{
  "abstract": "Background:: Obsessive–compulsive symptoms frequently co-occur with depression and anxiety, contributing to a complex and potentially treatment-resistant clinical phenotype. Although transcranial magnetic stimulation (TMS) is an established treatment option for obsessive–compulsive disorder (OCD), many patients continue to experience residual symptoms across multiple domains. Multi-target neuromodulation approaches may help address overlapping neural circuits. This study evaluated the real-world effectiveness and feasibility of an accelerated Triple-Target Obsessive–Depressive–Anxious (aTTODA) theta-burst stimulation protocol.\n\nMethods:: In this naturalistic cohort study, 25 patients with treatment-resistant depressive–anxious disorder and comorbid OCD were treated with TMS at a specialized neuropsychiatric center. All patients received the accelerated aTTODA protocol, consisting of 30 sessions delivered over 3 weeks. Obsessive–compulsive, depressive, and anxiety symptoms were assessed at baseline and post-treatment using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), 17-item Hamilton Depression Rating Scale (HDRS-17), and Hamilton Anxiety Rating Scale (HAM-A), respectively.\n\nResults:: Treatment with the aTTODA protocol was associated with significant improvements across all symptom domains (all p < 0.001), with large within-group effect sizes (Cohen’s d ≥1.0). Mean symptom reductions were 32.7% for the Y-BOCS, 44.6% for the HDRS-17, and 42.1% for the HAM-A. For OCD symptoms, 40% of patients met response criteria and 20% achieved remission. A shift toward lower Y-BOCS severity categories was also observed following treatment, suggesting broad clinical improvement beyond changes in mean symptom scores.\n\nConclusions:: In this complex, treatment-resistant population, the accelerated multi-target aTTODA protocol was associated with clinically meaningful improvements across obsessive–compulsive, depressive, and anxiety symptom domains. These preliminary findings support the feasibility of time-efficient, circuit-based neuromodulation strategies. However, controlled randomized, blinded, sham-controlled trials are needed to establish efficacy, durability of treatment effects, and optimal patient selection.",
  "abstract_shown": true,
  "affiliations": [
    "Psychiatry Service, Hospital Virgen del Rocío, 41013 Seville, Spain",
    "Instituto Andaluz de Salud Cerebral, 41010 Seville, Spain",
    "Clinical Medicine Department, Universidad Miguel Hernández, 03202 Alicante, Spain",
    "Psychiatry Department, Hospital Universitario de San Juan, 03550 Alicante, Spain",
    "CIBERSAM-ISCIII (Biomedical Research Networking Centre for Mental Health), 28029 Madrid, Spain",
    "Department of Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, 18012 Granada, Spain",
    "Psychiatry Service, Hospital San Cecilio, 18007 Granada, Spain",
    "Complutense University of Madrid (UCM), 28040 Madrid, Spain",
    "Research Institute Hospital 12 de Octubre (imas12), 28041 Madrid, Spain"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Álvaro Moleón-Ruiz",
      "orcid": "0009-0000-4355-399X"
    },
    {
      "affs": [
        1
      ],
      "name": "Lucía Duque-Fernández",
      "orcid": "0009-0001-4146-0930"
    },
    {
      "affs": [
        1
      ],
      "name": "Clara Regidor"
    },
    {
      "affs": [
        1
      ],
      "name": "Paloma Álvarez de Toledo",
      "orcid": "0000-0003-1682-2327"
    },
    {
      "affs": [
        1
      ],
      "name": "Gonzalo Martín-García"
    },
    {
      "affs": [
        2,
        3,
        4
      ],
      "name": "Lorena García-Fernández",
      "orcid": "0000-0001-5523-9762"
    },
    {
      "affs": [
        1
      ],
      "name": "Francisco Javier Narbona-Antunez",
      "orcid": "0009-0006-5637-7626"
    },
    {
      "affs": [
        5,
        6
      ],
      "name": "Luis Gutiérrez-Rojas",
      "orcid": "0000-0003-0082-2189"
    },
    {
      "affs": [
        4,
        7,
        8
      ],
      "name": "Roberto Rodriguez-Jimenez",
      "orcid": "0000-0003-2251-7249"
    },
    {
      "affs": [
        1
      ],
      "name": "Manuela Martín-Bejarano",
      "orcid": "0000-0003-2719-0687"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8b7spapvys3we.bib",
  "cited_by": 0,
  "doi": "10.31083/ap53996",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13731996/",
  "id": "8b7spapvys3we",
  "issns": [
    "2757-8038"
  ],
  "landing_url": "https://doi.org/10.31083/ap53996",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "3203|Obsessive-Compulsive Spectrum Disorders"
    ]
  ],
  "openalex": "W7224779076",
  "pdf_url": "https://storage.imrpress.com/IMR/2113524419355713500/application/2757-8038-27-5-53996.pdf",
  "pmcid": "PMC13731996",
  "pmid": "42984858",
  "published": "2026-10-23",
  "publisher": "IMR Press",
  "ris": "https://research.draconitic.com/paper/8b7spapvys3we.ris",
  "sources": [
    {
      "first_seen": "2026-11-08T12:22:04Z",
      "native_id": "PMC13731996",
      "source": "pmc",
      "url": "https://doi.org/10.31083/ap53996"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:3203|Obsessive-Compulsive Spectrum Disorders",
      "subfield": "psychiatry"
    }
  ],
  "title": "Accelerated Multi-Target Theta-Burst Stimulation for Obsessive–Depressive–Anxious Symptoms: Real-World Outcomes of the aTTODA Protocol",
  "title_text": "Accelerated Multi-Target Theta-Burst Stimulation for Obsessive–Depressive–Anxious Symptoms: Real-World Outcomes of the aTTODA Protocol",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:22:04Z",
  "url": "https://research.draconitic.com/paper/8b7spapvys3we",
  "venue": "Alpha Psychiatry",
  "versions": []
}