Treating anxious depression using repetitive transcranial magnetic stimulation

J Affect Disord. 2013 Oct;151(1):365-8. doi: 10.1016/j.jad.2013.05.094. Epub 2013 Jun 27.


Background: A subset of patients given a clinical diagnosis of major depressive disorder (MDD) are described as having "anxious depression," a presentation that, in some studies, has been an indicator of poor response to pharmacotherapy. The aim of this study was to determine if anxious depression is associated with attenuated response to repetitive transcranial magnetic stimulation (rTMS), an FDA-approved treatment for MDD.

Methods: Participants were 32 adult outpatients with treatment resistant MDD who were referred for rTMS. The Hamilton Rating Scale for Depression (HAMD) was administered to assess treatment response, and anxious depression was defined as a score of seven or above on the anxiety/somatization factor of the HAMD. A quarter of the sample met the anxious depression criterion at pretreatment.

Results: Both depression (total score) and anxiety symptoms improved from pre- to post-treatment with moderate to large treatment effects. Patients with and without anxious depression demonstrated similar rates of improvement in depression. Patients with versus without anxious depression demonstrated larger improvements in anxiety.

Limitations: The sample size was small, and assessments did not include structured diagnostic interview or independent measures of anxiety symptoms.

Conclusions: For the sample as a whole, there were significant improvements in both depression and anxiety. Anxious depression was not associated with attenuated treatment response to rTMS.

Keywords: Anxiety; Depression; Transcranial magnetic stimulation.

Publication types

  • Clinical Trial

MeSH terms

  • Anxiety / complications
  • Anxiety / psychology
  • Anxiety / therapy*
  • Depressive Disorder, Major / complications
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Transcranial Magnetic Stimulation* / methods
  • Treatment Outcome