Journal: Transcranial Magnetic Stimulation
Authors: Breiger, M; Baldi, S; Perlo, S; Brennan, B; Brown, J; Siddiqi, S; Razafsha, M.
Background:
Obsessive-Compulsive Disorder (OCD) significantly impairs patients’ quality of life and frequently co-occurs with Major Depressive Disorder (MDD), complicating the interpretation of treatment outcomes. Transcranial Magnetic Stimulation (TMS) is FDA-approved for treatment-resistant OCD; however, there is limited naturalistic data on its effectiveness or predictors of response. Additionally, it remains unclear whether improvements in OCD symptoms are driven by concurrent changes in depressive symptoms.
Objective:
The study aimed to determine if the improvement in OCD symptoms is independent or secondary to a MDD response. Additionally, it aimed to quantify the real-world response rates, predictors of response, and the utility of symptom provocation in OCD-targeted TMS treatment.
Methods:
The study analyzed naturalistic data from 45 patients receiving TMS treatment with the H7 coil, using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Quick Inventory of Depressive Symptomatology-16 (QIDS) to examine changes in OCD and MDD symptoms over the course of TMS treatment
Results:
A multiple regression analysis showed significant reductions in Y-BOCS scores over time, even when controlling for QIDS scores (p = 0.0048), suggesting that improvements in OCD were independent of changes in depressive symptoms. In contrast, QIDS scores did not significantly change when controlling for Y-BOCS scores (p = 0.82). The overall OCD response and partial response rates were 28.9 % and 40.0 %, respectively, for patients who received a full course of at least 29 treatments. To account for the high noncompletion rate (48 %), secondary analyses yielded a response rate of 23.0 % for the 74 patients who received at least 10 treatments. Higher baseline Y-BOCS scores and lower baseline QIDS scores were predictive of greater improvements in OCD symptoms, while level of care and symptom-provocation scores did not significantly influence outcomes. Both obsessional and compulsive symptom scores decreased significantly, with no difference in the magnitude of reduction between the subscales.
Conclusions:
These findings suggest that TMS with the H7 coil is effective in reducing OCD symptoms, independent of improvements in depressive symptoms.
