Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
Ann Clin Psychiatry. 2022 May;34(2):e2-e24. doi: 10.12788/acp.0050.
Repetitive transcranial magnetic stimulation (rTMS) is an FDA-approved, noninvasive modality for treating major depressive disorder and obsessive-compulsive disorder. Earlier studies evaluating therapeutic effects of rTMS on symptom scores of patients with generalized anxiety disorder (GAD) and panic disorder (PD) have yielded inconsistent findings.
We performed a systematic review and meta-analysis of interventional studies assessing the effect of rTMS on symptom scores in patients with GAD or PD with or without psychiatric comorbidities using studies published up to April 2021. We used DerSimonian-Laird random effects models to obtain pooled standardized mean difference (SMD) and 95% CI.
A total of 13 studies consisting of 677 participants (404 treated with rTMS and 273 without rTMS) were included in this meta-analysis. In GAD patients with or without any comorbidities, rTMS therapy demonstrated significant improvements in anxiety (SMD = 1.45; P < .001) and depression (SMD = 1.65; P < .001) scores regardless of rTMS parameters. Overall anxiety (SMD = 0.24; P = .48) and panic severity (SMD = 1.19; P = .054) scores did not significantly improve after rTMS therapy in patients with PD.
rTMS is safe and improves anxiety and depression scores only in GAD patients, regardless of underlying comorbidities or rTMS parameters.
重复经颅磁刺激（rTMS）是一种获得 FDA 批准的、用于治疗重度抑郁症和强迫症的非侵入性方法。早期评估 rTMS 对广泛性焦虑症（GAD）和惊恐障碍（PD）患者症状评分的治疗效果的研究结果不一致。
我们对截至 2021 年 4 月发表的评估 rTMS 对伴有或不伴有精神共病的 GAD 或 PD 患者症状评分影响的干预性研究进行了系统回顾和荟萃分析。我们使用 DerSimonian-Laird 随机效应模型获得合并标准化均数差（SMD）和 95%置信区间。
这项荟萃分析共纳入 13 项研究，共计 677 名参与者（404 名接受 rTMS 治疗，273 名未接受 rTMS 治疗）。对于伴有或不伴有任何共病的 GAD 患者，rTMS 治疗可显著改善焦虑（SMD=1.45；P<.001）和抑郁（SMD=1.65；P<.001）评分，无论 rTMS 参数如何。rTMS 治疗后，PD 患者的总体焦虑（SMD=0.24；P=.48）和惊恐严重程度（SMD=1.19；P=.054）评分无显著改善。
rTMS 是安全的，仅在 GAD 患者中可改善焦虑和抑郁评分，与潜在共病或 rTMS 参数无关。
