Repetitive transcranial magnetic stimulation therapy markedly reduces anxiety in adults with major depressive disorder: A retrospective analysis of 664 patients

Abstract

Abstract Background: Patients with MDD commonly have comorbid anxiety that can severely affect quality of life and, in some cases, predicts inferior response to antidepressant treatment. Nonetheless, for some antidepressant treatments, it is also established that clinical improvement in depressive symptoms is accompanied by improvement in comorbid anxiety symptoms. However, there is limited information on the impact of treatment with TMS on the severity of comorbid anxiety symptoms in MDD patients. Methods: Patient data was extracted from a clinical registry of patients treated with left-sided high frequency TMS. Six hundred and sixty-four (664) patients were identified who demonstrated at least moderate depression and anxiety symptom severity prior to commencing treatment for MDD. These patients had total scores greater than 10 on both the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. Patients were aged 22 to 70 years and had received a minimum course of 20 left-sided treatments. Results: GAD-7 response was defined as a postTMS decrease from baseline in GAD-7 scores ≥ 6 (minimally clinically important difference) and remission was defined as a final GAD-7 score < 5; 65.5% of patients (95% CI: 61.9%. 69.1%) were GAD-7 responders and 34% met the remission criterion. Mean change in the GAD-7 score was -8.0 ± 5.7 (p<0.0001). Mean change in total score on the PHQ-9 was -10.5±6.7 (p<0.0001), and 58.9% of patients demonstrated a 50% or greater improvement in PHQ-9 score. The correlation between change scores on the GAD-7 and PHQ-9 was 0.75 (p<00001), indicating substantial covariation. Conclusions: High frequency TMS may reduce symptoms of both anxiety and depression in adults with MDD. We will also contrast this group with significant co-morbid anxiety to MDD patients with low baseline levels of anxiety in likelihood of antidepressant response to TMS. Keywords: TMS, anxiety, depression, high frequency