4. Discussion
TBS-induced, depression, OCD
REMISSION
This is the first study to compare the efficacy of accelerated high-dose TBS to the more widely used 1-Hz rTMS for the treatment of OCD in a routine clinical setting. After 5 days of treatment, Y-BOCS scores were significantly reduced in both groups, with no difference in the mean percentage drop. This suggested that ahTBS was comparable in efficacy to traditional 1-Hz rTMS for OCD. Notably, however, there was a trend for a greater response rate after 5 days of ahTBS. Moreover, ahTBS was well-tolerated, suggesting that this modality was a safe and effective alternative for the rapid treatment of OCD symptoms.Under ideal conditions, treatments are deemed effective by randomized controlled trials (RCTs), while “real-world” research is typically observational and aims to measure the effectiveness of interventions in nonexperimental scenarios such as routine clinical practice [To our knowledge, only one preliminary study has examined the efficacy of ahTBS in patients with OCD. The authors reported a remission rate of 57% in seven patients after 5 days of treatment [There are several possible explanations for why ahTBS was not clearly more efficacious than 1-Hz rTMS.Despite the accelerated stimulation schedule used for ahTBS (10 daily treatments), a 5-day treatment cycle may still be insufficient to detect a significant difference in efficacy compared to 1-Hz TMS. For instance, TMS-induced neural plasticity may be a slower process [Almost all patients were taking medications that could potentially interfere with the effects of TMS, including TBS-induced plasticity [While the same high-dose sequence (18,000 pulses per day and a total dose of 90,000 pulses) achieved significant efficacy in patients with depression [Stimulation intensity is an important factor influencing cTBS therapeutic efficacy [