TY - JOUR
T1 - Repetitive Transcranial Magnetic Stimulation for Generalized Anxiety Disorder
T2 - A Systematic Literature Review and Meta-Analysis
AU - Parikh, Tapan K.
AU - Strawn, Jeffrey R.
AU - Walkup, John T.
AU - Croarkin, Paul E.
N1 - Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of CINP.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - Background: Anxiety disorders such as generalized anxiety disorder (GAD) impact 10% of the US population, and many patients do not completely respond to first-line treatments (e.g., selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and psychotherapy). Given the dearth of evidence for non-pharmacologic, non-psychotherapeutic interventions, we performed a systematic review and meta-analysis of repetitive transcranial magnetic stimulation (rTMS) in adults with GAD. Methods: A systematic literature review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines was conducted. Pre-and post-treatment anxiety scores were extracted, and a random-effects meta-analysis was conducted to determine the magnitude of improvement (standardized mean difference). Standard assessments of heterogeneity (e.g., Q-statistic, I2, and τ2) and publication bias were performed. Results: The initial search resulted in 3194 citations, of which 6 studies were included in the meta-analysis. In total, 152 patients were studied, including 97 patients who received active treatment and 55 who received sham treatment, and heterogeneity was modest (I2 13.32, Q = 5.77). In patients with GAD, rTMS produced a standardized mean difference of-1.857 (confidence interval:-2.219 to-1.494; P <. 001) with a prediction interval of-2.55 to-1.16. Conclusions: The results suggest a robust effect of rTMS in GAD in the context of limited, heterogenous studies. Rigorously designed, randomized controlled trials of rTMS for GAD and related anxiety disorders are urgently needed. These studies will provide opportunities for biomarker development and integration of concurrent evidence-based psychotherapy to maximize results.
AB - Background: Anxiety disorders such as generalized anxiety disorder (GAD) impact 10% of the US population, and many patients do not completely respond to first-line treatments (e.g., selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and psychotherapy). Given the dearth of evidence for non-pharmacologic, non-psychotherapeutic interventions, we performed a systematic review and meta-analysis of repetitive transcranial magnetic stimulation (rTMS) in adults with GAD. Methods: A systematic literature review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines was conducted. Pre-and post-treatment anxiety scores were extracted, and a random-effects meta-analysis was conducted to determine the magnitude of improvement (standardized mean difference). Standard assessments of heterogeneity (e.g., Q-statistic, I2, and τ2) and publication bias were performed. Results: The initial search resulted in 3194 citations, of which 6 studies were included in the meta-analysis. In total, 152 patients were studied, including 97 patients who received active treatment and 55 who received sham treatment, and heterogeneity was modest (I2 13.32, Q = 5.77). In patients with GAD, rTMS produced a standardized mean difference of-1.857 (confidence interval:-2.219 to-1.494; P <. 001) with a prediction interval of-2.55 to-1.16. Conclusions: The results suggest a robust effect of rTMS in GAD in the context of limited, heterogenous studies. Rigorously designed, randomized controlled trials of rTMS for GAD and related anxiety disorders are urgently needed. These studies will provide opportunities for biomarker development and integration of concurrent evidence-based psychotherapy to maximize results.
KW - Anxiolytic
KW - Clinical trial
KW - Hamilton anxiety rating scale
KW - Neuromodulation
KW - TMS
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U2 - 10.1093/ijnp/pyab077
DO - 10.1093/ijnp/pyab077
M3 - Review article
C2 - 34791241
AN - SCOPUS:85124497517
SN - 1461-1457
VL - 25
SP - 144
EP - 146
JO - International Journal of Neuropsychopharmacology
JF - International Journal of Neuropsychopharmacology
IS - 2
ER -