Repetitive transcranial magnetic stimulation treatment for obsessive–compulsive disorder

PURPOSE OF REVIEW: Repetitive transcranial magnetic stimulation (rTMS) and its modifications have emerged as promising interventions for obsessive-compulsive disorder (OCD). Although growing evidence supports the safety and clinical efficacy of rTMS, substantial heterogeneity in study designs and stimulation protocols continues to hinder the development of uniform, consensus-based guidelines. RECENT FINDINGS: Large-scale clinical trials capable of definitively establishing the effectiveness of existing rTMS protocols are still lacking. However, available findings from smaller randomized controlled trials and (network) meta-analyses suggest moderate efficacy for various rTMS targets and protocols. Accelerated protocols may shorten time to response, though comparative evidence of their efficacy remains limited. In the absence of clear clinical predictors, research is increasingly focused on personalized treatment protocols and biomarker-informed prediction of response. Also, integrated treatment approaches, with accumulating evidence supporting the combination of rTMS with psychotherapy or pharmacotherapy, seem promising. SUMMARY: rTMS shows promise as an adjunctive treatment for OCD. Large, well designed clinical trials are required to establish the most effective target and stimulation parameters and to verify long-term outcomes. Personalized targeting guided by neural predictors, as well as the integration of rTMS into broader therapeutic strategies, may enhance treatment efficacy.