The response rate of obsessive compulsive disorder is 21.6% to 61.3%; which shows the relative resistance to current treatments and a need for novel methods. Here, we have reported a case of resistant obsessive compulsive disorder (OCD) with fast and dramatic response to a relatively new method named repeated transcranial magnetic stimulation (rTMS). In rTMS a pulse magnetic field is emitted from a coil over the surface of the scalp which induces a localized electrical current in the cortex below. Cortical activity can then be either inhibited or stimulated.

The patient is a 40 years old female admitted for severe OCD in Mashhad Ibn-e-Sina Psychiatric Hospital. The patient was treated with 10 sessions of rTMS on right supplementary motor area (SMA) with 110% intensity, 1 Hz frequency and duration of 30 minutes per day (a total of 1200 pulses per day). Improvement of patient was evaluated serially with Yale Brown scale. By the end of the 2nd day she reported a major improvement of her symptoms. Her improvement was so dramatic in obsessive and compulsive behaviors and her avoidance recovered completely. She also reported significant improvement in her ability to control her obsessive thoughts and impulses and her anxiety symptoms.

Considering that rTMS is a low risk method and has almost no interaction with the common medications and the faster response with this method, it seems that it can be used as supplementary treatment in resistant cases and even in the initial stages of OCD.