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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents data from a meta-analysis of randomized controlled trials in transcranial magnetic stimulation (TMS) among depressed patients. The results showed that TMS appears effective in treating anxiety symptoms in patients with depression.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMood Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAnxiety Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychiatry Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychiatry\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMood Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAnxiety Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychiatry Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EGretchen J. Diefenbach, PhD, Institute of Living at Hartford Hospital, Hartford, Connecticut, USA, presented data from a meta-analysis of randomized controlled trials (RCTs) in transcranial magnetic stimulation (TMS) among depressed patients. The results showed that TMS appears effective in treating anxiety symptoms in patients with depression.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAlthough studies have increasingly shown evidence for the efficacy of TMS among patients with depression [Slotema CW et al. \u003Cem\u003EJ Clin Psychiatry\u003C\/em\u003E 2010; Schutter DJ. \u003Cem\u003EPsychol Med\u003C\/em\u003E 2009], its anxiolytic effect is poorly documented. However, based on the comorbidity of anxiety and depression, this is an important area to investigate. Additionally, among patients with depression who also have anxiety, its symptoms tend to be more severe and also maybe more treatment resistant.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ETo further investigate this, Dr. Diefenbach and colleagues conducted a meta-analysis of data from RCTs to establish the pooled anxiolytic treatment effect of TMS among depressed patients. They used the Hamilton Depression Rating Scale as an outcome measure to assess anxiety symptom change, specifically using the anxiety\/somatization subscale, which comprises 6 items: anxiety (psychic), anxiety (somatic), somatic symptoms (gastrointestinal), somatic symptoms (general), hypochondriasis, and insight.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThey performed a literature search of the Scopus, Medline, and PsycINFO databases, using search terms including \u003Cem\u003Etranscranial magnetic stimulation\u003C\/em\u003E or \u003Cem\u003ETMS\u003C\/em\u003E or \u003Cem\u003ErTMS; controlled trial\u003C\/em\u003E or \u003Cem\u003Esham\u003C\/em\u003E or \u003Cem\u003ERCT;\u003C\/em\u003E and \u003Cem\u003Edepression\u003C\/em\u003E or \u003Cem\u003Edepressive disorder\u003C\/em\u003E or \u003Cem\u003EMDD\u003C\/em\u003E, which identified 634 articles through June 2013. To be included in the meta-analysis, studies were required to be an RCT comparing TMS versus sham that treated depressive symptoms as the primary target, with TMS targeting the dorsolateral prefrontal cortex. They also had to comprise an adult sample with major depressive disorder, register the Hamilton Depression Rating Scale, and be published in English. Of these 634 articles, 64 met the inclusion criteria, but none of the publications contained all the relevant data, so authors were contacted directly. Complete data were subsequently acquired for 12 studies. Of the combined study participants (n=709), 395 received TMS and 314 received sham treatment.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThere was no significant difference in mean pretreatment scores between the 2 groups. The statistics associated with the null result are as follows: rTMS group mean score, 7.56; sham group mean score, 7.48; \u003Cem\u003Et\u003C\/em\u003E(25)=0.15; p=0.88. However, analysis of the in-group pooled treatment effect showed a moderate treatment effect for sham and a large treatment effect for TMS, with the difference between them trending toward statistical significance (p=0.065; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). There was also a moderate but significant difference (p\u0026lt;0.001) in posttreatment between-group effect sizes. Patients who received TMS reported lower anxiety somatization subscale scores than those who received sham. The large fail-safe number (n=102) suggests that these meta-analytic findings are robust.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/8\/15\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Posttreatment Between-Group Effect\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-927523013\u0022 data-figure-caption=\u0022Posttreatment Between-Group Effect\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/8\/15\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/8\/15\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/8\/15\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15839\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EPosttreatment Between-Group Effect\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ETMS=transcranial magnetic Stimulation.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from GJ Diefenbach, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EThe researchers did not pursue analyses of treatment moderators, since there was no significant difference (p=0.56) in between-study heterogeneity, which implied that the results were generally uniform across the different studies.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe results of this meta-analysis indicate that TMS is superior to sham for treating anxiety symptoms in patients with depression, and Dr. Diefenbach concluded that it is important to consider expanding TMS treatment to anxiety disorders. She also indicated that it is important for investigators in future studies to include anxiety assessments in their TMS research, to evaluate changes in individual symptoms, response rates, and anxious depression status.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/8\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp891\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp891\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}