RTMS Versus Fluvoxamine in the Treatment of OCD: A Randomized Open-label Pilot Study

TL;DR

This study compared repetitive transcranial magnetic stimulation and fluvoxamine for treating OCD in treatment-naïve patients, finding no significant difference in effectiveness.

Contribution

Preliminary evidence that low-frequency rTMS over the supplementary motor area may help treatment-naïve OCD patients.

Findings

No statistically significant difference in response rates between rTMS and fluvoxamine groups.

41.7% of rTMS patients and 60% of fluvoxamine patients showed improvement.

No severe adverse events were reported in either treatment group.

Abstract

Background: Obsessive‒compulsive disorder is a chronic, disabling mental disorder. While repetitive transcranial magnetic stimulation has emerged as a promising neuromodulation intervention for psychiatric disorders, its efficacy in treatment-naïve obsessive‒compulsive disorder patients remains understudied.

Objective: This study aimed to test the preliminary efficacy of low-frequency repetitive transcranial magnetic stimulation in treatment-naïve obsessive‒compulsive disorder patients.

Methods: Treatment-naïve obsessive‒compulsive disorder patients (n = 41) were randomized to receive either standardized fluvoxamine therapy (150-200 mg/day) or daily low-frequency (1 Hz) repetitive transcranial magnetic stimulation targeting the supplementary motor area for 2 weeks. Clinical outcomes were longitudinally assessed via validated instruments, with a Yale-Brown Obsessive-Compulsive Scale score reduction rate ≥ 25% as the primary endpoint, supplemented by the Beck Depression Inventory and Beck Anxiety Inventory for comorbid symptom evaluation. Safety profiles were monitored throughout the trial.

Results: The experimental results revealed that the difference in the response rate at the end of the intervention between the two groups was not statistically significant (χ2
= 0.183, p = 0.669), with 41.7% (5/12) in the repetitive transcranial magnetic stimulation group and 60% (6/10) in the fluvoxamine cohort. No severe adverse events were reported in either group.

Conclusion: This trial revealed that low-frequency repetitive transcranial magnetic stimulation over the supplementary motor area might have preliminary positive outcomes for treatment-naïve patients with obsessive‒compulsive disorder. Our findings can be considered a good signal to promote further research in the form of randomized, double-blind, sham-controlled multicenter trials with extended follow-up periods.

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