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Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis

BACKGROUND: Pharmacological and conventional non-pharmacological treatments are only moderately effective in treating generalised anxiety disorder (GAD). Recently, repetitive transcranial magnetic stimulation (rTMS) has attracted interest because of its potential therapeutic value. AIM: To investiga...

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Autores principales: Cui, Huiru, Jiang, Lijuan, Wei, Yanyan, Li, Wei, Li, Hui, Zhu, Junjuan, Pang, Jiaoyan, Wang, Jijun, Li, Chunbo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802976/
https://www.ncbi.nlm.nih.gov/pubmed/31673675
http://dx.doi.org/10.1136/gpsych-2019-100051
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author Cui, Huiru
Jiang, Lijuan
Wei, Yanyan
Li, Wei
Li, Hui
Zhu, Junjuan
Pang, Jiaoyan
Wang, Jijun
Li, Chunbo
author_facet Cui, Huiru
Jiang, Lijuan
Wei, Yanyan
Li, Wei
Li, Hui
Zhu, Junjuan
Pang, Jiaoyan
Wang, Jijun
Li, Chunbo
author_sort Cui, Huiru
collection PubMed
description BACKGROUND: Pharmacological and conventional non-pharmacological treatments are only moderately effective in treating generalised anxiety disorder (GAD). Recently, repetitive transcranial magnetic stimulation (rTMS) has attracted interest because of its potential therapeutic value. AIM: To investigate the efficacy and safety of rTMS treatment for GAD. METHODS: Literature studies published in English or Chinese were screened in 10 electronic databases up to 5 December 2018. The included studies’ bias risk was assessed using Cochrane risk of bias assessment tool. Meta-analysis was performed to compute the standardised mean difference (SMD) and risk ratio (RR) along with its 95% CIs through using RevMan V.5.3. Heterogeneity was inspected by I(2) and the χ(2) test. We performed subgroup analysis and meta-regression to investigate heterogeneity. We used funnel plot to assess publication bias. We used the GRADE approach to assess the whole quality of evidence. RESULTS: Twenty-one studies, with a total sample size of 1481, were analysed. The risk of bias in most studies included is moderate, the majority of which are lacking of blinding methods of treatment allocation. The treatment had beneficial effects in the rTMS group compared with the control group in mean anxiety score (SMD=−0.68; 95% CI −0.89 to −0.46). None of the 21 studies included here reported severe adverse events. As for dropout rates, there are no statistically significant differences between the two groups (RR 1.14, 95% CI 0.72 to 1.82) or adverse events (RR 0.95, 95% CI 0.77 to 1.18). No particular influence on the heterogeneity of any variable was observed. The risk of publication bias was low. According to the GRADE approach, the evidence levels of primary outcome (treatment effects) and secondary outcomes (acceptability and safety) were rated as ‘medium’. CONCLUSION: The use of rTMS combined with medication treatment may have a significant positive anti-anxiety effect on patients with GAD. However, we should interpret the results cautiously due to the relatively high heterogeneity of the meta-analysis. Future high-quality clinical trials are needed to confirm our results.
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spelling pubmed-68029762019-10-31 Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis Cui, Huiru Jiang, Lijuan Wei, Yanyan Li, Wei Li, Hui Zhu, Junjuan Pang, Jiaoyan Wang, Jijun Li, Chunbo Gen Psychiatr Systematic Review BACKGROUND: Pharmacological and conventional non-pharmacological treatments are only moderately effective in treating generalised anxiety disorder (GAD). Recently, repetitive transcranial magnetic stimulation (rTMS) has attracted interest because of its potential therapeutic value. AIM: To investigate the efficacy and safety of rTMS treatment for GAD. METHODS: Literature studies published in English or Chinese were screened in 10 electronic databases up to 5 December 2018. The included studies’ bias risk was assessed using Cochrane risk of bias assessment tool. Meta-analysis was performed to compute the standardised mean difference (SMD) and risk ratio (RR) along with its 95% CIs through using RevMan V.5.3. Heterogeneity was inspected by I(2) and the χ(2) test. We performed subgroup analysis and meta-regression to investigate heterogeneity. We used funnel plot to assess publication bias. We used the GRADE approach to assess the whole quality of evidence. RESULTS: Twenty-one studies, with a total sample size of 1481, were analysed. The risk of bias in most studies included is moderate, the majority of which are lacking of blinding methods of treatment allocation. The treatment had beneficial effects in the rTMS group compared with the control group in mean anxiety score (SMD=−0.68; 95% CI −0.89 to −0.46). None of the 21 studies included here reported severe adverse events. As for dropout rates, there are no statistically significant differences between the two groups (RR 1.14, 95% CI 0.72 to 1.82) or adverse events (RR 0.95, 95% CI 0.77 to 1.18). No particular influence on the heterogeneity of any variable was observed. The risk of publication bias was low. According to the GRADE approach, the evidence levels of primary outcome (treatment effects) and secondary outcomes (acceptability and safety) were rated as ‘medium’. CONCLUSION: The use of rTMS combined with medication treatment may have a significant positive anti-anxiety effect on patients with GAD. However, we should interpret the results cautiously due to the relatively high heterogeneity of the meta-analysis. Future high-quality clinical trials are needed to confirm our results. BMJ Publishing Group 2019-09-24 /pmc/articles/PMC6802976/ /pubmed/31673675 http://dx.doi.org/10.1136/gpsych-2019-100051 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Systematic Review
Cui, Huiru
Jiang, Lijuan
Wei, Yanyan
Li, Wei
Li, Hui
Zhu, Junjuan
Pang, Jiaoyan
Wang, Jijun
Li, Chunbo
Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis
title Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis
title_full Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis
title_fullStr Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis
title_full_unstemmed Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis
title_short Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis
title_sort efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: a meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802976/
https://www.ncbi.nlm.nih.gov/pubmed/31673675
http://dx.doi.org/10.1136/gpsych-2019-100051
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