Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis

Abstract

BackgroundPharmacological and conventional non-pharmacological treatments are only moderately effective in treating generalised anxiety disorder (GAD). Recently, repetitive transcranial magnetic stimulation (rTMS) has attracted interest because of its potential therapeutic value.AimTo investigate the efficacy and safety of rTMS treatment for GAD.MethodsLiterature studies published in English or Chinese were screened in 10 electronic databases up to 5 December 2018. The included studies’ bias risk was assessed using Cochrane risk of bias assessment tool. Meta-analysis was performed to compute the standardised mean difference (SMD) and risk ratio (RR) along with its 95% CIs through using RevMan V.5.3. Heterogeneity was inspected by I2 and the χ2 test. We performed subgroup analysis and meta-regression to investigate heterogeneity. We used funnel plot to assess publication bias. We used the GRADE approach to assess the whole quality of evidence.ResultsTwenty-one studies, with a total sample size of 1481, were analysed. The risk of bias in most studies included is moderate, the majority of which are lacking of blinding methods of treatment allocation. The treatment had beneficial effects in the rTMS group compared with the control group in mean anxiety score (SMD=−0.68; 95% CI −0.89 to −0.46). None of the 21 studies included here reported severe adverse events. As for dropout rates, there are no statistically significant differences between the two groups (RR 1.14, 95% CI 0.72 to 1.82) or adverse events (RR 0.95, 95% CI 0.77 to 1.18). No particular influence on the heterogeneity of any variable was observed. The risk of publication bias was low. According to the GRADE approach, the evidence levels of primary outcome (treatment effects) and secondary outcomes (acceptability and safety) were rated as ‘medium’.ConclusionThe use of rTMS combined with medication treatment may have a significant positive anti-anxiety effect on patients with GAD. However, we should interpret the results cautiously due to the relatively high heterogeneity of the meta-analysis. Future high-quality clinical trials are needed to confirm our results.

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

“…Crucially, the effect was not likely to have been influenced by publication or reporting bias. In line with previous systematic reviews 35 and meta-analyses, 72,73 we also acknowledge the limitations of these results, which are based on a restricted sample of studies but a relatively large pool of patients (318 in total). We included only representative moderators in our moderation analyses because of the small number of studies in our analysis.…”

“…However, so far they have included single-case studies and protocols without a control condition, providing an overview of the state of the art, but without cumulatively quantifying the results. To our knowledge, 3 meta-analyses [71][72][73] have investigated the efficacy of rTMS from a quantitative perspective. Cui and colleagues 72 investigated the efficacy of rTMS in treating generalized anxiety disorder.…”

“…To our knowledge, 3 meta-analyses [71][72][73] have investigated the efficacy of rTMS from a quantitative perspective. Cui and colleagues 72 investigated the efficacy of rTMS in treating generalized anxiety disorder. They included 21 studies (2 in English and 19 in Chinese), all with a control group receiving sham rTMS or no intervention, suggesting that rTMS was a useful option for decreasing the symptoms of generalized anxiety disorder.…”

Non-invasive brain stimulation effectiveness in anxiety disorder treatment: a meta-analysis on sham/behavior-controlled studies

“…Crucially, the effect was not likely influenced by publication or reporting bias. In line with previous systematic reviews 34 and meta-analyses 71, 72 , we also acknowledge the limitation of the present results, which are based on a restricted sample of studies, but a relatively big pool of patients (318 in total).…”

Repetitive transcranial magnetic stimulation: an innovative medical therapy

“…It has been shown that rTMS is promising treatment option for many neuropsychiatric conditions like depression, 2,24,25 OCD, 28 BD, 36,37 negative symptoms 29 and auditory hallucinations 30,31 in schizophrenia, addiction,s [33][34][35] anxiety and anxiety related disorders, [39][40][41] fibromyalgia, 44,45 chronic pain, 42,43 and dementia/Alzheimer's disease. [46][47][48][49] It is also very important that many studies reported that rTMS causes significant improvement of cognition.…”