Efficacy and acceptability of brain stimulation for anxiety disorders, OCD, and PTSD: A systematic review and network meta-analysis of randomized controlled trials

J Affect Disord. 2025 Feb 1:370:62-75. doi: 10.1016/j.jad.2024.10.071. Epub 2024 Oct 28.

Abstract

Background: The present study aimed to conduct a systematic review and network meta-analysis to investigate the efficacy and acceptability of brain stimulation techniques (BSTs) for anxiety disorders, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).

Methods: A comprehensive search was performed in Embase, PubMed, Web of Science, PsycINFO, Cochrane, ClinicalTrials.gov and HowNet databases for studies published before September 10, 2023. Randomized clinical trials that involved deep brain stimulation (DBS), electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), sham therapy, or health control were included for analysis. The primary outcome was efficacy, while acceptability was considered as a secondary outcome.

Results: The sample consisted of 1333 patients with various anxiety disorders including social anxiety disorder, general anxiety disorder, panic disorder, social panic, obsessive-compulsive disorder, post-traumatic stress disorder, and agoraphobia, recruited from 41 trials with 86 treatment arms. Network meta-analysis showed that some BSTs had higher efficacy compared to controls, including DBS, ECT, cathodal tDCS, high-frequency rTMS (hf-rTMS), anodal tDCS, and low-frequency rTMS (lf-rTMS). Furthermore, hf-rTMS, lf-rTMS, and ECT had high acceptability in terms of odds ratio (OR).

Limitations: This study has limitations, including a focus on specific types of brain stimulation for anxiety disorders, OCD and PTSD and not considering factors like stimulation parameters. Future research should explore a broader range of technologies and parameters across various psychiatric and neurological conditions.

Conclusion: The study results suggest that BSTs are effective treatments for anxiety disorders, OCD and PTSD; lf-rTMS may be considered as the most promising option.

Keywords: Anxiety disorders; Brain stimulation; DBS; ECT; TMS; tDCS.

Publication types

  • Systematic Review
  • Network Meta-Analysis

MeSH terms

  • Anxiety Disorders* / therapy
  • Deep Brain Stimulation* / methods
  • Deep Brain Stimulation* / psychology
  • Electroconvulsive Therapy* / methods
  • Electroconvulsive Therapy* / psychology
  • Humans
  • Obsessive-Compulsive Disorder* / therapy
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data
  • Randomized Controlled Trials as Topic
  • Stress Disorders, Post-Traumatic* / therapy
  • Transcranial Direct Current Stimulation* / methods
  • Transcranial Direct Current Stimulation* / psychology
  • Transcranial Magnetic Stimulation* / methods
  • Transcranial Magnetic Stimulation* / psychology
  • Treatment Outcome