First-line treatment typically consists of either cognitive-behavioural therapy and/or pharmacotherapy with serotonin reuptake inhibitors (SSRI's or clomipramine). Ordinarily only modest benefits are obtained with conventional pharmacotherapy, with the majority of patients considered nonresponsive or only partially responsive. The limited success of conventional treatment makes identifying alternative treatments a priority. Although psychosurgery is regarded as a valid alternative for severe and refractory individuals, the potential for serious and irreversible adverse consequences is significant, rendering this a treatment of 'last resort' only. Repetitive TMS appears to represent a safe and effective alternative for severe sufferers.