Background Transcranial magnetic stimulation (TMS) has been evaluated as an effective treatment option for patients with major depressive disorder. However, there are limited studies that have evaluated the efficacy of TMS for other neuropsychiatric disorders such as anxiety and trauma‐related disorders. We reviewed the literature that has evaluated TMS as a treatment for anxiety and trauma‐related disorders. Methods We searched for articles published up to December 2017 in Embase, Medline, and ISI Web of Science databases, following the Preferred Items for Reporting of Systematic Reviews and Meta‐Analyses (PRISMA) statement. Articles ( n = 520) evaluating TMS in anxiety and trauma‐related disorders were screened and a small subset of these that met the eligibility criteria ( n = 17) were included in the systematic review, of which nine evaluated TMS in posttraumatic stress disorder (PTSD), four in generalized anxiety disorder (GAD), two in specific phobia (SP), and two in panic disorder (PD). The meta‐analysis was performed with PTSD and GAD since PD and SP had an insufficient number of studies and sample sizes. Results Among anxiety and trauma‐related disorders, TMS has been most widely studied as a treatment for PTSD. TMS demonstrated large overall treatment effect for both PTSD (ES = −0.88, 95% CI: −1.42, −0.34) and GAD (ES = −2.06, 95% CI: −2.64, −1.48), including applying high frequency over the right dorsolateral prefrontal cortex. Since few studies have evaluated TMS for SP and PD, few conclusions can be drawn. Conclusions Our meta‐analysis suggests that TMS may be an effective treatment for GAD and PTSD.

BackgroundThe growth of the Internet has led to significant change and has become an integral part of modern life. It has made life easier and provided innumerous benefits; however, excessive use has brought about the potential for addiction, leading to severe impairments in social, academic, financial, psychological, and work domains. Individuals addicted to the Internet usually have comorbid psychiatric disorders. Panic disorder (PD) and generalized anxiety disorder (GAD) are prevalent mental disorders, involving a great deal of damage in the patient’s life.ObjectiveThis open trial study describes a treatment protocol among 39 patients with anxiety disorders and Internet addiction (IA) involving pharmacotherapy and modified cognitive behavioral therapy (CBT).MethodsOf the 39 patients, 25 were diagnosed with PD and 14 with GAD, in addition to Internet addiction. At screening, patients responded to the MINI 5.0, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Clinical Global Impressions Scale, and the Young Internet Addiction Scale. At that time, IA was observed taking into consideration the IAT scale (cutoff score above 50), while anxiety disorders were diagnosed by a psychiatrist. Patients were forwarded for pharmacotherapy and a modified CBT protocol. Psychotherapy was conducted individually, once a week, over a period of 10 weeks, and results suggest that the treatment was effective for anxiety and Internet addiction.ResultsBefore treatment, anxiety levels suggested severe anxiety, with an average score of 34.26 (SD 6.13); however, after treatment the mean score was 15.03 (SD 3.88) (P<.001). A significant improvement in mean Internet addiction scores was observed, from 67.67 (SD 7.69) before treatment, showing problematic internet use, to 37.56 (SD 9.32) after treatment (P<.001), indicating medium Internet use. With respect to the relationship between IA and anxiety, the correlation between scores was .724.ConclusionsThis study is the first research into IA treatment of a Brazilian population. The improvement was remarkable due to the complete engagement of patients in therapy, which contributed to the success of the treatment from a behavioral perspective, and gave patients the confidence to continue to manage Internet use in their lives.

Future investigations should attempt to stabilize hormonal levels through the continuous use of contraceptives to target a reduction in symptom severity. In addition, psychiatrists should note menstrual period dates and compare symptom intensity between the luteal and follicular phases. Finally, PMS and PMDD patients should be studied separately.

Background Many patients with bipolar disorder (BD) fail to experience benefit following traditional pharmacotherapy, necessitating alternative treatment options that will enable such patients to achieve remission. Transcranial magnetic stimulation (TMS) is a relatively new, noninvasive neuromodulation technique that involves the application of magnetic pulses on hyperactive or hypoactive cortical brain areas. We evaluated the existing literature on TMS as a treatment for BD across varied mood states. Methods We searched PubMed up to October 2018 for original data articles published in English that evaluated outcomes in a bipolar sample across depressive, manic, mixed, and maintenance phases of BD. Results Clinical trials of TMS for BD particularly suggest the potential of repetitive TMS for reducing depressive symptoms. Studies of TMS for mania have yielded more mixed findings. Few studies have evaluated TMS in other phases of the bipolar illness. TMS is generally associated with mild side effects though, in a few studies, it has been shown to contribute to a manic switch in previously depressed bipolar patients. Conclusions Transcranial magnetic stimulation is a promising approach for treating patients with BD who have failed to respond to pharmacological or psychosocial treatment. Future research should more clearly elucidate which TMS protocols may be most effective for a given bipolar patient.

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Introduction: Prospective studies have shown that the course of bipolar disorder (BD) is characterized by the persistence of symptoms, predominantly depression, along most of the time. However, to our knowledge, no studies in Latin America have investigated it. Objectives: To replicate international studies using a Brazilian sample to prospectively analyze treatment outcomes in the first year and to determine potential chronicity factors. Methods: We followed up 102 patients with BD for 12 months and evaluated the number of months with affective episodes and the intensity of manic and depressive symptoms using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D17). Sociodemographic and retrospective clinical data were examined to determine possible predictors of outcome. Results: Almost 50% of the patients had symptoms about half of the time, and there was a predominance of depressive episodes. Disease duration and number of depressive episodes were predictors of chronicity. Depressive polarity of the first episode and a higher number of depressive episodes predicted the occurrence of new depressive episodes. Conclusion: In general, BD outcome seems to be poor in the first year of monitoring, despite adequate treatment. There is a predominance of depressive symptoms, and previous depressive episodes are a predictor of new depressive episodes and worse outcome.

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