Abstract
(1) Background: While the therapeutic efficacy of Transcranial Magnetic Stimulation (TMS) for major depressive disorder (MDD) is well established, less is known about the technique’s efficacy for treating comorbid anxiety. (2) Methods: Data were retrospectively analyzed from randomized controlled trials (RCTs) that used Deep TMS with the H1 Coil for MDD treatment. The primary endpoint was the difference relative to sham treatment following 4 weeks of stimulation. The effect size was compared to literature values for superficial TMS and medication treatments. (3) Results: In the pivotal RCT, active Deep TMS compared with sham treatment showed significantly larger improvements in anxiety score (effect size = 0.34, p = 0.03 (FDR)) which were sustained until 16 weeks (effect size = 0.35, p = 0.04). The pooled effect size between all the RCTs was 0.55, which compares favorably to alternative treatments. A direct comparison to Figure-8 Coil treatment indicated that treatment with the H1 Coil was significantly more effective (p = 0.042). In contrast to previously reported studies using superficial TMS and medication for which anxiety has been shown to be a negative predictor of effectiveness, higher baseline anxiety was found to be predictive of successful outcome for the H1-Coil treatment. (4) Conclusions: Deep TMS is effective in treating comorbid anxiety in MDD and, unlike alternative treatments, the outcome does not appear to be adversely affected by high baseline anxiety levels.
Highlights
Comorbid anxiety is common in patients with major depressive disorder (MDD), and these disorders may share a common underlying pathophysiology [1]
(3) Results: In the pivotal randomized controlled trials (RCTs), active Deep Transcranial Magnetic Stimulation (TMS) compared with sham treatment showed significantly larger improvements in anxiety score (effect size = 0.34, p = 0.03 (FDR)) which were sustained until 16 weeks
(4) Conclusions: Deep TMS is effective in treating comorbid anxiety in MDD and, unlike alternative treatments, the outcome does not appear to be adversely affected by high baseline anxiety levels
Summary
Comorbid anxiety is common in patients with major depressive disorder (MDD), and these disorders may share a common underlying pathophysiology [1]. Relying on ICD-10 or DSM diagnoses (i.e., syndromal criteria) yields a clinical picture of a comparatively mild or transient disorder. Using dimensional criteria such as DSM combined with additional rating scales—most commonly, the Anxiety/Somatization factor score from the Hamilton Depression Rating Scale (HDRS-A/S) [8]—yields a more serious clinical picture. The latter have, far, provided the most clinically relevant data on differences between subjects with anxious depression and those with depression or anxiety alone [9]. Patients with anxious depression have worse clinical course trajectories and outcomes, including greater depression severity, lower remission rates, higher dysfunction, and increased risk for suicide [11]
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