Effectiveness of accelerated transcranial magnetic stimulation application in patients with obsessive-compulsive disorder

20-30% of patients with OCD (Obsessive-Compulsive Disorder) do not respond to first-line treatment methods. While TMS (Transcranial Magnetic Stimulation) application is a treatment option for OCD patients who do not respond to treatment, there is still no clarified protocol. In this study, we plan to evaluate the effectiveness of the iTBS (intermittent theta burst stimulation - 50 Hz) protocol by applying deep stimulation to the mPFC (medial prefrontal cortex) and ACC (anterior cingulate cortex) regions of OCD patients at 90% motor resting threshold. In this randomized, double-blind study, a total of 50 sessions of intensive treatment protocol were administered to patients over 10 days, with 5 sessions per day. The aim was to investigate whether this intensified treatment could lead to an earlier improvement in OCD symptoms. This study was completed with 30 OCD patients diagnosed according to DSM-V criteria, who had been using an effective dose of SSRIs (Selective Serotonin Reuptake Inhibitors) for at least 8 weeks but had not responded. Patients were divided into groups using a randomization system, with 16 receiving active treatment and 14 receiving placebo treatment. All participants completed the treatment, and no side effects were reported other than headache, dizziness, nausea, and sedation during the treatment period. Patients were evaluated using the YBOKÖ, BOKÖ, HAM-D, and HAM-A scales before treatment, at the end of treatment, and two weeks after treatment. At the end of treatment, a response to therapy was observed in 50% of both groups based on the reduction in the YBOKÖ evaluation scale. In the assessment conducted two weeks after the end of treatment, the response rate was 62.5% (10 out of 16) in the active iTBS group and 42.8% (6 out of 14) in the placebo treatment group, while the remission rate was 31.25% (5 out of 16) in the active iTBS group and 7.14% (1 out of 14) in the placebo treatment group. The findings of this study suggest that accelerated iTBS applied for two weeks (5 sessions per day for a total of 50 sessions) to the mPFK and ACC regions using a double-cone coil may be an effective and safe treatment method for OCD patients who do not respond to treatment. However, intensive sessions did not shorten the duration of the therapeutic effect of ITBS, and the superiority of ITBS over placebo at the end of treatment (study 2.not during the week), but at the controls (4 of the study.during the week) was formed.