Effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders: a meta-analysis of sham or behaviour-controlled studies

Vergallito, Alessandra; Gallucci, Alessia; Pisoni, Alberto; Punzi, Mariacristina; Caselli, Gabriele; Ruggiero, Giovanni Maria; Sassaroli, Sandra; Lauro, Leonor J. Romero

doi:10.1503/jpn.210050

Cited by 18 publications

(16 citation statements)

References 177 publications

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“…While there is no firm consensus on the optimal tDCS dosage, meta-analyses indicate that increased session numbers may be associated with improved clinical outcomes (Brunoni et al, 2016b;Moffa et al, 2020;Shiozawa et al, 2014). tDCS and rTMS have demonstrated efficacy in treating anxiety disorders (Matza et al, 2010;Vergallito et al, 2021), and we observed a further long term maintenance of the improvements in the present study.…”

Section: Discussionsupporting

confidence: 53%

Adjunctive home-based transcranial direct current stimulation treatment for major depression with real-time remote supervision: An open-label, single-arm feasibility study with long term outcomes

Woodham

Rimmer

Young

et al. 2022

Journal of Psychiatric Research

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Section: Discussionsupporting

confidence: 53%

Adjunctive home-based transcranial direct current stimulation treatment for major depression with real-time remote supervision: An open-label, single-arm feasibility study with long term outcomes

Woodham

Rimmer

Young

et al. 2022

Journal of Psychiatric Research

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“…Based on the core role of the dlPFC in emotion regulation and in the pathological mechanisms of anxiety disorders, studies of GAD have used the dlPFC as a stimulation site for rTMS. 14 An open-label study 3 applied 6 sessions of 1 Hz rTMS over the right prefrontal cortex (PFC) with a stimulating intensity of 90% of the resting motor threshold (RMT) and found that 6 of the 10 participants responded to treatment. Another open-label study 6 applied 24 to 36 sessions of rTMS over the bilateral dlPFC in 13 patients with comorbid major depressive disorder and GAD.…”

Section: Introductionmentioning

confidence: 99%

Frontoparietal paired associative stimulation versus single-site stimulation for generalized anxiety disorder: a pilot rTMS study

Wang

Zhou

Wang

et al. 2022

jpn

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Background: At present, the use of repetitive transcranial magnetic stimulation (rTMS) for generalized anxiety disorder (GAD) is limited to single-site interventions. We investigated whether dual-site frontoparietal stimulation delivered using cortical–cortical paired associative stimulation (ccPAS) had stronger clinical efficacy than single-site stimulation in patients with GAD. Methods: We randomized 50 patients with GAD to 1 Hz rTMS (10 sessions) using 1 of the following protocols: single-site stimulation over the right dorsolateral prefrontal cortex (dlPFC; 1500 pulses per session); single-site stimulation over the right posterior parietal cortex (PPC; 1500 pulses per session); repetitive dual-site ccPAS (rds-ccPAS) over the right dlPFC and right PPC with 1500 pulses per session (rd-ccPAS-1500); or rds-ccPAS over the right dlPFC and right PPC with 750 pulses per session (rd-ccPAS-750). Both rds-ccPAS treatments used a between-site interval of 100 ms. Results: Clinical scores for anxiety, depression and insomnia were reduced in all 4 groups after treatment. We found greater improvements in anxiety symptoms in the rds-ccPAS-1500 group compared to the rds-ccPAS-750 and single-site groups. We found greater improvements in depression symptoms and insomnia in the rds-PAS-1500 group compared to the single-site groups. The rds-ccPAS-1500 group also showed significant or trend-level improvements in anxiety symptoms and insomnia at 10-day and 1-month followup. More patients responded to treatment with rds-ccPAS-1500 than with single-site stimulation. The between-group differences in response rates persisted to the 3-month follow-up. Treatment using rds-ccPAS with a between-site interval of 100 ms induced a more significant improvement than the between-site interval of 50 ms we evaluated in a previous study. Limitations: These results need to be replicated in a larger sample using sham control and equal-pulse single-site stimulation. Conclusion: Frontoparietal rds-ccPAS may be a better treatment option for GAD.

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“…Differences for the PTSD subgroup may be partly accounted for by the publication after 2016 of studies included in our review. During the conduct of our study -i.e., after the protocol was pre-registered-a closely related work has been released by Vergallito et al (78). Using both disorder-specific and generic anxiety scores, they found that rTMS and tDCS reduced anxiety levels across ADs.…”

Section: Discussionmentioning

confidence: 97%

“…This main finding is in agreement with our primary and secondary analyses. Depression scores were also lower in intervention vs. control groups (78). In addition to our analysis, one study was included for which we could not obtain original results despite contacting the authors (79).…”

Section: Discussionmentioning

confidence: 99%

Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-Analysis

et al. 2022

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BackgroundPathological anxiety is responsible for major functional impairments and resistance to conventional treatments in anxiety disorders (ADs), posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Focal neuromodulation therapies such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) are being developed to treat those disorders.MethodsWe performed a dimensional systematic review and meta-analysis to assess the evidence of the efficacy of TMS, tDCS and DBS in reducing anxiety symptoms across ADs, PTSD and MDD. Reports were identified through systematic searches in PubMed/Medline, Scopus and Cochrane library (inception to November 2020), followed by review according to the PRISMA guidelines. Controlled clinical trials examining the effectiveness of brain stimulation techniques on generic anxiety symptoms in patients with ADs, PTSD or MDD were selected.ResultsNineteen studies (RCTs) met inclusion criteria, which included 589 participants. Overall, focal brain activity modulation interventions were associated with greater reduction of anxiety levels than controls [SMD: −0.56 (95% CI, −0.93 to−0.20, I2 = 77%]. Subgroup analyses revealed positive effects for TMS across disorders, and of focal neuromodulation in generalized anxiety disorder and PTSD. Rates of clinical responses and remission were higher in the active conditions. However, the risk of bias was high in most studies.ConclusionsThere is moderate quality evidence for the efficacy of neuromodulation in treating pathological anxiety.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=233084, identifier: PROSPERO CRD42021233084. It was submitted on January 29th, 2021, and registered on March 1st, 2021. No amendment was made to the recorded protocol. A change was applied for the subgroup analyses based on target brain regions, we added the putative nature (excitatory/inhibitory) of brain activity modulation.

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Effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders: a meta-analysis of sham or behaviour-controlled studies

Cited by 18 publications

References 177 publications

Adjunctive home-based transcranial direct current stimulation treatment for major depression with real-time remote supervision: An open-label, single-arm feasibility study with long term outcomes

Adjunctive home-based transcranial direct current stimulation treatment for major depression with real-time remote supervision: An open-label, single-arm feasibility study with long term outcomes

Frontoparietal paired associative stimulation versus single-site stimulation for generalized anxiety disorder: a pilot rTMS study

Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-Analysis

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