Assessing the feasibility of accelerated deep TMS in patients with OCD as an adjunct to inpatient treatment: A case series

This case series describes the safety and feasibility of accelerated deep transcranial magnetic stimulation (adTMS) as an adjunct to specialised inpatient care, including exposure and response prevention (ERP) therapy, for ten patients with obsessive-compulsive disorder (OCD). Stimulation was administered four times daily over two weeks using a high-frequency protocol targeting the medial prefrontal cortex and anterior cingulate cortex, delivering a total of 64,000 pulses. Protocol adherence was 100%, and the intervention was generally feasible and well tolerated. One serious adverse event occurred two weeks after treatment completion: an acute psychotic episode in a patient with a prior history of brief psychotic decompensation. Mean scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) decreased from 31.5 to 23.5. Three patients (30%) achieved clinical response (=35% reduction), with one (10%) achieving remission (Y-BOCS<7). These preliminary findings suggest that adTMS can be implemented alongside intensive inpatient ERP with high adherence and acceptable tolerability.