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Neurostimulation in Anxiety Disorders, Post-traumatic Stress Disorder, and Obsessive-Compulsive Disorder

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Anxiety Disorders

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1191))

Abstract

Many pharmacological treatments were proved effective in the treatment of panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD); still many patients do not achieve remission with these treatments. Neurostimulation techniques have been studied as promising alternatives or augmentation treatments to pharmacological and psychological therapies. The most studied neurostimulation method for anxiety disorders, PTSD, and OCD was repetitive transcranial magnetic stimulation (rTMS). This neurostimulation technique had the highest level of evidence for GAD. There were also randomized sham-controlled trials indicating that rTMS may be effective in the treatment of PTSD and OCD, but there were conflicting findings regarding these two disorders. There is indication that rTMS may be effective in the treatment of panic disorder, but the level of evidence is low. Deep brain stimulation (DBS) was most studied for treatment of OCD, but the randomized sham-controlled trials had mixed findings. Preliminary findings indicate that DBS could be affective for PTSD. There is weak evidence indicating that electroconvulsive therapy, transcranial direct current stimulation, vagus nerve stimulation, and trigeminal nerve stimulation could be effective in the treatment of anxiety disorders, PTSD, and OCD. Regarding these disorders, there is no support in the current literature for the use of neurostimulation in clinical practice. Large high-quality studies are warranted.

Parts of the chapter were previously published in Understanding Depression Volume II, pp. 277–288, Springer Nature, 2018.

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Abbreviations

ALIC:

Anterior limb of the internal capsule

BOLD:

Blood-oxygen-level-dependent

BST:

Bed nucleus of the stria terminalis

CANMAT:

Canadian Network for Mood and Anxiety Treatments

CAPS:

Clinician-administered post-traumatic stress disorder scale

CES:

Cranial electrotherapy stimulation

DBS:

Deep brain stimulation

DLPFC:

Dorsolateral prefrontal cortex

ECT:

Electroconvulsive therapy

GAD:

Generalized anxiety disorder

HAM-A:

Hamilton Anxiety Rating Scale

IPG:

Implantable pulse generator

iTBS:

Intermittent theta burst stimulation

ITP:

Inferior thalamic peduncle

MDD:

Major depressive disorder

MFB:

Medial forebrain bundle

MPFC:

Medial prefrontal cortex

MRI:

Magnetic resonance imaging

NAc:

Nucleus accumbens

NS:

Neurostimulator.

NTS:

Nucleus tractus solitarius

OCD:

Obsessive-compulsive disorder

OFC:

Orbitofrontal cortex

PD:

Panic disorder

PDSS:

Panic Disorder Severity Scale

PTSD:

Post-traumatic stress disorder

REAC:

Radio electric asymmetric conveyor

RMT:

Resting motor threshold

rTMS:

Repetitive transcranial magnetic stimulation

SAD:

Social anxiety disorder

SCC:

Subcallosal cingulate

SMA:

Supplementary motor area

STN:

Subthalamic nucleus

tDCS:

Transcranial direct current stimulation

TNS:

External Trigeminal Nerve Stimulation

VC/VS:

Ventral internal capsule/ventral striatum

VNS:

Vagus nerve stimulation

Y-BOCS:

Yale-Brown Obsessive Compulsive Scale

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Author information

Authors and Affiliations

  1. Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Rafael Christophe Freire

  2. Department of Psychiatry, Queen’s University, Kingston, ON, Canada

    Rafael Christophe Freire & Roumen Milev

  3. Department of Psychiatry, Queen’s University and Providence Care Hospital, Kingston, ON, Canada

    Casimiro Cabrera-Abreu

  4. Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada

    Roumen Milev

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  1. Rafael Christophe Freire
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  2. Casimiro Cabrera-Abreu
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  3. Roumen Milev
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Editors and Affiliations

  1. College of Medicine, Korea University, Gyeonggido, Korea (Republic of)

    Yong-Ku Kim

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Freire, R.C., Cabrera-Abreu, C., Milev, R. (2020). Neurostimulation in Anxiety Disorders, Post-traumatic Stress Disorder, and Obsessive-Compulsive Disorder. In: Kim, YK. (eds) Anxiety Disorders. Advances in Experimental Medicine and Biology, vol 1191. Springer, Singapore. https://doi.org/10.1007/978-981-32-9705-0_18

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