Deep transcranial magnetic stimulation (dTMS) may help the many patients with obsessive-compulsive disorder (OCD) who have an inadequate response to medication or psychological interventions, according to a study published online in The American Journal of Psychiatry.
“Obsessive-compulsive disorder is a chronic and disabling condition that often responds unsatisfactorily to pharmacological and psychological treatments,” researchers wrote. “Converging evidence suggests a dysfunction of the cortical-striatal-thalamic-cortical circuit in OCD, and a previous feasibility study indicated beneficial effects of dTMS targeting the medial prefrontal cortex and the anterior cingulate cortex.”
Researchers investigated the efficacy of dTMS in 99 patients with OCD at 11 centers in the United States, Canada, and Israel. The double-blind trial randomized patients to 29 treatment sessions with either high-frequency (20 Hz) dTMS or sham dTMS over 6 weeks. Before and during each session, researchers provoked OCD thoughts in participants to activate parts of the brain involved in the disordered thinking, according to Psychiatric News.
Patients who received active dTMS had significantly greater score reductions on the Yale-Brown Obsessive Compulsive Scale compared with patients who received sham dTMS, according to the study. The average drop with active dTMS was 6 points, compared with 3.3 points with sham dTMS.
Rates of treatment response—defined as a 30% or more drop in score on the Yale-Brown scale—were 38.1% with active dTMS and 11.1% with sham dTMS. Four weeks after the last treatment, response rates with active dTMS were 45.2%, researchers reported, and 17.8% with sham treatment.
Headache was the most common adverse event, affecting 37.5% of participants receiving active dTMS and 35.3% of those receiving sham dTMS, according to Psychiatric News.
“High-frequency dTMS over the medial prefrontal cortex and anterior cingulate cortex significantly improved OCD symptoms,” researchers concluded, “and may be considered as a potential intervention for patients who do not respond adequately to pharmacological and psychological interventions.”
Carmi L, Tendler A, Bystritsky A, et al. Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial. The American Journal of Psychiatry. 2019 May 21;[Epub ahead of print].