Repetitive transcranial magnetic stimulation for treatment of major depressive disorder with comorbid generalized anxiety disorder

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) has shown promising results in treating individuals with behavioral disorders such as major depressive disorder (MDD), posttraumatic stress disorder, obsessive-compulsive disorder, and social anxiety disorder. A number of applications of rTMS to different regions of the left and right prefrontal cortex have been used to treat these disorders, but no study of treatment for MDD with generalized anxiety disorder (GAD) has been conducted with application of rTMS to both the left and right prefrontal cortex. We hypothesized that applying low-frequency rTMS to the right dorsolateral prefrontal cortex (DLPFC) before applying it to the left DLPFC for the treatment of depression would be anxiolytic in patients with MDD with GAD. METHODS: Thirteen adult patients with comorbid MDD and GAD received treatment with rTMS in an outpatient setting. The number of treatments ranged from 24 to 36 over 5 to 6 weeks. Response was defined as a >= 50% reduction in symptoms from baseline, and remission was defined as a score of <5 for anxiety symptoms on the 7-item Generalized Anxiety Disorder (GAD-7) scale and <8 for depressive symptoms on the 21-item Hamilton Rating Scale for Depression (HAM-D-21). RESULTS: At the end of the treatment period, for the GAD-7 scale, 11 out of 13 (84.6%) patients' anxiety symptoms were in remission, achieving a score of <5 on the GAD-7, and 10 out of 13 patients (76.9%) achieved a HAM-D-21 score of <8 for depressive symptoms. CONCLUSIONS: In this small pilot study of 13 patients with comorbid MDD and GAD, significant improvement in anxiety symptoms along with depressive symptoms was achieved in a majority of patients after bilateral rTMS application.