Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-Analysis
BackgroundPathological anxiety is responsible for major functional impairments and resistance to conventional treatments in anxiety disorders (ADs), posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Focal neuromodulation therapies such as transcranial magnetic stimulation (TM...
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2022.910897/full |
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| author | Florian Gay Florian Gay Allison Singier Allison Singier Bruno Aouizerate Bruno Aouizerate Bruno Aouizerate Francesco Salvo Francesco Salvo Francesco Salvo Thomas C. M. Bienvenu Thomas C. M. Bienvenu Thomas C. M. Bienvenu |
| author_facet | Florian Gay Florian Gay Allison Singier Allison Singier Bruno Aouizerate Bruno Aouizerate Bruno Aouizerate Francesco Salvo Francesco Salvo Francesco Salvo Thomas C. M. Bienvenu Thomas C. M. Bienvenu Thomas C. M. Bienvenu |
| author_sort | Florian Gay |
| collection | DOAJ |
| description | BackgroundPathological anxiety is responsible for major functional impairments and resistance to conventional treatments in anxiety disorders (ADs), posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Focal neuromodulation therapies such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) are being developed to treat those disorders.MethodsWe performed a dimensional systematic review and meta-analysis to assess the evidence of the efficacy of TMS, tDCS and DBS in reducing anxiety symptoms across ADs, PTSD and MDD. Reports were identified through systematic searches in PubMed/Medline, Scopus and Cochrane library (inception to November 2020), followed by review according to the PRISMA guidelines. Controlled clinical trials examining the effectiveness of brain stimulation techniques on generic anxiety symptoms in patients with ADs, PTSD or MDD were selected.ResultsNineteen studies (RCTs) met inclusion criteria, which included 589 participants. Overall, focal brain activity modulation interventions were associated with greater reduction of anxiety levels than controls [SMD: −0.56 (95% CI, −0.93 to−0.20, I2 = 77%]. Subgroup analyses revealed positive effects for TMS across disorders, and of focal neuromodulation in generalized anxiety disorder and PTSD. Rates of clinical responses and remission were higher in the active conditions. However, the risk of bias was high in most studies.ConclusionsThere is moderate quality evidence for the efficacy of neuromodulation in treating pathological anxiety.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=233084, identifier: PROSPERO CRD42021233084. It was submitted on January 29th, 2021, and registered on March 1st, 2021. No amendment was made to the recorded protocol. A change was applied for the subgroup analyses based on target brain regions, we added the putative nature (excitatory/inhibitory) of brain activity modulation. |
| first_indexed | 2024-12-10T08:32:39Z |
| format | Article |
| id | doaj.art-880385a024744f2caf435d1a1877c7b6 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-10T08:32:39Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-880385a024744f2caf435d1a1877c7b62022-12-22T01:56:03ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402022-07-011310.3389/fpsyt.2022.910897910897Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-AnalysisFlorian Gay0Florian Gay1Allison Singier2Allison Singier3Bruno Aouizerate4Bruno Aouizerate5Bruno Aouizerate6Francesco Salvo7Francesco Salvo8Francesco Salvo9Thomas C. M. Bienvenu10Thomas C. M. Bienvenu11Thomas C. M. Bienvenu12Université de Bordeaux, Bordeaux, FranceCentre de Référence Régional des Pathologies Anxieuses et de la Dépression, Pôle de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, FranceUniversité de Bordeaux, Bordeaux, FranceBordeaux Population Health, Inserm U1219, Bordeaux, FranceUniversité de Bordeaux, Bordeaux, FranceCentre de Référence Régional des Pathologies Anxieuses et de la Dépression, Pôle de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, FranceNutriNeuro, UMR 1286, INRAE, Bordeaux INP, Bordeaux, FranceUniversité de Bordeaux, Bordeaux, FranceBordeaux Population Health, Inserm U1219, Bordeaux, FranceCHU de Bordeaux, Bordeaux, FranceUniversité de Bordeaux, Bordeaux, FranceCentre de Référence Régional des Pathologies Anxieuses et de la Dépression, Pôle de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, FranceNeurocentre Magendie, Inserm U1215, Bordeaux, FranceBackgroundPathological anxiety is responsible for major functional impairments and resistance to conventional treatments in anxiety disorders (ADs), posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Focal neuromodulation therapies such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) are being developed to treat those disorders.MethodsWe performed a dimensional systematic review and meta-analysis to assess the evidence of the efficacy of TMS, tDCS and DBS in reducing anxiety symptoms across ADs, PTSD and MDD. Reports were identified through systematic searches in PubMed/Medline, Scopus and Cochrane library (inception to November 2020), followed by review according to the PRISMA guidelines. Controlled clinical trials examining the effectiveness of brain stimulation techniques on generic anxiety symptoms in patients with ADs, PTSD or MDD were selected.ResultsNineteen studies (RCTs) met inclusion criteria, which included 589 participants. Overall, focal brain activity modulation interventions were associated with greater reduction of anxiety levels than controls [SMD: −0.56 (95% CI, −0.93 to−0.20, I2 = 77%]. Subgroup analyses revealed positive effects for TMS across disorders, and of focal neuromodulation in generalized anxiety disorder and PTSD. Rates of clinical responses and remission were higher in the active conditions. However, the risk of bias was high in most studies.ConclusionsThere is moderate quality evidence for the efficacy of neuromodulation in treating pathological anxiety.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=233084, identifier: PROSPERO CRD42021233084. It was submitted on January 29th, 2021, and registered on March 1st, 2021. No amendment was made to the recorded protocol. A change was applied for the subgroup analyses based on target brain regions, we added the putative nature (excitatory/inhibitory) of brain activity modulation.https://www.frontiersin.org/articles/10.3389/fpsyt.2022.910897/fullDBS (deep brain stimulation)tDCS – transcranial direct current stimulationrTMS (repetitive transcranial magnetic stimulation)anxietymeta-analysis |
| spellingShingle | Florian Gay Florian Gay Allison Singier Allison Singier Bruno Aouizerate Bruno Aouizerate Bruno Aouizerate Francesco Salvo Francesco Salvo Francesco Salvo Thomas C. M. Bienvenu Thomas C. M. Bienvenu Thomas C. M. Bienvenu Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-Analysis Frontiers in Psychiatry DBS (deep brain stimulation) tDCS – transcranial direct current stimulation rTMS (repetitive transcranial magnetic stimulation) anxiety meta-analysis |
| title | Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-Analysis |
| title_full | Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-Analysis |
| title_fullStr | Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-Analysis |
| title_full_unstemmed | Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-Analysis |
| title_short | Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-Analysis |
| title_sort | neuromodulation treatments of pathological anxiety in anxiety disorders stressor related disorders and major depressive disorder a dimensional systematic review and meta analysis |
| topic | DBS (deep brain stimulation) tDCS – transcranial direct current stimulation rTMS (repetitive transcranial magnetic stimulation) anxiety meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2022.910897/full |
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