Prof. Dr. Kemal Arıkan
Psikiyatrist

Generalized Anxiety Disorder and rTMS

The lexical meaning of anxiety is the sensation of fear or panic. Possible to be experienced by all in daily life, this sensation is frequent and constant in generalized anxiety disorder (GAD). These sensations may cause physical symptoms like accelerated heart rate and shivering. The symptoms must be observed for 6 months to make a diagnosis.

Generalized Anxiety Disorder has a prevalence of %3 – 8%. It is more prevalent in women compared to men.

Psychotherapy or pharmacotherapies (antidepressant and anxiolytics) are effective in the treatment of Generalized Anxiety Disorder. Nevertheless, alternative methods of treatment can be used for patients couldn’t benefit from these treatments. Researches are carried out on rTMS to be used as an alternative treatment in Generalized Anxiety Disorder.

Functional neuroimaging studies show that GAD might be arising from a decrease in the effectiveness of the biological mechanisms related to emotional regulation. An increase is observed in the cortex activity of the brain, while the amygdala activity is on the decline, during the anxiety. While this activity goes back to normal levels following the anxiety in healthy individuals, the post-anxiety neural activity does not go back to normal in individuals with anxiety disorder.

The functional neuroimaging studies and animal researches conducted show that anxiety is related to the increase in the right prefrontal cortex activity.

The studies carried out on rats having high anxiety behaviors demonstrate that the behavioral and neuroendocrine effects of rTMS implemented on the frontal brain area can compete with the antidepressant treatment.

In a sham (placebo)-controlled rTMS study, the preliminary results of which were presented at the American Psychiatric Association (APA) in 2014, the right DLPFC area was stimulated at low frequencies (repressive) for 30 sessions (5 sessions a week for 6 weeks). It was shown that more 2/3 of the patients who received active rTMS treatment benefited from the treatment, and that the effects of the treatment continued in the patients who were monitored for 3 months. In another study, it was stated that the remission period had been observed for 6 months in the patients.

As the number of the studies searching the effect of rTMS on Generalized Anxiety Disorder increases, it will be used as an alternative method that is applicable in clinical treatment.