Multi-target theta burst stimulation (cTBS) as an adjunctive strategy for refractory obsessive-compulsive and major depressive disorders: A case report

This case report describes the use of various Transcranial Magnetic Stimulation (TMS) protocols in a patient with comorbid obsessive-compulsive disorder (OCD) and major depressive disorder (MDD), resistant to pharmacological and psychotherapeutic treatments.Initial TMS targeting the dorsolateral prefrontal cortex (DLPFC) improved MDD symptoms but not OCD.A subsequent multi-target protocol (orbitofrontal cortex [OFC] and supplementary motor area [SMA]), combined with high-dose SSRI and cognitive behavioral therapy, reduced the Yale-Brown Obsessive-Compulsive Scale (YBOCS) score from 28 to 17 after 71 sessions.OCD symptoms later recurred (YBOCS: 35), prompting a switch to clomipramine (150 mg/day) and a novel neuromodulation approach using accelerated, intensive, continuous theta-burst stimulation (cTBS) targeting both the SMA and OFC.After 48 sessions, YBOCS improved to 18.This case supports the safety, efficacy, and feasibility of accelerated cTBS protocols targeting SMA and OFC in treatment-resistant OCD.