Nervousness signs with Main Depressive Dysfunction are lowered by repeated transcranial magnetic stimulation

The severity of comorbid anxiety symptoms was reduced by repeated transcranial magnetic stimulation (rTMS), according to a study published in Depression and Anxiety. The data come from the randomized three-D study with no inferiority, which compared intermittent theta burst stimulation (iTBS) and high frequency (10 Hz) rTMS delivered to the left dorsolateral prefrontal cortex (HFL).

In the THREE-D study, an analytical cohort of 388 adult outpatients, ages 18 to 65, were naive to rTMS treatment who had been diagnosed with major depression (MDD) and who had 1-3 adequate antidepressant studies failed or at least not tolerated 2 separate studies with antidepressants were randomly treated with iTBS (199 participants, 63.8% with anxiety depression) or HFL (189 participants, 63.5% with anxiety depression).

In the respective groups, HFL treatments were carried out at 120% resting motor threshold (RMT) (4 s on, 26 s off (3000 pulses / session over 37.5 min) and iTBS in triplet 50 Hz bursts at 5 Hz , 2 s on, 8 s off (600 pulses per session over 3 min) to the left DLPFC 5 days per week for 4 to 6 weeks.

After the first 20 treatments, participants who achieved at least a 30% reduction in the 17-point HAM-D score (Hamilton Depression Rating Scale) but did not achieve remission received an additional 10 treatments over 2 weeks. Patients were withdrawn from the study if their HAM-D score worsened by more than 25% in 2 consecutive assessments (and 4 consecutive treatments were absent) or if they developed significant suicidal ideation.

From the baseline to the end of the rTMS course in week 4 or 6, the combined score of the anxiety / somatization elements from the HAM-D fell from 7.42 (standard deviation (SD) = 2.15) to 4.57 (SD = 2.68) in the HFL group and 7.33 (SD = 2.13) to 4.51 (SD = 2.60) in the iTBS group. The maximum improvement in depression and anxiety occurred at week 5, with a similar effect size over time for both models (η2 of 0.159 and 0.237, respectively).

In the short symptom inventory (BSI-A) the values ​​fell from 10.36 (SD = 5.2) to 7.0 (5.5) in the HFL group (mean change = -3.5 ± 5.4) and from 9.6 (SD = 5.3) to 6.1 (4.8)) in the iTBS group (mean change = -3.2 ± 4.8).

A comorbid diagnosis of generalized anxiety disorder (GAD), panic disorder and / or social anxiety had a significant negative effect on the probability of achieving remission (odds ratio (OR) = 0.63; 95% (CI), 0, 40-0.98; P. = 0.039).

The limitations of the study included the large variability in concomitant use of antidepressants and benzodiazepines during the trial and the lack of a sham control.

Disclosure: Some authors of the study have declared industry affiliations. For a full list of the authors’ information, see the original reference.


Trevizol AP, Downar J., Vila-Rodriguez F., Konstantinou G., Daskalakis ZJ, Blumberger DN. Influence of repetitive transcranial magnetic stimulation on anxiety symptoms in patients with major depression: An analysis from the DREI-D study. Depression anxiety. Published online December 11, 2020.

This article originally appeared on Psychiatry Advisor

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