Convergent therapeutic networks across neuromodulation in obsessive-compulsive disorder reveal a multiscale biological architecture

<title>Abstract</title> <p>Neuromodulatory treatments for obsessive-compulsive disorder (OCD) target diverse anatomical regions yet yield comparable clinical benefit. Integrating 142 studies with normative functional connectomics, we identified a convergent, outcome-weighted brain network whose engagement predicted symptom improvement across modalities. This network, localized to low-myelinated association cortex, was enriched for mu-opioid, mGluR5, and histamine H3 receptors, providing a multiscale framework linking circuit modulation, molecular systems, and clinical response in refractory OCD.</p>