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Meta-Analysis
. 2019 Jun;9(6):e01284.
doi: 10.1002/brb3.1284. Epub 2019 May 7.

Transcranial magnetic stimulation in anxiety and trauma-related disorders: A systematic review and meta-analysis

Patricia Cirillo  1   2   3 , Alexandra K Gold  4   5 , Antonio E Nardi  3 , Ana C Ornelas  3 , Andrew A Nierenberg  1   5   6 , Joan Camprodon  1   2   5 , Gustavo Kinrys  1   5   6
Affiliations
Meta-Analysis

Transcranial magnetic stimulation in anxiety and trauma-related disorders: A systematic review and meta-analysis

Patricia Cirillo et al. Brain Behav. 2019 Jun.

Abstract

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.

Keywords: anxiety disorders; meta-analysis; posttraumatic stress disorder; systematic review; theta burst; transcranial magnetic stimulation.

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Conflict of interest statement

AKG receives research support from NIMH. AAN reports the following disclosures: Consultant ‐ Abbott Laboratories, Alkermes, American Psychiatric Association, Appliance Computing Inc. (Mindsite), Basliea, Brain Cells, Inc., Brandeis University, Bristol Myers Squibb, Clintara, Corcept, Dey Pharmaceuticals, Dainippon Sumitomo (now Sunovion), Eli Lilly and Company, EpiQ, L.P./Mylan Inc., Forest, Genaissance, Genentech, GlaxoSmithKline, Healthcare Global Village, Hoffman LaRoche, Infomedic, Intra‐Cellular Therapies, Lundbeck, Janssen Pharmaceutica, Jazz Pharmaceuticals, Medavante, Merck, Methylation Sciences, NeuroRx, Naurex, Novartis, PamLabs, Parexel, Pfizer, PGx Health, Otsuka, Ridge Diagnostics Shire, Schering‐Plough, Somerset, Sunovion, Takeda Pharmaceuticals, Targacept, and Teva; consulted through the MGH Clinical Trials Network and Institute (CTNI) for Astra Zeneca, Brain Cells, Inc, Dianippon Sumitomo/Sepracor, Johnson and Johnson, Labopharm, Merck, Methylation Science, Novartis, PGx Health, Shire, Schering‐Plough, Targacept and Takeda/Lundbeck Pharmaceuticals, NeuroRx Pharma, Pfizer, Physician's Postgraduate Press, Inc. Grants/Research support ‐ American Foundation for Suicide Prevention, AHRQ, Brain and Behavior Research Foundation, Bristol‐Myers Squibb, Cederroth, Cephalon, Cyberonics, Elan, Eli Lilly & Company, Forest, GlaxoSmithKline, Intra‐Cellular Therapies, Janssen Pharmaceuticals, Lichtwer Pharma, Marriott Foundation, Mylan, NIMH, PamLabs, Patient Centered Outcomes Research Institute (PCORI), Pfizer Pharmaceuticals, Shire, Stanley Foundation, Takeda/Lundbeck, and Wyeth‐Ayerst. Honoraria ‐ Belvoir Publishing, University of Texas Southwestern Dallas, Brandeis University, Bristol‐Myers Squibb, Hillside Hospital, American Drug Utilization Review, American Society for Clinical Psychopharmacology, Baystate Medical Center, Columbia University, CRICO, Dartmouth Medical School, Health New England, Harold Grinspoon Charitable Foundation, IMEDEX, International Society for Bipolar Disorder, Israel Society for Biological Psychiatry, Johns Hopkins University, MJ Consulting, New York State, Medscape, MBL Publishing, MGH Psychiatry Academy, National Association of Continuing Education, Physicians Postgraduate Press, SUNY Buffalo, University of Wisconsin, University of Pisa, University of Michigan, University of Miami, University of Wisconsin at Madison, APSARD, ISBD, SciMed, Slack Publishing and Wolters Klower Publishing, ASCP, NCDEU, Rush Medical College, Yale University School of Medicine, NNDC, Nova Southeastern University, NAMI, Institute of Medicine, CME Institute, ISCTM, World Congress on Brain Behavior and Emotion, Congress of the Hellenic Society for Basic and Clinical Pharmacology, ADAA. Stock ‐ Appliance Computing, Inc. (MindSite); Brain Cells, Inc., Medavante. Copyrights ‐ Clinical Positive Affect Scale and the MGH Structured Clinical Interview for the Montgomery Asberg Depression Scale exclusively licensed to the MGH Clinical Trials Network and Institute (CTNI). Speaker Bureaus ‐ none since 2003. JAC is a scientific advisor for Apex Neuroscience. GK has received research support from Astra‐Zeneca, Bristol‐Myers Squibb Company, Cephalon, Elan Pharmaceuticals, Eli Lilly & Company, Forest Pharmaceuticals Inc., GlaxoSmithkline, Sanofi/Synthelabo, Sepracor Inc., Pfizer Inc, UCB Pharma, and Wyeth‐Ayerst Laboratories, Agency for Healthcare Research and Quality (AHRQ) Grant R01 HS019371‐01, and Takeda Pharmaceuticals. He has been an advisor or consultant for Astra‐Zeneca, Cephalon, Eli Lilly & Company, Forest Pharmaceuticals Inc., GlaxoSmithkline, Janssen Pharmaceutica, Pfizer Inc, Sepracor Inc., UCB Pharma, and Wyeth‐Ayerst Laboratories. GK has been a speaker for Astra‐Zeneca, Forest Pharmaceuticals Inc., GlaxoSmithkline, Sepracor Inc., and Wyeth‐Ayerst Laboratories. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of the search results and studies selection for the review of TMS and traumatic and anxiety disorders. From Moher et al. (2009)
Figure 2
Figure 2
Forest plot of the 4 studies that evaluated rTMS as a treatment for GAD (2 RCT and 2 uncontrolled open‐label studies)
Figure 3
Figure 3
Funnel plot of the four studies that evaluated rTMS as a treatment for GAD
Figure 4
Figure 4
Forest plot of all nine PTSD and TMS studies
Figure 5
Figure 5
Forest plot for the meta‐analysis of the treatment of PTSD with TMS
See this image and copyright information in PMC

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