More Than Half of People With Hard-to-Treat OCD Improved With rTMS: A Study of 79 Patients

Part of Healthy Minds India's published research, written for patients, families and doctors. Based on: Singh S, Kumar S, Gupta A, Verma R, Kumar N. Journal of ECT 2019;35(1):61-66.

More than half of people with hard-to-treat OCD improved with gentle magnetic brain stimulation. This article explains what a real-world study of 79 patients treated at AIIMS, New Delhi tells families about rTMS for obsessive-compulsive disorder, and who is most likely to benefit. I am a co-author (second author) of the study.

01 · Why it matters

Brain stimulation for OCD, tested in everyday practice

Obsessive-compulsive disorder traps people in loops of intrusive thoughts (obsessions) and repeated actions or rituals (compulsions): washing, checking, counting, seeking reassurance. It can consume hours every day, strain families and derail education and careers.

The first-line treatments, SSRI medicines and exposure and response prevention (ERP) therapy, help many people. But a large share do not respond to the first treatment offered; our group's earlier review put this at 40 to 60%.³ For them, families often hear the same frustrating words: "try another tablet."

Repetitive transcranial magnetic stimulation (rTMS) offers a different route. Instead of acting on the whole body through the bloodstream, it uses focused magnetic pulses to calm specific brain circuits that are overactive in OCD. Two targets had shown promise in research: the supplementary motor area (SMA) and the orbitofrontal cortex (OFC). Most rTMS evidence, however, came from small, tightly controlled trials. Clinicians and families needed to know something simpler and more practical: does rTMS work for ordinary patients in a real hospital, and which of the two targets should we choose?

02 · How the research was done

Real patients, real clinic, careful records

The team reviewed the records of every patient with medication-refractory OCD who had completed a course of rTMS as part of routine clinical care. All had continued their usual treatment, so rTMS was studied as an add-on (adjunctive) therapy, just as it is used in practice.¹

• The protocol: 1 Hz low-frequency rTMS, a "calming" rhythm that reduces activity in overactive circuits. 20 sessions per patient, delivered as part of routine care.
• The measure: the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the international gold-standard measure, recorded before and after treatment.
• Response defined: a fall of 25% or more in Y-BOCS is a partial response; a fall of 35% or more is a full (complete) response.

Why a real-world design matters: clinical trials often exclude people with other conditions such as depression. By studying everyone treated in routine care, this study shows what patients and families can realistically expect, and it can reveal which patients respond less well.

03 · What we found

Symptoms fell clearly, whichever target was used

By the end of the course, OCD severity had dropped significantly. The average fall was 7.7 points on the Y-BOCS (7.68 ± 5.62; P < 0.001), a change people typically notice as less time lost to rituals and more room for daily life.

SMA or OFC? There was no significant difference in outcomes between the two targets. Either is a reasonable 1-Hz target, which allows flexibility with equipment, comfort and symptom profile.

The team looked for features, recorded before treatment, that predicted a weaker response. Two stood out.

The message is clear: two different, well-tolerated targets both helped, so clinicians can choose based on the individual patient. And the best results come when rTMS is offered before OCD becomes most severe, and when depression is treated alongside.

04 · Why this research matters to you

How this research helps the general public

A result is only useful if it changes what people do. This study turns "rTMS might help OCD" into practical guidance that patients, families and doctors can act on.

For India's health system: OCD affects about 1 to 3 in every 100 people, and many cannot access specialised therapy. This study provides Indian real-world evidence that rTMS can be delivered effectively within routine hospital care, supporting its wider availability beyond metro cities, including in Bihar and eastern India.

05 · From finding to action

What the study found, and what you can do

Evidence-based steps that help OCD

What you can do: ask your psychiatrist whether rTMS is suitable for you; track symptoms with the Y-BOCS before and after treatment; let your doctor choose the target that fits your symptoms; mention low mood openly and ask about treating both together; seek specialist help early rather than waiting years; and continue prescribed treatment and ERP unless advised otherwise.

06 · A quick self-reflection

Is it time to ask about rTMS?

These questions are not a diagnostic test, but they can start an honest conversation with your psychiatrist. Think about the past few months and count how many are true.

• Obsessions or rituals take up more than an hour of my day.
• I have tried at least two OCD medicines at a proper dose for several weeks.
• I have tried, or could not access, ERP therapy.
• OCD still affects my studies, work, relationships or sleep.
• Side effects make it hard to increase or continue my medicines.
• I also feel low, hopeless or have lost interest in things.

Warning signs for families

• Hours spent washing, checking, arranging or repeating
• Repeated questions seeking reassurance
• Avoiding places, people or objects out of fear
• Distress or anger when rituals are interrupted
• Falling marks, late arrivals or missed work
• Withdrawal, low mood or loss of interest

Start with understanding, not argument. Arguing with obsessions or repeatedly reassuring a loved one usually feeds the cycle. Calm support and professional help work better. A psychiatrist can assess OCD, mood and the next best step.

07 · About the researcher

Dr. Saurabh Kumar's contribution

I am the second author of this study, carried out by the psychiatry team at the All India Institute of Medical Sciences (AIIMS), New Delhi. It formed part of a connected body of work on rTMS in OCD by the same group. A year earlier, I had led a companion study as first author. It looked at low-frequency rTMS over the orbitofrontal cortex in 25 medication-refractory patients: 52% showed partial response and 44% full response, and the gains held at one-month follow-up (Journal of ECT, 2017).² I also co-authored a review of rTMS in OCD, which traced why more sessions and targets such as the SMA and OFC improve results (Neuropsychiatry, 2016).³ The 2019 study took this work further. It used a larger real-world sample, compared two targets head to head, and identified who is less likely to benefit. This is the kind of practical knowledge that shapes treatment decisions in clinic every day.

From research to the clinic: 2016 review of rTMS in OCD (Neuropsychiatry); 2017 lead author, OFC rTMS in refractory OCD (J ECT); 2019 this study, SMA versus OFC and predictors (J ECT); today iTBS, deep TMS (H7) and tDCS at Healthy Minds India, Patna. Every OCD patient is screened for depression, severity is measured with the Y-BOCS, and stimulation targets are chosen from the evidence. Read more in brain stimulation treatment in Patna and the Research Atlas.

rTMS for OCD: your questions answered

Frequently Asked Questions

• Is rTMS the same as shock treatment (ECT)?

  No. rTMS uses magnetic pulses to a small area of the brain. You stay fully awake, there is no anaesthesia and no fit is induced, and memory is not affected. You can return to normal activities after each session.

• Does it hurt?

  Most people feel a tapping on the scalp and hear clicking sounds. Mild headache or scalp discomfort can occur early in the course and usually settles within hours.

• How many sessions are needed?

  Patients in this study received 20 sessions of 1-Hz rTMS. The right number for you depends on your diagnosis and response, and your doctor will explain your plan after assessment.

• Do I have to stop my medicines?

  Usually not. In this study rTMS was an add-on to ongoing treatment. Your psychiatrist will review your prescriptions before starting.

• Which is better, SMA or OFC stimulation?

  In this study, outcomes were similar. Your doctor chooses based on your symptoms, other conditions and the available equipment. Deep TMS with the H7 coil is another FDA-cleared option for OCD.

• Why does depression matter?

  Patients with co-existing depression responded less well. Treating depression alongside OCD, with medicines, therapy or a stimulation protocol that also targets mood, may improve results.

• Is rTMS safe?

  rTMS is generally well tolerated. Seizures are very rare, and careful screening reduces the risk further. People with metal implants in the head or certain implanted devices cannot have rTMS.

• Where can I get rTMS for OCD in Patna?

  Healthy Minds India in Patna offers assessment and treatment of OCD, including rTMS, theta burst stimulation (iTBS), deep TMS (H7 coil) and tDCS, alongside ERP therapy and medication management.

About this article

Written and medically reviewed by

Dr. Saurabh Kumar

• MD (Psychiatry) AIIMS New Delhi
• Associate Professor & HOD, Dept. of Psychiatry, RDJM Medical College, Muzaffarpur
• Ex-Assistant Professor, PMCH Patna
• Consultant, Healthy Minds India, Patna

Published

9 October 2026

Format

Research made simple

Focus

rTMS for medication-refractory OCD

Sources

7 references

• With thanks to co-authors Dr. Swarndeep Singh, Dr. Ankit Gupta, Dr. Rohit Verma and Dr. Nand Kumar, and to the patients whose care made this knowledge possible.
• A note on interpretation: this was a retrospective review of clinical records without a sham (placebo) comparison group, and patients continued their usual treatment. Part of the improvement may therefore reflect other factors, and the findings show real-world outcomes rather than proof of cause.
• For education and awareness only. It does not diagnose any condition and is not a substitute for consultation with a qualified mental health professional.

© 2026 Healthy Minds India, Patna · Edition 1.0, September 2026, 2026