Efficacy and safety of accelerated transcranial magnetic stimulation for obsessive-compulsive disorder: A systematic review and meta-analysis

BACKGROUND: Obsessive-Compulsive Disorder (OCD) is a chronic condition with limited treatment options. Standard transcranial magnetic stimulation (TMS) has shown moderate efficacy but requires 6-8 weeks of daily sessions. This review evaluates the efficacy, safety, and feasibility of accelerated TMS (aTMS) protocols for faster treatment response. METHODS: We systematically searched PubMed, Web of Science, and Embase databases for randomized controlled trials (RCTs) comparing aTMS to placebo or once-daily TMS, conducting a meta-analysis of clinical and tolerability outcomes. The Cochrane Risk of Bias tool and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach were used to evaluate the quality and strength of evidence. RESULTS: Of 97 screened records, 7 RCTs were included in the review. Six were analyzed quantitatively, showing that aTMS significantly reduced OCD symptoms (SMD 0.63), depressive symptoms (SMD 0.52), and increased response rate (OR 4.28) compared to sham aTMS. Adverse effects were higher in the aTMS group (OR 5.16), though mild, and dropout rates were similar (OR 0.74). At follow-ups, aTMS sustained significant reductions in depressive symptoms (SMD 0.74), but not in OCD or anxiety symptoms. On risk of bias assessment there were "some concerns" for all included studies. GRADE assessment showed moderate certainty for the primary outcome. CONCLUSION: Accelerated TMS offers promising, faster treatment for OCD and significantly reduces depressive symptoms, though it has no effect on anxiety. Further studies should explore optimal protocols and long-term effects.