Neuronavigated 20hz theta burst TMS for OCD comorbid with depression and anxiety sequentially targeting RDLPFC, LDLPFC, and ROFC

Background: Preliminary studies using neuronavigated TBS-50Hz (50Hz pulse frequency theta burst stimulation) and TBS-30Hz have shown promise for the treatment of obsessive-compulsive disorder (OCD), but TBS-20Hz has not been tested OCD or with depression anxiety. Methods: Fourteen patients moderate-to-severe comorbid major depressive (MDD), generalized anxiety (GAD) and/or panic (PD) were treated in a private outpatient clinic. All obtained individual 3T T1-weighted Magnetic Resonance Imaging (MRI) scans. Neuronavigated cTBS-20Hz (continuous iTBS-20Hz (intermittent sequentially applied to right left dorsolateral prefrontal cortex (DLPFC), respectively. Augmentation was then orbitofrontal (ROFC). Results: 64% (9/14) remitted (Y-BOCS-SR <15) (R2=0.76, p<0.01) an average 6.1 weeks 48% mean decrease Y-BOCS-SR scores. 58% (7/12) from MDD (BDI-II < 13) (R2=0.73, p<0.01), 62% (8/13) GAD/PD (BAI 8) (R2=0.63, p<0.01). Patients baseline suicidal ideation (SI) had SI 63% at one week 75% by end treatment. Conclusions: sequential TMS RDLPFC LDLPFC followed ROFC augmentation significantly reduced OCD, MDD, symptoms remission rates 64%, 58%, 62%, decreased substantially first week. Prospective randomized, sham-controlled trials are warranted. Conflicts Interest: Dr. Stubbeman IP on some stimulation protocols including TBS-20Hz. Funding: None Disclosures: