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Repetitive transcranial magnetic stimulation (rTMS) holds promise for treating generalised anxiety disorder (GAD) but has only been studied in uncontrolled research.
This is the first randomised controlled trial (clinicaltrials.gov: NCT01659736) to investigate the efficacy and neural correlates of rTMS in GAD.
Twenty five participants (active n = 13; sham, n = 12) enrolled. rTMS was targeted at the right dorsolateral prefrontal cortex (DLPFC, 1 Hz, 90% resting motor threshold).
Response and remission rates were higher in the active v. sham groups and there were significant group × time interactions for anxiety, worry and depressive symptoms, favouring active v. sham. In addition, right DLPFC activation during a decision-making gambling task increased at post-treatment for active rTMS only, and changes in neuroactivation correlated significantly with changes in worry symptoms.
Findings provide preliminary evidence that rTMS may improve GAD symptoms in association with modifying neural activity in the stimulation site.
This chapter summarizes the available evidence for the pharmacological management of social anxiety disorder (SAD). Monoamine oxidase inhibitors (MAOIs) were the first medications to be widely studied as a treatment for SAD. Six double-blind, placebo-controlled trials have consistently demonstrated the efficacy of phenelzine in the treatment of SAD, resulting in symptomatic and functional improvement. Compared with non-reversible MAOIs, reversible inhibitors of monoamine oxidase-A (RIMAs) have a significantly lower risk of potentiating the dangerous pressor effect of tyramine, which allows for relaxation or total elimination of dietary restrictions. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) have been studied widely because of their efficacy, safety, and tolerability compared with earlier medications. The evidence from the reviewed clinical trials and meta-analyses suggests that a number of medications are efficacious in the treat.
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