{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T08:53:42Z","timestamp":1785228822261,"version":"3.55.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to compare the short-term clinical outcomes of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS), fluoxetine, and their combination in adolescents with first-onset obsessive-compulsive disorder (OCD) using a single-center retrospective, non-randomized design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single-center retrospective, non-randomized analysis was conducted on 167 adolescents (aged 12\u201318 years) diagnosed with obsessive-compulsive disorder (OCD) and treated at Dazhuang Hospital, Shandong Province, between January 2018 and June 2024. Based on treatment received, patients were categorized into three observational groups: LF-rTMS alone (n=32), fluoxetine alone (n=55), and combined fluoxetine plus LF-rTMS (n=80). LF-rTMS was delivered at 1 Hz over the right supplementary motor area (SMA), 20 sessions in total. Clinical outcomes were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Clinical Global Impressions-Improvement (CGI-I), Wisconsin Card Sorting Test (WCST), and quantitative electroencephalography (qEEG) at baseline, 2 weeks, and 4 weeks. Adverse events were monitored with the Treatment Emergent Symptom Scale (TESS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After 4 weeks of treatment, 68.26% of patients overall met the predefined response threshold (\u226535% Y-BOCS reduction), with rates of 34.38% in the LF-rTMS group, 63.64% in the fluoxetine group, and 85.00% in the combined treatment group; remission (Y-BOCS \u226412) was observed in 12.5%, 20.0%, and 32.5% of the groups, respectively (\u03c7\u00b2=27.85, P&amp;lt;0.001). Repeated-measures analyses further indicated significant Time and Time\u00d7Group effects for both Y-BOCS and CGI-I scores (P&amp;lt;0.001), confirming differential symptom trajectories across treatment groups. The combined group also showed comparatively greater improvements in cognitive performance (WCST indices) and more favorable qEEG changes relative to the monotherapy groups (P&amp;lt;0.001). No statistically significant differences in the distribution of adverse reactions were observed among the three groups (P = 0.549).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings suggest that combining fluoxetine with LF-rTMS may be associated with greater short-term improvements in symptom severity, cognitive function, and neural activity compared with monotherapy, while maintaining a favorable safety profile.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1663611","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T06:25:20Z","timestamp":1762323920000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Short-term outcomes associated with fluoxetine, low-frequency rTMS, and their combination in first-onset adolescent OCD: a single-center retrospective cohort"],"prefix":"10.3389","volume":"16","author":[{"given":"Zhenzhen","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunfeng","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haixia","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"g2183","DOI":"10.1136\/bmj.g2183","article-title":"Obsessive-compulsive disorder","volume":"348","author":"Veale","year":"2014","journal-title":"BMJ"},{"key":"B2","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1038\/mp.2008.94","article-title":"The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication","volume":"15","author":"Ruscio","year":"2010","journal-title":"Mol Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-021-01161-7","article-title":"Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies","volume":"27","author":"Solmi","year":"2022","journal-title":"Mol Psychiatry"},{"key":"B4","doi-asserted-by":"publisher","first-page":"152342","DOI":"10.1016\/j.comppsych.2022.152342","article-title":"The global assessment of OCD","volume":"118","author":"Pampaloni","year":"2022","journal-title":"Compr Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.jaac.2010.10.006","article-title":"Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A)","volume":"50","author":"Merikangas","year":"2011","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2014-306934","article-title":"Obsessive-compulsive disorder in children and adolescents","volume":"100","author":"Krebs","year":"2015","journal-title":"Arch Dis Child"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/eip.12535","article-title":"A call for prevention and early intervention in obsessive-compulsive disorder","volume":"12","author":"Brakoulias","year":"2018","journal-title":"Early Interv Psychiatry"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2019.02.002","article-title":"Early intervention for obsessive compulsive disorder: An expert consensus statement","volume":"29","author":"Fineberg","year":"2019","journal-title":"Eur Neuropsychopharmacol J Eur Coll Neuropsychopharmacol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2174\/1570159X16666180813155017","article-title":"Psychopharmacological treatment of obsessive-compulsive disorder (OCD)","volume":"17","author":"Del Casale","year":"2019","journal-title":"Curr Neuropharmacol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12974-022-02389-y","article-title":"Fluoxetine inhibited the activation of A1 reactive astrocyte in a mouse model of major depressive disorder through astrocytic 5-HT(2B)R\/\u03b2-arrestin2 pathway","volume":"19","author":"Fang","year":"2022","journal-title":"J Neuroinflamm"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.4103\/indianjpsychiatry.indianjpsychiatry_492_22","article-title":"Clinical practice guidelines for the therapeutic use of repetitive transcranial magnetic stimulation in neuropsychiatric disorders","volume":"65","author":"Tikka","year":"2023","journal-title":"Indian J Psychiatry"},{"key":"B12","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1038\/s41398-021-01453-0","article-title":"Efficacy and tolerability of repetitive transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis","volume":"11","author":"Liang","year":"2021","journal-title":"Transl Psychiatry"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2022.01.048","article-title":"Repetitive transcranial magnetic stimulation for obsessive-compulsive disorder: A systematic review and pairwise\/network meta-analysis","volume":"302","author":"Fitzsimmons","year":"2022","journal-title":"J Affect Disord"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2022.997259","article-title":"Low frequency repetitive transcranial magnetic stimulation to the right dorsolateral prefrontal cortex engages thalamus, striatum, and the default mode network","volume":"16","author":"Caparelli E de","year":"2022","journal-title":"Front Neurosci"},{"key":"B15","article-title":"The effect of repetitive transcranial magnetic stimulation (rTMS) on symptoms in obsessive compulsive disorder. A randomized, double blind, sham controlled study","volume":"27","author":"Prasko","year":"2006","journal-title":"Neuro Endocrinol Lett"},{"key":"B16","doi-asserted-by":"publisher","first-page":"5358","DOI":"10.3390\/jcm13185358","article-title":"Metaanalysis of repetitive transcranial magnetic stimulation (rTMS) efficacy for OCD treatment: the impact of stimulation parameters, symptom subtype and rTMS-induced electrical field","volume":"13","author":"Dehghani-Arani","year":"2024","journal-title":"J Clin Med"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.4103\/psychiatry.IndianJPsychiatry_521_18","article-title":"Course and outcome of obsessive-compulsive disorder","author":"Sharma","year":"2019","journal-title":"Indian J Psychiatry"},{"key":"B18","first-page":"11","article-title":"Use of repetitive transcranial magnetic stimulation in child psychiatry","volume":"19","author":"Bejenaru","year":"2022","journal-title":"Innov Clin Neurosci"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.pscychresns.2015.07.020","article-title":"Neural correlates associated with symptom provocation in pediatric obsessive compulsive disorder after a single session of sham-controlled repetitive transcranial magnetic stimulation","volume":"233","author":"Pedapati","year":"2015","journal-title":"Psychiatry Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s40779-023-00488-2","article-title":"How to use the Surveillance, Epidemiology, and End Results (SEER) data: research design and methodology","volume":"10","author":"Che","year":"2023","journal-title":"Mil Med Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1186\/s13104-023-06474-0","article-title":"Exploring the structure of the university-students obsessive-compulsive tendency scale in Iranian university students: a network analysis study","volume":"16","author":"Davoudi","year":"2023","journal-title":"BMC Res Notes"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2016.02.031","article-title":"Repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorders: Double blind randomized clinical trial","volume":"238","author":"Elbeh","year":"2016","journal-title":"Psychiatry Res"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2017.06.254","article-title":"The standardized EEG electrode array of the IFCN","volume":"128","author":"Seeck","year":"2017","journal-title":"Clin Neurophysiol Off J Int Fed Clin Neurophysiol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000005773","article-title":"Statistics from A (Agreement) to Z (z score): A guide to interpreting common measures of association, agreement, diagnostic accuracy, effect size, heterogeneity, and reliability in medical research","volume":"133","author":"Schober","year":"2021","journal-title":"Anesth Analg"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.21037\/tp.2019.10.02","article-title":"Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management","volume":"9","author":"Nazeer","year":"2019","journal-title":"Transl Pediatr"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.2174\/1570159X16666180426151746","article-title":"Diagnostic issues in early-onset obsessive-compulsive disorder and their treatment implications","volume":"17","author":"Burchi","year":"2019","journal-title":"Curr Neuropharmacol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.806872","article-title":"Obsessive-compulsive disorder during the COVID-19 pandemic-A systematic review","volume":"13","author":"Linde","year":"2022","journal-title":"Front Psychiatry"},{"key":"B28","doi-asserted-by":"publisher","first-page":"100626","DOI":"10.1016\/j.jocrd.2021.100626","article-title":"The impact of the coronavirus pandemic on specific symptom dimensions and severity in OCD: A comparison before and during COVID-19 in the context of stress responses","volume":"29","author":"Khosravani","year":"2021","journal-title":"J Obsess Compuls Relat Disord"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.31887\/DCNS.2011.13.4\/bboileau","article-title":"A review of obsessive-compulsive disorder in children and adolescents","volume":"13","author":"Boileau","year":"2011","journal-title":"Dialog Clin Neurosci"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1038\/s41583-021-00457-5","article-title":"Environmental influences on the pace of brain development","volume":"22","author":"Tooley","year":"2021","journal-title":"Nat Rev Neurosci"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2012.06.003","article-title":"The epidemiology of obsessive\u2013compulsive disorder in Spanish school children","volume":"26","author":"Canals","year":"2012","journal-title":"J Anxiety Disord"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/1475-2832-3-2","article-title":"Fluoxetine: a review on evidence based medicine","volume":"3","author":"Rossi","year":"2004","journal-title":"Ann Gen Hosp Psychiatry"},{"key":"B33","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13030-021-00219-w","article-title":"Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies","volume":"15","author":"Nakao","year":"2021","journal-title":"Biopsychosoc Med"},{"key":"B34","doi-asserted-by":"publisher","first-page":"100495","DOI":"10.1016\/j.ejro.2023.100495","article-title":"Effects of repetitive transcranial magnetic stimulation and their underlying neural mechanisms evaluated with magnetic resonance imaging-based brain connectivity network analyses","volume":"10","author":"Han","year":"2023","journal-title":"Eur J Radiol Open"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2014.05.021","article-title":"Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS)","volume":"125","author":"Lefaucheur","year":"2014","journal-title":"Clin Neurophysiol Off J Int Fed Clin Neurophysiol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1016\/j.jpsychires.2013.03.022","article-title":"Repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD): an exploratory meta-analysis of randomized and sham-controlled trials","volume":"47","author":"Berlim","year":"2013","journal-title":"J Psychiatr Res"},{"key":"B37","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.tics.2011.11.003","article-title":"Obsessive-compulsive disorder: beyond segregated cortico-striatal pathways","volume":"16","author":"Milad","year":"2012","journal-title":"Trends Cognit Sci"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3758\/s13428-021-01551-3","article-title":"Considerations for using the Wisconsin Card Sorting Test to assess cognitive flexibility","volume":"53","author":"Miles","year":"2021","journal-title":"Behav Res Methods"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1109\/EMBC.2017.8036985","article-title":"Neuronal activity in human anterior cingulate cortex modulates with internal cognitive state during multi-source interference task","volume":"2017","author":"Sklar","year":"2017","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc IEEE Eng Med Biol Soc Annu Int Conf"},{"key":"B40","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1007\/s00213-011-2190-y","article-title":"Fluoxetine regulates the expression of neurotrophic\/growth factors and glucose metabolism in astrocytes","volume":"216","author":"Allaman","year":"2011","journal-title":"Psychopharmacol (Berl)"},{"key":"B41","doi-asserted-by":"publisher","first-page":"6311","DOI":"10.1038\/s41598-019-42775-w","article-title":"5-HTT independent effects of fluoxetine on neuroplasticity","volume":"9","author":"Levy","year":"2019","journal-title":"Sci Rep"},{"key":"B42","doi-asserted-by":"publisher","first-page":"105809","DOI":"10.1016\/j.bandc.2021.105809","article-title":"Improvements in error-monitoring and symptoms following low-frequency rTMS of dorsal anterior cingulate cortex in obsessive compulsive disorder; a randomized, sham-controlled study","volume":"154","author":"Meek","year":"2021","journal-title":"Brain Cogn"},{"key":"B43","doi-asserted-by":"publisher","first-page":"2465","DOI":"10.3390\/ijerph19042465","article-title":"Quantitative electroencephalography (QEEG) as an innovative diagnostic tool in mental disorders","volume":"19","author":"Kopa\u0144ska","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/j.proeng.2012.06.298","article-title":"Analysis of electroencephalography (EEG) signals and its categorization\u2013A study","volume":"38","author":"Kumar","year":"2012","journal-title":"Proc Eng"},{"key":"B45","doi-asserted-by":"publisher","first-page":"5954","DOI":"10.3390\/ijms23115954","article-title":"Neurotransmitters-key factors in neurological and neurodegenerative disorders of the central nervous system","volume":"23","author":"Teleanu","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1016\/j.procs.2019.12.075","article-title":"EEG Beta band frequency domain evaluation for assessing stress and anxiety in resting, eyes closed, basal conditions","volume":"162","author":"D\u00edaz","year":"2019","journal-title":"Proc Comput Sci"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1663611\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T06:25:23Z","timestamp":1762323923000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1663611\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,5]]},"references-count":46,"alternative-id":["10.3389\/fpsyt.2025.1663611"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1663611","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,5]]},"article-number":"1663611"}}