Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Int J Neuropsychopharmacol. 2022 Feb 11;25(2):144-146. doi: 10.1093/ijnp/pyab077.
Anxiety disorders such as generalized anxiety disorder (GAD) impact 10% of the US population, and many patients do not completely respond to first-line treatments (e.g., selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and psychotherapy). Given the dearth of evidence for non-pharmacologic, non-psychotherapeutic interventions, we performed a systematic review and meta-analysis of repetitive transcranial magnetic stimulation (rTMS) in adults with GAD.
A systematic literature review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines was conducted. Pre- and post-treatment anxiety scores were extracted, and a random-effects meta-analysis was conducted to determine the magnitude of improvement (standardized mean difference). Standard assessments of heterogeneity (e.g., Q-statistic, I2, and τ 2) and publication bias were performed.
The initial search resulted in 3194 citations, of which 6 studies were included in the meta-analysis. In total, 152 patients were studied, including 97 patients who received active treatment and 55 who received sham treatment, and heterogeneity was modest (I2 13.32, Q = 5.77). In patients with GAD, rTMS produced a standardized mean difference of -1.857 (confidence interval: -2.219 to -1.494; P < .001) with a prediction interval of -2.55 to -1.16.
The results suggest a robust effect of rTMS in GAD in the context of limited, heterogenous studies. Rigorously designed, randomized controlled trials of rTMS for GAD and related anxiety disorders are urgently needed. These studies will provide opportunities for biomarker development and integration of concurrent evidence-based psychotherapy to maximize results.
焦虑症，如广泛性焦虑症（GAD），影响了美国 10%的人口，许多患者对一线治疗（如选择性 5-羟色胺再摄取抑制剂、5-羟色胺-去甲肾上腺素再摄取抑制剂和心理疗法）没有完全反应。鉴于缺乏非药物、非心理治疗干预的证据，我们对成人 GAD 患者的重复经颅磁刺激（rTMS）进行了系统评价和荟萃分析。
按照系统评价和荟萃分析的首选报告项目指南进行了系统文献检索。提取治疗前后的焦虑评分，并进行随机效应荟萃分析，以确定改善幅度（标准化均数差）。进行了标准的异质性评估（如 Q 统计量、I2 和 τ2）和发表偏倚。
最初的搜索产生了 3194 条引文，其中 6 项研究纳入荟萃分析。共有 152 名患者参与了研究，其中 97 名患者接受了积极治疗，55 名患者接受了假治疗，异质性中等（I2 为 13.32，Q=5.77）。在 GAD 患者中，rTMS 产生了 -1.857 的标准化均数差（置信区间：-2.219 至-1.494；P<0.001），预测区间为-2.55 至-1.16。
结果表明，在有限的、异质的研究背景下，rTMS 在 GAD 中具有强大的效果。迫切需要针对 GAD 和相关焦虑障碍的 rTMS 的严格设计、随机对照试验。这些研究将为生物标志物的开发和基于证据的心理治疗的整合提供机会，以最大限度地提高结果。
