Prefrontal tDCS and sertraline in obsessive compulsive disorder: a case report and review of the literature.

Obsessive-compulsive (OC) disorder is a disabling disorder resulting in tremendous individual and social burden. It has a large overlap with depression and anxiety disorders and shows treatment resistance in a relevant proportion of patients. Since a couple of years, different noninvasive brain stimulation methods have been investigated to improve OC symptoms. The application of transcranial direct current stimulation (tDCS) has shown inconsistent results which can probably be attributed to a lack in randomized controlled trials with adequate sample size. Anodal stimulation of pre-supplementary motor areas has shown promising results, and there is also sparse data on orbitofrontal and prefrontal stimulation. Here, we provide the first report on a patient with treatment-refractory OC disorder treated with sertraline and an enhanced prefrontal tDCS protocol (twice per day, 10 days) with a classic left-anodal/right cathodal montage, experiencing a 22% reduction of OC symptoms as well as reduction in depression (-10%) and anxiety symptoms (-21%). Due to multifactorial origin of OC disorder and the variety of brain circuits involved, there are probably multiple approaches for brain stimulation regarding site, polarity, and frequency to be assessed in future studies.