Effects of transcranial magnetic stimulation of the rostromedial prefrontal cortex in obsessive–compulsive disorder: a randomized clinical trial

New interventions are needed for obsessive-compulsive disorder. Here we present a randomized single-blinded, two-arm, parallel-group, sham-controlled clinical trial assessing the efficacy of prefrontal cortex stimulation in reducing obsessive-compulsive disorder symptoms and frontostriatal connectivity (ACTRN12616001687482). Conducted at a single academic center, the trial enrolled participants diagnosed with obsessive-compulsive disorder who underwent baseline clinical assessments and neuroimaging. The intervention comprised 20 weekday sessions of neuronavigated continuous theta burst stimulation of the frontal pole or sham. Participants and all staff assessing intervention outcomes were blind to the conditions. We enrolled a sample of 50 individuals (26 active continuous theta burst stimulation) who completed the neuroimaging and clinical assessments at the primary 4 week endpoint. Clinical data at the secondary 6 month endpoint were obtained from 46 participants (23 active). Symptoms of obsessive-compulsive disorder (primary outcome) decreased in both groups (active −4.35, P