Repetitive transcranial magnetic stimulation versus Fluvoxamine in the treatment of obsessive-compulsive disorder: A randomized open-label pilot study

Background: Obsessive-compulsive disorder (OCD) is a chronic, disabling mental disorder. While repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising neuromodulation intervention for psychiatric disorders, its efficacy in treatment-naïve OCD populations remains understudied. This randomized controlled trial investigates the comparative effectiveness of low-frequency rTMS versus first-line pharmacotherapy in treatment-naïve OCD patients. Methods: Treatment-naïve OCD patients (n = 41) were randomized to receive either standardized fluvoxamine therapy (150-200 mg/day) or daily low-frequency (1 Hz) rTMS targeting the supplementary motor area (SMA) for 2 weeks. Clinical outcomes were longitudinally assessed using validated instruments: Yale-Brown Obsessive-Compulsive Scale score reduction rate ≥ 25% as primary endpoint, supplemented by Beck Depression Inventory and Beck Anxiety Inventory for comorbid symptom evaluation. Safety profiles were monitored throughout the trial. Results: The experimental results showed that the difference of response rate at the end of intervention between two groups had no statistical significance ( χ ² = 0.183, p = 0.669 ), with 41.7% (5/12) in rTMS group versus 60% (6/10) in fluvoxamine cohort. No severe adverse events were reported in either group, and no patients withdrew due to adverse events in the rTMS group. Conclusion: This trail found that low-frequency rTMS over SMA might have a similar therapeutic effect as that of fluvoxamine for treatment-naïve patients with OCD. These findings support rTMS as a potential treatment option for medication-averse OCD populations. Trial registration: The study was retrospectively registered in https://www.chictr.org.cn on June 30, 2023 (ChiCTR2300072654).