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

Patricia Cirillo, Alexandra K Gold, Antonio E Nardi, Ana C Ornelas, Andrew A Nierenberg, Joan Camprodon, Gustavo Kinrys, Patricia Cirillo, Alexandra K Gold, Antonio E Nardi, Ana C Ornelas, Andrew A Nierenberg, Joan Camprodon, Gustavo Kinrys

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.

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.

© 2019 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

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

References

    1. Association, A. P. (2000). Diagnostic and statistical manual of mental disorders (4th text rev. ed.). Washington, DC: Author.
    1. Ballenger, J. C. , Davidson, J. R. , Lecrubier, Y. , Nutt, D. J. , Marshall, R. D. , Nemeroff, C. B. , … Yehuda, R. (2004). Consensus statement update on posttraumatic stress disorder from the international consensus group on depression and anxiety. The Journal of Clinical Psychiatry, 65(Suppl 1), 55–62.
    1. Bandelow, B. , & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335.
    1. Boggio, P. S. , Rocha, M. , Oliveira, M. O. , Fecteau, S. , Cohen, R. B. , Campanhã, C. , … Fregni, F. (2010). Noninvasive brain stimulation with high‐frequency and low‐intensity repetitive transcranial magnetic stimulation treatment for posttraumatic stress disorder. The Journal of Clinical Psychiatry, 71(8), 992–999. 10.4088/JCP.08m04638blu
    1. Boggio, P. S. , Valasek, C. A. , Campanha, C. , Giglio, A. C. , Baptista, N. I. , Lapenta, O. M. , & Fregni, F. (2011). Non‐invasive brain stimulation to assess and modulate neuroplasticity in Alzheimer's disease. Neuropsychological Rehabilitation, 21(5), 703–716. 10.1080/09602011.2011.617943
    1. Borenstein, M. , Hedges, L. V. , Higgins, J. P. , & Rothstein, H. R. (2009). Effect sizes based on means In Borenstein M., Hedges L. V., Higgins J. P., & Rothstein H. R. (Eds.), Introduction to meta‐analysis (Chapter 4, pp. 21–32). Chichester, UK: Wiley & Sons.
    1. Bystritsky, A. , Kaplan, J. T. , Feusner, J. D. , Kerwin, L. E. , Wadekar, M. , Burock, M. , … Iacoboni, M. (2008). A preliminary study of fMRI‐guided rTMS in the treatment of generalized anxiety disorder. The Journal of Clinical Psychiatry, 69(7), 1092–1098. 10.4088/JCP.v69n0708
    1. Bystritsky, A. , Kerwin, L. E. , & Feusner, J. D. (2009). A preliminary study of fMRI‐guided rTMS in the treatment of generalized anxiety disorder: 6‐month follow‐up. The Journal of Clinical Psychiatry, 70(3), 431–432. 10.4088/JCP.08l04641
    1. Camprodon, J. A. , & Pascual‐Leone, A. (2016). Multimodal applications of transcranial magnetic stimulation for circuit‐based psychiatry. JAMA Psychiatry, 73(4), 407–408. 10.1001/jamapsychiatry.2015.3127
    1. Chantarujikapong, S. I. , Scherrer, J. F. , Xian, H. , Eisen, S. A. , Lyons, M. J. , Goldberg, J. , … True, W. R. (2001). A twin study of generalized anxiety disorder symptoms, panic disorder symptoms and post‐traumatic stress disorder in men. Psychiatry Res, 103(2–3), 133–145. 10.1016/S0165-1781(01)00285-2
    1. Cohen, H. , Kaplan, Z. , Kotler, M. , Kouperman, I. , Moisa, R. , & Grisaru, N. (2004). Repetitive transcranial magnetic stimulation of the right dorsolateral prefrontal cortex in posttraumatic stress disorder: A double‐blind, placebo‐controlled study. Am J Psychiatry, 161(3), 515–524. 10.1176/appi.ajp.161.3.515
    1. Cotelli, M. , Manenti, R. , Cappa, S. F. , Zanetti, O. , & Miniussi, C. (2018). Transcranial magnetic stimulation improves naming in Alzheimer disease patients at different stages of cognitive decline. European Journal of Neurology, 15(12), 1286–1292. 10.1111/j.1468-1331.2008.02202.x
    1. Deppermann, S. , Vennewald, N. , Diemer, J. , Sickinger, S. , Haeussinger, F. B. , Notzon, S. , … Fallgatter, A. J. (2014). Does rTMS alter neurocognitive functioning in patients with panic disorder/agoraphobia? An fNIRS‐based investigation of prefrontal activation during a cognitive task and its modulation via sham‐controlled rTMS. BioMed Research International, 2014, 1–12. 10.1155/2014/542526
    1. Diefenbach, G. J. , Bragdon, L. B. , Zertuche, L. , Hyatt, C. J. , Hallion, L. S. , Tolin, D. F. , … Assaf, M. (2016). Repetitive transcranial magnetic stimulation for generalised anxiety disorder: A pilot randomised, double‐blind, sham‐controlled trial. British Journal of Psychiatry, 209(3), 222–228. 10.1192/bjp.bp.115.168203
    1. Dilkov, D. , Hawken, E. R. , Kaludiev, E. , & Milev, R. (2017). Repetitive transcranial magnetic stimulation of the right dorsal lateral prefrontal cortex in the treatment of generalized anxiety disorder: A randomized, double‐blind sham controlled clinical trial. Progress in Neuro‐Psychopharmacology and Biological Psychiatry, 78, 61–65. 10.1016/j.pnpbp.2017.05.018
    1. Egger, M. , Davey Smith, G. , Schneider, M. , & Minder, C. (1997). Bias in meta‐analysis detected by a simple, graphical test. The BMJ, 315(7109), 629–634.
    1. Guhn, A. , Dresler, T. , Hahn, T. , Muhlberger, A. , Strohle, A. , Deckert, J. , & Herrmann, M. J. (2012). Medial prefrontal cortex activity during the extinction of conditioned fear: An investigation using functional near‐infrared spectroscopy. Neuropsychobiology, 65(4), 173–182. 10.1159/000337002
    1. Herrmann, L. L. , & Ebmeier, K. P. (2006). Factors modifying the efficacy of transcranial magnetic stimulation in the treatment of depression: A review. The Journal of Clinical Psychiatry, 67(12), 1870–1876. 10.4088/JCP.v67n1206
    1. Herrmann, M. J. , Katzorke, A. , Busch, Y. , Gromer, D. , Polak, T. , Pauli, P. , & Deckert, J. (2017). Medial prefrontal cortex stimulation accelerates therapy response of exposure therapy in acrophobia. Brain stimulation, 10(2), 291–297.
    1. Higgins, J. P. T., &Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of interventions. Hoboken, NJ: John Wiley & Sons.
    1. Huerta, P. T. , & Volpe, B. T. (2009). Transcranial magnetic stimulation, synaptic plasticity and network oscillations. Journal of NeuroEngineering and Rehabilitation, 6, 7 10.1186/1743-0003-6-7
    1. Isserles, M. , Shalev, A. Y. , Roth, Y. , Peri, T. , Kutz, I. , Zlotnick, E. , & Zangen, A. (2013). Effectiveness of deep transcranial magnetic stimulation combined with a brief exposure procedure in post‐traumatic stress disorder–a pilot study. Brain Stimulation, 6(3), 377–383. 10.1016/j.brs.2012.07.008
    1. Lefaucheur, J.‐P. , André‐Obadia, N. , Antal, A. , Ayache, S. S. , Baeken, C. , Benninger, D. H. , … Garcia‐Larrea, L. (2014). Evidence‐based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clinical Neurophysiology, 125(11), 2150–2206. 10.1016/j.clinph.2014.05.021
    1. Lundh, A. , & Gøtzsche, P. C. (2008). Recommendations by Cochrane Review Groups for assessment of the risk of bias in studies. BMC Medical Research Methodology, 8(1), 10.1186/1471-2288-8-22
    1. Mantovani, A. , Aly, M. , Dagan, Y. , Allart, A. , & Lisanby, S. H. (2013). Randomized sham controlled trial of repetitive transcranial magnetic stimulation to the dorsolateral prefrontal cortex for the treatment of panic disorder with comorbid major depression. Journal of Affective Disorders, 144(1–2), 153–159. 10.1016/j.jad.2012.05.038
    1. Marin, M. F. , Camprodon, J. A. , Dougherty, D. D. , & Milad, M. R. (2014). Device‐based brain stimulation to augment fear extinction: Implications for PTSD treatment and beyond. Depression and Anxiety, 31(4), 269–278. 10.1002/da.22252
    1. Moher, D. , Liberati, A. , Tetzlaff, J. , & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta‐analyses: The PRISMA statement. Journal of Clinical Epidemiology, 62(10), 1006–1012. 10.1016/j.jclinepi.2009.06.005
    1. Nahas, Z. , Kozel, F. A. , Li, X. , Anderson, B. , & George, M. S. (2003). Left prefrontal transcranial magnetic stimulation (TMS) treatment of depression in bipolar affective disorder: A pilot study of acute safety and efficacy. Bipolar Disorders, 5(1), 40–47. 10.1034/j.1399-5618.2003.00011.x
    1. Nam, D. H. , Pae, C. U. , & Chae, J. H. (2013). Low‐frequency, repetitive transcranial magnetic stimulation for the treatment of patients with posttraumatic stress disorder: A double‐blind Sham‐controlled study. Clinical Psychopharmacology and Neuroscience, 11(2), 96–102. 10.9758/cpn.2013.11.2.96
    1. Notzon, S. , Deppermann, S. , Fallgatter, A. , Diemer, J. , Kroczek, A. , Domschke, K. , … Ehlis, A.‐C. (2015). Psychophysiological effects of an iTBS modulated virtual reality challenge including participants with spider phobia. Biological Psychology, 112, 66–76. 10.1016/j.biopsycho.2015.10.003
    1. O'Reardon, J. P. , Solvason, H. B. , Janicak, P. G. , Sampson, S. , Isenberg, K. E. , Nahas, Z. , … Sackeim, H. A. (2007). Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: A multisite randomized controlled trial. Biological Psychiatry, 62(11), 1208–1216. 10.1016/j.biopsych.2007.01.018
    1. Osuch, E. A. , Benson, B. E. , Luckenbaugh, D. A. , Geraci, M. , Post, R. M. , & McCann, U. (2009). Repetitive TMS combined with exposure therapy for PTSD: A preliminary study. Journal of Anxiety Disorders, 23(1), 54–59. 10.1016/j.janxdis.2008.03.015
    1. Oznur, T. , Akarsu, S. , Celik, C. , Bolu, A. , Ozdemir, B. , Akcay, B. D. , … Ozmenler, K. N. (2014). Is transcranial magnetic stimulation effective in treatment‐resistant combat related posttraumatic stress disorder? Neurosciences (Riyadh), 19(1), 29–32.
    1. Perkonigg, A. , Kessler, R. C. , Storz, S. , & Wittchen, H. U. (2000). Traumatic events and post‐traumatic stress disorder in the community: Prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica, 101(1), 46–59. 10.1034/j.1600-0447.2000.101001046.x
    1. Philip, N. S. , Barredo, J. , van 't Wout‐Frank, M., Tyrka, A. R., … L. L. (2017). Network mechanisms of clinical response to transcranial magnetic stimulation in posttraumatic stress disorder and major depressive disorder. Biological Psychiatry, 83, 263–272. 10.1016/j.biopsych.2017.07.021
    1. Philip, N. S. , Ridout, S. J. , Albright, S. E. , Sanchez, G. , & Carpenter, L. L. (2016). 5‐Hz transcranial magnetic stimulation for comorbid posttraumatic stress disorder and major depression. Journal of Traumatic Stress, 29(1), 93–96. 10.1002/jts.22065
    1. Racine, R. J. , Chapman, C. A. , Trepel, C. , Teskey, G. C. , & Milgram, N. W. (1995). Post‐activation potentiation in the neocortex. IV. Multiple sessions required for induction of long‐term potentiation in the chronic preparation. Brain Research, 702(1–2), 87–93.
    1. Rosenberg, P. B. , Mehndiratta, R. B. , Mehndiratta, Y. P. , Wamer, A. , Rosse, R. B. , & Balish, M. (2002). Repetitive transcranial magnetic stimulation treatment of comorbid posttraumatic stress disorder and major depression. The Journal of Neuropsychiatry and Clinical Neurosciences, 14(3), 270–276. 10.1176/jnp.14.3.270
    1. Ruggiero, K. J. , Del Ben, K. , Scotti, J. R. , & Rabalais, A. E. (2003). Psychometric properties of the PTSD Checklist‐Civilian Version. Journal of Traumatic Stress, 16(5), 495–502. 10.1023/a:1025714729117
    1. Watts, B. V. , Landon, B. , Groft, A. , & Young‐Xu, Y. (2012). A sham controlled study of repetitive transcranial magnetic stimulation for posttraumatic stress disorder. Brain Stimulation, 5(1), 38–43. 10.1016/j.brs.2011.02.002
    1. White, D. , & Tavakoli, S. (2015). Repetitive transcranial magnetic stimulation for treatment of major depressive disorder with comorbid generalized anxiety disorder. Annals of Clinical Psychiatry, 27(3), 192–196.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel