Behavior

Deep TMS · BrainsWay H7 coil

TMS for OCD — a different coil, a different target.

The BrainsWay H7 coil is FDA-cleared specifically for obsessive-compulsive disorder. It is not the same device or the same treatment as TMS for depression, and it is worth understanding why if medication and therapy haven't gotten you where you need to be.

Request an appointment Call (804) 476-8274
BrainsWay Deep TMS equipment in the Northside Richmond office

Medically reviewed by C. Britt Beasley, MD · Last reviewed June 10, 2026

The mechanism

Why OCD needs a different coil

The brain circuits most implicated in OCD — the medial prefrontal cortex and anterior cingulate cortex — sit several centimetres below the surface, deeper than the dorsolateral prefrontal cortex targeted in depression treatment. A conventional figure-8 TMS coil produces a field that falls off quickly with depth, which is a real constraint when the target is deep rather than superficial.

The BrainsWay H7 coil is a helmet-shaped design that produces a broader, deeper field capable of reaching those structures. It received FDA clearance for OCD in 2018 — a clearance separate from the H1 coil used for depression. Treating OCD with it is an on-label use of a device cleared for exactly this condition.

What the evidence shows

Honest about the numbers

Clearance rested on a multicenter randomized trial in patients whose OCD had not responded adequately to standard treatment. At the six-week endpoint, roughly one in three patients receiving active treatment met the trial's response threshold, compared with roughly one in nine receiving sham.

Two things about that are worth saying plainly. It is a meaningful result in a population that had already failed other treatments — and it also means most participants did not reach the response threshold in six weeks. Deep TMS is a real option for treatment-resistant OCD. It is not a guarantee, and anyone who presents it as one is overselling it.

Response is also not binary. Dr. Beasley tracks your symptoms with standardized measures through the course, so the question of whether it is working is answered with data rather than impressions.

The part that surprises people

An OCD session does not begin with the coil. It begins with a brief, individualized symptom provocation — you and Dr. Beasley work out what actually sets off your obsessions, and that is used to activate the relevant circuits immediately before stimulation.

It is deliberate, it is part of the cleared protocol, and it is brief. It is also the reason this treatment benefits from a physician who knows your case — the provocation is specific to you, and getting it right is clinical work rather than a setting on a machine.

What a course involves

Treatment is a course of short daily weekday sessions over several weeks, not a single appointment. You are awake throughout, and you can drive yourself home and go straight back to your day — there is no sedation and no recovery period.

Most people notice change gradually across the course rather than suddenly. Dr. Beasley will tell you what to expect for your situation at the evaluation, including how long before it is reasonable to judge whether it is working.

Candidacy

Who this is for

  • OCD that hasn't responded adequately to medication and therapy — typically an SSRI trial at an adequate dose and duration, and exposure and response prevention (ERP) if it has been available to you
  • You want a treatment that works through a different mechanism than another medication
  • You have OCD and depression together, and would rather have both assessed by one physician

There are also reasons Dr. Beasley will say no. Metal implanted in or near the head, certain implanted devices, and a seizure history all require careful review and may rule treatment out. And if you have not yet had a proper trial of ERP — the psychotherapy with the strongest evidence base in OCD — that conversation comes first. Skipping straight to a device because it is the newer option is not better care.

More about Deep TMS at this practice

Common questions

Straight answers about TMS for OCD

Is TMS FDA-cleared for OCD, or is this off-label?
Cleared. The BrainsWay H7 coil received FDA clearance for obsessive-compulsive disorder in 2018, which is a separate clearance from the H1 coil used for depression. This is an on-label use of a device cleared for exactly this condition.
How is TMS for OCD different from TMS for depression?
Different coil, different target, and a different session. OCD treatment uses the H7 coil aimed at the medial prefrontal cortex and anterior cingulate cortex, rather than the H1 coil aimed at the dorsolateral prefrontal cortex. OCD sessions also begin with a brief, individualized symptom provocation — you and Dr. Beasley identify what actually triggers your obsessions, and that is used to activate the relevant circuits immediately before stimulation.
Do I have to stop my medication?
No. Deep TMS is typically used alongside your existing treatment, not instead of it. Many patients continue their SSRI and their therapy throughout the course. Dr. Beasley coordinates with your existing prescriber and therapist rather than asking you to leave them.
Does it hurt?
Most people describe a tapping sensation on the scalp, and scalp discomfort or headache is common early in the course and usually settles as you adjust. You are awake the whole time and can drive yourself home and return to your day immediately afterward.
Is TMS for OCD covered by insurance?
Coverage for OCD is more variable than for depression, though it has been improving as the clearance ages. Most plans that do cover it require documentation of prior treatment attempts and a prior authorization before a course begins. We verify your benefits and handle the authorization with you before you commit to a course, so you are not weeks into treatment before finding out where you stand.
What if I have both OCD and depression?
That combination is common, and it is worth raising at the evaluation. Dr. Beasley treats with both BrainsWay coils and practices general psychiatry alongside the interventional work, so a co-occurring picture is assessed as one picture rather than referred out in pieces.

Now accepting new patients

Find out whether Deep TMS fits your OCD.

Request an evaluation and Dr. Beasley will review what you have already tried, screen for safety, and tell you honestly whether the H7 coil is the right next step — including if he thinks something else should come first. New patients are typically seen within days.

Request an appointment Call (804) 476-8274