title: Better than treated as usual: Transcranial magnetic stimulation augmentation in selective serotonin reuptake inhibitor-refractory obsessive-compulsive disorder, mini-review and pilot open-label trial.
abstract: 1 Hz repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area has been shown to be effective in a subset of obsessive-compulsive disorder (OCD) subjects, yet these results are still to be confirmed. This preliminary study compares the efficacy of augmentation with 1 Hz rTMS over the supplementary motor area and the usual augmentation treatment (TAU; treated as usual) with antipsychotics in a sample of selective serotonin reuptake inhibitor (SSRI)-refractory OCD patients.
  
  
  
  Fifty SSRI-refractory OCD patients consecutively admitted were studied: 25 were treated with a three-week trial of 1Hz, bilateral rTMS over the supplementary motor area and 25 with antipsychotic drugs. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; primary outcome measure), Hamilton Depression and Hamilton Anxiety scales were administered at first, second and third week of treatment.
  
  
  
  Y-BOCS showed a statistically significant time effect from the baseline to the third week, with a 68% of responders (Y-BOCS score reduction of ⩾ 25%), in comparison with 24.0% in the TAU group. In the rTMS group, 17.6% of patients achieved remission.
  
  
  
  1 Hz rTMS over the supplementary motor area appeared to be effective in approximately 2/3 of SSRI-refractory OCD subjects, whereas in the TAU group only 1/4 of subjects were responders. The supplementary motor area might be a new target area to be further explored with neuromodulation for OCD treatment.
authors: Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Florence, Italy Department of Psychiatry and Behavioral Sciences, UC Davis Health System, Sacramento, CA, USA Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, USA stefanopallanti@yahoo.it.
authors: Stefano
authors: S
authors: Pallanti
authors: Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Florence, Italy Institute of Neurosciences, Florence, Italy.
authors: Anna
authors: A
authors: Marras
authors: Institute of Neurosciences, Florence, Italy.
authors: Luana
authors: L
authors: Salerno
authors: Center for Morphometric Analysis, Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Nikos
authors: N
authors: Makris
authors: Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, USA.
authors: Eric
authors: E
authors: Hollander
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D010865:Pilot Projects; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D050781:Transcranial Magnetic Stimulation
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: OCD; Repetitive transcranial magnetic stimulation; SMA; SSRI-refractory OCD; obsessive–compulsive disorder; rTMS; supplementary motor area