1. What is the main target region in the brain for dTMS when treating OCD?
   1. A. Temporal lobe
   2. B. Prefrontal cortex
   3. C. Anterior cingulate cortex (ACC)
   4. D. Occipital lobe

1. What is the proposed mechanism of action for dTMS in the treatment of OCD?
   1. A. Regulating sleep patterns
   2. B. Modulating brain activity in the prefrontal cortex
   3. C. Enhancing sensory perception
   4. D. Modulating brain activity in the ACC to reduce obsessive thoughts and compulsive behaviors

1. How is a typical dTMS treatment protocol for OCD structured?
   1. A. One session per month
   2. B. Multiple sessions administered in a single day
   3. C. Multiple sessions administered over several weeks
   4. D. Single session with high intensity

1. What are some common side effects associated with dTMS treatment for OCD?
   1. A. Nausea and dizziness
   2. B. Severe and long-lasting headaches
   3. C. Mild discomfort or temporary headache at the stimulation site
   4. D. Memory loss and visual disturbances

1. In terms of efficacy, what have research findings on dTMS for OCD shown?
   1. A. Consistently significant benefits for all individuals
   2. B. No impact on OCD symptoms
   3. C. Mixed results with some individuals experiencing a reduction in symptoms
   4. D. A complete cure for OCD

1. Why is individualized treatment evaluation important when considering dTMS as a treatment option for OCD?
   1. A. To determine the color of the treatment device
   2. B. To streamline the treatment process
   3. C. To ensure a one-size-fits-all approach
   4. D. Because the effectiveness of dTMS varies from person to person

1. Who conducted a study to evaluate the current research on the effectiveness of dTMS therapy for individuals with treatment-resistant OCD?
   1. A. Dr. John Smith
   2. B. Dr. Emily Johnson
   3. C. McCathern et al.
   4. D. Roth et al.

1. In a study by Smárason et al., what was the primary focus regarding the relationship between dTMS and OCD symptoms?
   1. A. The impact of dTMS on anxiety symptoms
   2. B. The relationship between dTMS and depression symptoms
   3. C. The impact of dTMS on sleep patterns
   4. D. The effects of dTMS on cognitive functioning

1. What was the conclusion of the study by Smárason et al. regarding the impact of dTMS on depression symptoms during the treatment of OCD?
   1. A. dTMS significantly worsened depression symptoms
   2. B. dTMS had no effect on depression symptoms
   3. C. dTMS significantly improved depression symptoms
   4. D. Changes in depression symptoms were unpredictable

1. In a case series by Ikawa et al., what was the response rate to dTMS treatment for OCD, and what were the key findings in terms of symptom improvements?
   1. A. 100% response rate; no symptom improvements observed
   2. B. 75% response rate; moderate symptom improvements
   3. C. 53.9% response rate; significant improvements in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores
   4. D. 30% response rate; slight symptom improvements

—- Answers:

C. Anterior cingulate cortex (ACC)

D. Modulating brain activity in the ACC to reduce obsessive thoughts and compulsive behaviors

C. Multiple sessions administered over several weeks

C. Mild discomfort or temporary headache at the stimulation site

C. Mixed results with some individuals experiencing a reduction in symptoms

D. Because the effectiveness of dTMS varies from person to person

C. McCathern et al.

B. The relationship between dTMS and depression symptoms

D. Changes in depression symptoms were unpredictable

C. 53.9% response rate; significant improvements in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores

Deep Transcranial Magnetic Stimulation (dTMS) has been explored as a potential treatment for Obsessive-Compulsive Disorder (OCD). OCD is a mental health condition characterized by recurrent, distressing obsessions and repetitive, often ritualistic compulsions. While conventional treatments such as cognitive-behavioral therapy and medication are effective for many individuals with OCD, some people do not respond adequately or experience significant side effects. This has led to the investigation of alternative approaches, including dTMS.

Here are some key points regarding dTMS for OCD treatment:

Targeted Brain Regions: In the context of OCD treatment, dTMS typically targets the anterior cingulate cortex (ACC), a brain region associated with the regulation of cognitive and emotional processes. Dysfunction in this area is believed to play a role in the development and persistence of OCD symptoms.

Mechanism of Action: The idea behind dTMS for OCD is to modulate brain activity in the ACC and normalize its functioning. By applying magnetic pulses to this region, the hope is to reduce obsessive thoughts and compulsive behaviors.

Treatment Protocol: A typical dTMS treatment protocol for OCD involves multiple sessions administered over several weeks. The specific parameters, such as the frequency, intensity, and duration of each session, will be determined by the healthcare provider based on the patient’s needs and response to treatment.

Safety and Side Effects: dTMS is generally considered safe with relatively mild side effects, such as mild discomfort or headache at the stimulation site. These side effects are typically temporary and well-tolerated. However, the treatment should be administered by trained professionals to ensure safety and effectiveness.

Efficacy: Research on the use of dTMS for OCD is still evolving, and the results have been mixed. Some studies have shown promising outcomes, with a reduction in OCD symptoms, while others have not demonstrated significant benefits. Response to dTMS can vary among individuals.

Individualized Treatment: The effectiveness of dTMS for OCD, like other treatment options, can vary from person to person. The suitability of dTMS as a treatment for a specific individual should be determined through a comprehensive evaluation by a qualified mental health professional.

McCathern et al. evaluate the current research on the effectiveness of dTMS therapy for individuals with treatment-resistant OCD. This review also investigates shortcomings in current dTMS research and the hypothesized future of dTMS therapy ¹⁾

Roth et al. analyzed data from a double-blind multicenter dTMS study and found the efficacy of this novel treatment even in OCD patient cohorts who previously failed to respond to multiple medications and CBT ²⁾.

Whether dTMS affects depression symptoms similarly to cognitive behavioral therapy (CBT) remains to be examined.

The study employed a random intercept cross-lagged panel model (RI-CLPM) to examine the relationship of OCD and depression symptoms in 94 treatment-refractory patients, undergoing dTMS or sham treatment.

Both OCD and depression symptoms improved significantly. However, a stable, cross-lagged relationship between the variables was not supported. Changes in one symptom domain could not be used to predict the other.

The present study was conducted in a treatment-refractory population, meaning the present findings may not generalize to treatment patients or those with less severe OCD symptoms. It is unclear whether the study was sufficiently powered to detect the effects of interest, and this concern also meant that examining the dTMS and sham groups independently was not feasible.

When treating OCD with dTMS, depression symptoms appear likely to diminish but should be monitored throughout, and additional interventions applied if needed ³⁾.

The study provides valuable insights into the potential benefits of dTMS for treatment-refractory patients with OCD and comorbid depression symptoms. However, it also highlights limitations related to generalizability and statistical power, emphasizing the need for further research to better understand the interplay between OCD and depression symptoms in various patient populations. Additionally, it underscores the importance of ongoing monitoring and a holistic approach to mental health treatment.

Ikawa et al. conducted an FDA-approved dTMS protocol for 26 patients with OCD. In addition, individual exposure stimulation that elicited each patient’s obsessive thoughts was also combined during dTMS treatment. Before and after 30 sessions of TMS treatment, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess changes in the severity of each patient’s obsessive-compulsive disorder. Response to dTMS treatment in patients with OCD was determined by whether the total score on the Y-BOCS after a course of treatment was reduced by 30% or more compared with the score at baseline. The percentage of responders in this case series following the 30 sessions of dTMS treatment was 53.9%. In addition, total Y-BOCS scores and scores on each item were significantly improved. The percent changes in total Y-BOCS scores did not differ between the sexes or between on- and off-medication patients. No obvious adverse events were observed in this case series. In line with the results of TMS studies for OCD patients reported overseas, dTMS treatment for Japanese patients with OCD may have a favorable therapeutic effect ⁴⁾

The study conducted by Ikawa et al. presents promising results for the use of dTMS in the treatment of OCD. The response rate, improvements in Y-BOCS scores, and the absence of adverse events are positive indicators. However, further research with larger sample sizes, control groups, and long-term follow-up is needed to confirm the efficacy of dTMS for OCD and to understand its place in the broader spectrum of OCD treatments.

• Depressive symptoms during deep transcranial magnetic stimulation or sham treatment for obsessive-compulsive disorder
• Considerations for the treatment of obsessive-compulsive disorder in patients who have comorbid major depression
• Personalized Definition of Surgical Targets in Major Depression and Obsessive-Compulsive Disorder: A Potential Role for Low-Intensity Focused Ultrasound?
• Safety and efficacy of H7 deep transcranial magnetic stimulation in adolescent obsessive-compulsive disorder: A case report
• Accelerated deep transcranial magnetic stimulation using iTBS protocol for refractory obsessive-compulsive disorder
• Transcranial Magnetic Stimulation in Obsessive-Compulsive Disorder
• Mapping the future of interventional psychiatry for the obsessive-compulsive related disorders: A scoping review
• A Case Series of Deep Transcranial Magnetic Stimulation Treatment for Patients with Obsessive-Compulsive Disorder in the Tokyo Metropolitan Area