A 215-patient multi-site sham-controlled trial reported significant anxiety reductions in patients with generalized anxiety disorder following six weeks of right dorsolateral prefrontal cortex TMS. Hamilton Anxiety Rating Scale scores dropped by an average of 13.4 points in the active arm versus 5.8 points in sham.
Patients enrolled in the trial had failed at least two prior treatments — typically including an SSRI and either buspirone or psychotherapy. The trial used 1Hz inhibitory stimulation, opposite to the protocol used in depression, reflecting different mechanistic theories about anxiety neurocircuitry.
The findings position TMS as a potential evidence-based option for treatment-resistant generalized anxiety disorder. FDA clearance for an anxiety-specific indication is not yet pending, but the data may support an indication submission. Off-label TMS for anxiety is currently delivered at a small number of specialty clinics.
Insurance coverage for anxiety-indicated TMS is currently rare. The American Psychiatric Association indicated the data would be reviewed in the next update of its anxiety disorders guidelines.
Source
Reporting based on coverage from JAMA Psychiatry. This article is editorial summary intended for general information; it is not medical advice.