Patterns, predictors, and effectiveness of TMS for treatment-resistant OCD: A naturalistic study

A C TObsessive-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.This 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.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.These findings suggest that TMS with the H7 coil is effective in reducing OCD symptoms, independent of improvements in depressive symptoms.