Repetitive Transcranial Magnetic Stimulation for Anxiety in Depression

Commonly used repetitive transcranial magnetic stimulation protocols, including left‐sided high‐frequency, right‐sided low-frequency, and sequential bilateral, were effective in treating patient’s anxiety symptoms of major depressive disorder, according to a study published in Depression and Anxiety.

Researchers analyzed pooled data from 3 clinical trials to assess if repetitive transcranial magnetic stimulation was effective for treating anxiety symptoms in major depressive disorder, and if so, which protocol — left‐sided high‐frequency, right‐sided low-frequency, or sequential bilateral — was most effective. The randomized and double-blind studies included psychiatric diagnoses, depression symptomatology, and changes in anxiety symptoms throughout the course of 20 repetitive transcranial magnetic stimulation sessions over 4 weeks.

Of the 697 patients included in this analysis, 150 were treated with left‐sided high‐frequency repetitive transcranial magnetic stimulation, 312 were treated with right‐sided low-frequency repetitive transcranial magnetic stimulation, and 235 were treated with sequential bilateral repetitive transcranial magnetic stimulation, and there were no significant differences between the treatment cohorts with regards to demographics or clinical variables.

After controlling for gender, left‐sided high‐frequency repetitive transcranial magnetic stimulation significantly reduced the Hamilton Depression Rating Scale growth score compared with right‐sided low-frequency repetitive transcranial magnetic stimulation (β=−0.25; P =.009) and sequential bilateral repetitive transcranial magnetic stimulation (β=−0.35; P <.001). Over time, all protocols were effective at reducing the Beck’s Anxiety Inventory by a mean score of 8.13 points (P <.001) and the Hamilton Depression Rating Scale by a mean score of 8.61 points (P <.001).

Limitations of this study include the heterogeneity of the treatment protocols for stimulation pulses per session between the trials, a potential placebo effect from not sham-controlled trials, and limiting follow-up outcomes to a 4-week time frame.

Researchers concluded that their “findings suggest therapeutic equivalence across left‐sided high‐frequency, right‐sided low‐frequency, and sequential bilateral [repetitive transcranial magnetic stimulation] approaches” for treating anxiety symptoms in major depressive disorder.

Reference

Chen L, Hudaib AR, Hoy KE, Fitzgerald PB. Is rTMS effective for anxiety symptoms in major depressive disorder? An efficacy analysis comparing left-sided high-frequency, right-sided low-frequency, and sequential bilateral rTMS protocols [published online April 8, 2019]. Depress Anxiety. doi: 10.1002/da.22894