Acute reduction in anxiety after deep transcranial magnetic stimulation (DTMS) in unipolar major depression-a systematic reviewand meta-analysis


Compared to the conventional repetitive transcranial magnetic stimulation (rTMS) typically administered with the figure-of-eight coil, deep transcranial magnetic stimulation (dTMS), utilizing the H-coil,stimulates wider and, most likely, deeper neural structures. While dTMS appears to be a promising antidepressant treatment, particularly in unipolar depression, it is not clear if it could also reduce anxiety symptoms in major depression.


This study investigated the anxiolytic properties of the deep transcranial magnetic stimulation (dTMS) in unipolar major depression using a systematic literature review and meta-analysis.


A systematic literature search of Medline and PsycInfo databases (any time-January 2015) identified k=17 studies containing terms ‘deep transcranial magnetic stimulation’ and ‘depression’. Following exclusion criteria, sixopen-label studies were included inthe quantitative analysis. All studies reported anxiety anddepression severity scores according to Hamilton Anxiety RatingScale (HARS) and Hamilton Depression RatingScale (HDRS), respectively.


There was a large acute anxiolytic effect after DTMS comparedto baseline (pooled weighted d=1.45; 95% confidence interval, 95%CI: 1.10–1.80; p<.001; k=6 studies; N=95 patients). The anxiolytic effect was accompanied by a large acute reduction in depression severity after dTMS compared to baseline in the same studies (pooled weighted d=1.69; 95%CI: 1.38–2.01; p<.001; k=6 studies; N=95 patients). Unlike the anti-depressant effect, the anxiolytic effect was more heterogeneous among studies and did not depend onconcurrent treatment with antidepressants.


These results suggest that high-frequencydTMS might have both anxiolytic and antidepressant properties in treatment-resistant, unipolar major depression. Future controlled studies are necessary to investigate the neural correlates, predictors, and durability of anxiolytic effects of dTMS in unipolarmajor depression.

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