Efficacy of Adjunctive Deep Transcranial Magnetic Stimulation in Obsessive-Compulsive Disorder: A Randomized Sham-Controlled Study.

Objectives: Obsessive-compulsive disorder is one of the most common neuropsychiatric disorders with a higher lifetime prevalence than schizophrenia, often showing inadequate response to pharmacological and psychotherapeutic treatments. This study aimed to examine the efficacy of adjunctive deep transcranial magnetic stimulation (dTMS) in a randomized, sham-controlled set-up, addressing inadequate response to standard treatments.

Methods: Forty-nine obsessive-compulsive disorder patients were randomly allocated to receive either high-frequency dTMS (20 Hz) or sham stimulation and received 10 sessions of treatment using the H7 coil to target the dorsal anterior cingulate cortex and the medial prefrontal cortex over a period of 2 weeks. Change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores was the primary outcome measure. Secondary efficacy measures were changes in Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale scores and response rates as measured by Y-BOCS.

Results: The active dTMS group demonstrated a significant reduction in Y-BOCS scores compared with sham (-10.4 vs -2.6 points; P < 0.001), with an effect size of 1.39. Full response rates were 75% in the active group versus 5% in the sham group (P < 0.001). Anxiety and depressive symptoms also improved significantly in the active group (Hamilton Anxiety Rating Scale: -9.1 vs -2.4 points, P < 0.001; Hamilton Depression Rating Scale: -5.9 vs -1.8 points, P < 0.001).

Conclusion: Our study demonstrated that dTMS targeting the dorsal anterior cingulate cortex and medial prefrontal cortex significantly improved obsessive-compulsive, anxiety, and depressive symptoms, with faster response rates and fewer sessions compared with previous trials, suggesting that dTMS may serve as an effective early intervention for a wider range of obsessive-compulsive disorder patients.