Table 1.
Patients with anxiety disorders, according to DSM 5
| Author/Year | Patient/Sham group | Diagnosis | Study design | Target | # of rTMS sessions | Frequency | Pulses per session | Stimulation intensity | NP tests | Relevant results following treatment | Tolerability and safety | Sustained effect of response |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Zhang, 201937 | 117 rTMS | Mood or Anxiety Disorders | RCT | Left DLPFC | 10 | 10 Hz | 2400 | 120% of RMT | HAMA | All the age groups showed significant improvements in clinical symptoms | No safety or tolerability concerns were identified | Yes for adolescents, but not in adults |
| Lu R, 201838 | 28 rTMS | GAD | Open-label | Right DLPFC + left DLPFC | 10 | 1 Hz | 750 | 80% of RMT | HRSA | In this study, low-frequency rTMS which was successively delivered to right and left DLPFC effectively alleviated anxiety symptoms in GAD patients | All patients tolerated rTMS well without any adverse effects | Yes |
| Dilkov D, 201733 | 9 rTMS/12 sham | GAD | RCT | Right DLPFC | 25 | 20 Hz | 3600 | 110% of RMT | HRSA | Participants receiving rTMS showed clinically significant decrease in reported anxiety symptoms. | One participant in the active group had seizure; transient dizziness was reported in three patients | Yes |
| Diefenbach GJ, 201635 | 13 rTMS/12 sham | GAD | RCT | Right DLPFC | 30 | 1 Hz | 900 | 90% of RMT | HRSA; DASS | ANOVA demonstrated significant group x time interaction for the primary and secondary outcomes with the gains maintained only in the rTMS group at follow-up. | No seizures occurred; mild adverse effects were reported and was similar in rTMS and sham groups | Yes |
| White D and Tavakoli S, 20155 | 13 rTMS | Comorbid MDD and GAD | Open-label, pilot study | Right DLPFC + left DLPFC | 2436 | 1Hz (right side)+10hz (left side) | 1000 | NR | GAD-7 | Paired T-test comparing baseline to final scores showed a markedly significant difference for both GAD-7 and the HDRS-21, suggesting a decrease of 65% and 75% in depression and anxiety, respectively. | NR | Not applicable |
| Mantovani A, 201334 | 12 rTMS/13 sham | PD and comorbid MDD | RCT. Two phases: Phase I 4-week double-blind followed by Phase II (optional) 4-week open-label | Right DLPFC | Phase I: 20; Phase II: 20 | 1Hz | 1800 | 110% of RMT | PDSS; HRSA-14 | Repeated-measures ANOVA revealed a significant time by group interaction with PDSS, with greater reduction in active group. | No seizures were reported. None of the patients reported significant side effects | Yes |
| Prasko J, 200736 | 7 rTMS/8 sham | PD or PD with agoraphobia | RCT | Right DLPFC | 10 | 1 Hz | 1800 | 110% of RMT | HRSA; BAI; PDSS | No statistical difference between groups were observed after treatment. | No seizures, headaches, neurological and cognitive decline occurred | Not applicable |
Abbreviations: BAI, Beck Anxiety Inventory; DASS, Depression Anxiety Stress Scales; DLPFC, Dorsolateral Prefrontal Cortex; GAD, Generalized Anxiety Disorder; GAD-7, Generalized Anxiety Disorder scale; HAMA, Hamilton Rating Scale for Anxiety; HRSA, Hamilton Rating Scale for Anxiety; MDD, major depressive disorder; NP, neuropsychological; NR, Not Reported; PD, Panic Disorder; PDSS, Panic Disorder Severity Scale; RCT, Randomized Controlled Trial; RMT, Resting Motor Threshold; rTMS, repetitive Transcranial Magnetic Stimulation.