A systematic review and meta-analysis found that repetitive transcranial magnetic stimulation (rTMS) was an effective treatment for obsessive-compulsive disorder (OCD). These findings were published in Psychiatry Research.
Investigators at the First Affiliated Hospital of Harbin Medical University in China searched publication databases through March 2021 for studies of noninvasive brain stimulation treatments for OCD.
A total of 18 studies were included in this analysis. Most studies (n=18) evaluated rTMS and 4 evaluated transcranial direct current stimulation (tDCS). The primary outcome in all studies was change in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and sham stimulation was used as the comparator.
Overall, active stimulation was favored over sham stimulation (standardized mean difference [SMD], -0.62; 95% CI, -0.88 to -0.36; P <.00001; I2, 49%).
Stratified by type of intervention, active rTMS stimulation (SMD, -0.72; 95% CI, -1.06 to -0.37; P <.0001; I2, 58%) and tDCS stimulation (SMD, -0.39; 95% CI, -0.72 to -0.07; P =.02; I2, 0%) were favored over sham treatment.
Stratified by high- and low-frequency rTMS, both the high frequency (SMD, -0.62; 95% CI, -1.00 to -0.25; P =.0010; I2, 18%) and low frequency (SMD, -0.69; 95% CI, -1.21 to -0.17; P =.009; I2, 71%) interventions were favored for the treatment of OCD.
For the subset of studies (n=11) which targeted the dorsolateral prefrontal cortex, active treatment was favored (SMD, -0.70; 95% CI, -0.96 to -0.45; P =.00001; I2, 29%). The studies (n=4) which targeted the supplementary motor area did not find an effect of noninvasive brain stimulation (SMD, -0.76; 95% CI, -1.78 to 0.26; P =.14; I2, 83%).
This analysis was limited by the significant study heterogeneity observed among some of the comparisons.
The study authors concluded, “In summary, noninvasive brain stimulation is effective for obsessive-compulsive disorder, especially the rTMS. In subgroup analysis, a better response trend of stimulating the dorsolateral prefrontal cortex was observed compared to that of the supplementary motor area. There was no statistical difference between the high frequency and the low-frequency stimulation. However, further investigations are still required regarding the best stimulation site and frequency.”
Gao T, Du J, Tian S, Liu W. A meta-analysis of the effects of noninvasive brain stimulation on obsessive-compulsive disorder. Psychiatry Res. 2022;312:114530. doi:10.1016/j.psychres.2022.114530