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

Background:

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.

Objective:

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.

Methods:

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.

Results:

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.

Conclusions:

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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