Accelerated Multi-Target Theta-Burst Stimulation for Obsessive–Depressive–Anxious Symptoms: Real-World Outcomes of the aTTODA Protocol
9 affiliations
- 1Psychiatry Service, Hospital Virgen del Rocío, 41013 Seville, Spain
- 2Instituto Andaluz de Salud Cerebral, 41010 Seville, Spain
- 3Clinical Medicine Department, Universidad Miguel Hernández, 03202 Alicante, Spain
- 4Psychiatry Department, Hospital Universitario de San Juan, 03550 Alicante, Spain
- 5CIBERSAM-ISCIII (Biomedical Research Networking Centre for Mental Health), 28029 Madrid, Spain
- 6Department of Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, 18012 Granada, Spain
- 7Psychiatry Service, Hospital San Cecilio, 18007 Granada, Spain
- 8Complutense University of Madrid (UCM), 28040 Madrid, Spain
- 9Research Institute Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
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.
Methods:: 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.
Results:: 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.
Conclusions:: 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.
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BibTeX
@article{moleonruiz2026accelerated,
title = {{Accelerated Multi-Target Theta-Burst Stimulation for Obsessive–Depressive–Anxious Symptoms: Real-World Outcomes of the aTTODA Protocol}},
author = {Álvaro Moleón-Ruiz and Lucía Duque-Fernández and Clara Regidor and Paloma Álvarez de Toledo and Gonzalo Martín-García and Lorena García-Fernández and Francisco Javier Narbona-Antunez and Luis Gutiérrez-Rojas and Roberto Rodriguez-Jimenez and Manuela Martín-Bejarano},
journal = {Alpha Psychiatry},
year = {2026},
month = oct,
doi = {10.31083/ap53996},
url = {https://doi.org/10.31083/ap53996},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Accelerated Multi-Target Theta-Burst Stimulation for Obsessive–Depressive–Anxious Symptoms: Real-World Outcomes of the aTTODA Protocol
AU - Álvaro Moleón-Ruiz
AU - Lucía Duque-Fernández
AU - Clara Regidor
AU - Paloma Álvarez de Toledo
AU - Gonzalo Martín-García
AU - Lorena García-Fernández
AU - Francisco Javier Narbona-Antunez
AU - Luis Gutiérrez-Rojas
AU - Roberto Rodriguez-Jimenez
AU - Manuela Martín-Bejarano
PY - 2026
DA - 2026/10/23
JO - Alpha Psychiatry
DO - 10.31083/ap53996
UR - https://doi.org/10.31083/ap53996
AB - 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. Methods:: 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. Results:: 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. Conclusions:: 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.
SN - 2757-8038
ER -