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Safety and efficacy of early augmentation with repetitive transcranial magnetic stimulation in the treatment of drug-free patients with obsessive–compulsive disorder

Published online by Cambridge University Press:  27 January 2022

Mohita Joshi ,
Sujita Kumar Kar Open the ORCID record for Sujita Kumar Kar [Opens in a new window]  and
Pronob K. Dalal
Mohita Joshi
Affiliation:
Department of Psychiatry, King George’s Medical University, Lucknow, India
Sujita Kumar Kar*
Affiliation:
Department of Psychiatry, King George’s Medical University, Lucknow, India
Pronob K. Dalal
Affiliation:
Department of Psychiatry, King George’s Medical University, Lucknow, India
*
*Author for correspondence: Sujita Kumar Kar, Email: drsujita@gmail.com
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Abstract

Background

Obsessive–compulsive disorder (OCD) is a chronic psychiatric disorder that results in significant disability and substantial compromise in the quality of life. Until now, the role of repetitive transcranial magnetic stimulation (rTMS) has been primarily explored in individuals with treatment-resistant OCD. In this study, we investigated the safety and efficacy of rTMS as an early augmentation strategy in drug-free patients with OCD.

Methods

This is a randomized double-blind, placebo-controlled study that involved the administration of a total of 20 sessions of rTMS (active/sham) to drug-naïve OCD patients using a standard protocol (1-Hz; 20 trains [80 pulses/train]; 1600 pulses per session at 100% resting motor threshold) at supplementary motor area. All patients (active and sham) were started on escitalopram 10 mg/d, which was subsequently increased to 20 mg/d after 10 days.

Results

Out of the 24 patients, 13 received active and 11 received sham rTMS. At the end of rTMS therapy, there was a substantial reduction (P = .001) in total Yale-Brown Obsessive–Compulsive Scale, obsessions (P = .030) and compulsions (P = .001) between the groups. Only few patients (N = 8) reported mild side effect with rTMS, local pain, and headache being the commonest. The study revealed large effect size (Cohen’s d = 1.6) of rTMS as an early augmentation strategy in drug-free patients of OCD.

Conclusions

rTMS is a safe and effective early augmentation strategy in the management of OCD. Larger randomized controlled trials are required to establish the therapeutic role of rTMS as early augmentation in OCD.

Keywords

Obsessive–compulsive disorderrepetitive transcranial magnetic stimulationaugmentationsafetyefficacy
Type
Original Research
Information
CNS Spectrums , Volume 28 , Issue 2 , April 2023 , pp. 190 - 196
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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