Deep transcranial magnetic stimulation for obsessive-compulsive disorder is efficacious even in patients who failed multiple medications and CBT

Journal: Psychiatry Research (2020)

Authors: Y Roth, N Barnea-Ygael, L Carmi, EA Storch, A Tendler, A Zangen

Background:

Recently, six weeks of daily deep transcranial magnetic stimulation (Deep TMS) therapy have been shown to be safe and effective in OCD patients who had insufficient response to medication and/or CBT. This present a novel treatment option for OCD, but an important clinical question is how efficacious is Deep TMS in OCD patients with unsatisfactory symptoms reduction following multiple medication and/or CBT treatments

Objective:

Analyze data from a multi-center double-blind clinical trial using Deep TMS in OCD patients (Carmi et al., 2019) to evaluate whether high number of medication trials and/or prior CBT limit the potential effectiveness of Deep TMS in OCD.

Methods:

At 11 centers, 99 OCD patients were randomly allocated to treatment with either high-frequency (20 Hz) or sham dTMS and received daily treatments following individualized symptom provocation, for 6 weeks. Clinical response to treatment was determined using the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the primary efficacy endpoint was the change in score from baseline to post-treatment assessment. Additional measures were response rates (defined as a reduction of>30% in YBOCS score) at the post-treatment assessment and after another month of follow-up.

For the current analysis the sample was divided into groups containing subjects with insufficient response to one or two medications (1–2 Meds cohort) versus subjects with insufficient response to three or more medications (3+ Meds cohort). In addition, subjects were divided into cohorts who either received prior CBT (of at least 2 months with a therapist) or did not receive prior CBT (Past CBT/ No CBT).

Results:

Response at post-treatment was significantly higher in the dTMS group compare to sham in the larger cohorts of 3+ meds (dTMS: 41.4%; sham: 8.3%; p = 0.0109) and of Past CBT (dTMS: 33.3%; sham: 3.3%; p = 0.0041).

Conclusions:

This analysis demonstrates that Deep TMS is an effective treatment option for OCD patients, regardless of prior non-response to SRIs±antipsychotics or CBT sessions.

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