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Objectives: Social anxiety disorder (SAD) is a common and debilitating anxiety disorders. However, few studies had been dedicated to the neurobiology underlying SAD until the last decade. Rates of non-responders to standard methods of treatment remain unsatisfactorily high of approximately 25%, including SAD. Advances in our understanding of SAD could lead to new treatment strategies. A potential non invasive therapeutic option is repetitive transcranial magnetic stimulation (rTMS). Thus, we reported two cases of SAD treated with rTMS Methods: The bibliographical search used Pubmed/Medline, ISI Web of Knowledge and Scielo databases. The terms chosen for the search were: anxiety disorders, neuroimaging, repetitive transcranial magnetic stimulation. Results: In most of the studies conducted on anxiety disorders, except SAD, the right prefrontal cortex (PFC), more specifically dorsolateral PFC was stimulated, with marked results when applying high-rTMS compared with studies stimulating the opposite side. However, according to the “valence hypothesis”, anxiety disorders might be characterized by an interhemispheric imbalance associated with increased right-hemispheric activity. With regard to the two cases treated with rTMS, we found a decrease in BDI, BAI and LSAS scores from baseline to follow-up. Conclusion: We hypothesize that the application of low-rTMS over the right medial PFC (mPFC; the main structure involved in SAD circuitry) combined with high-rTMS over the left mPFC, for at least 4 weeks on consecutive weekdays, may induce a balance in brain activity, opening an attractive therapeutic option for the treatment of SAD.

Binge eating disorder (BED) has limited therapeutic options. Repetitive transcranial magnetic stimulation (rTMS) is a modulation technique of cortical excitability that has shown good results in treating certain psychiatric disorders by correcting dysfunctional cortical regions. We hypothesize that rTMS could be an alternative therapy for BED through potential modulation action on frontostriatal abnormalities and dopaminergic pathways noted by neuroimaging. We report the case of a young woman presenting refractory BED and comorbid depression treated with 20 sessions of rTMS for 30 minutes over the left dorsolateral prefrontal cortex at 10 Hz for about a month (2400 stimuli per day). She answered two self-report questionnaires, the Binge Eating Scale (BES) and the Beck Depression Inventory (BDI). Before rTMS treatment, the BES score was 38, and the BDI score was 42. Three days after rTMS treatment, the BES score was 27 and the BDI score was 23, and the patient referred to no binge eating episodes for that week. Therefore, rTMS could offer a new option of treatment for BED and comorbid depression.

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