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Evidence-Based Reviews
Generalized anxiety disorder: 8 studies of biological interventions
Current Psychiatry. 2022 July;21(7):10-12,20,22-27 | doi: 10.12788/cp.0264
Sy Atezaz Saeed, MD, MS Professor and Chair Emeritus Department of Psychiatry and Behavioral Medicine East Carolina University Brody School of Medicine Greenville, North Carolina
Daniel John Majarwitz, MD PGY-2 Resident Internal Medicine and Psychiatry Combined Program Department of Psychiatry and Behavioral Medicine East Carolina University Brody School of Medicine Greenville, North Carolina
Disclosures The authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
Patients with comorbid depression experienced a greater, statistically significant reduction in HAM-D core symptom scores (depressed mood, guilt, suicide ideation, work and interest, retardation, and somatic symptoms general).
The comorbid depression group experienced a trend (but not significant) reduction in total HAM-D and BDI scores.
Conclusions/limitations
Chamomileextract may help reduce depressive symptoms in patients with GAD who also have depression.
This study was not powered to detect significant differences in depression outcome ratings between groups, was exploratory, and was not a controlled trial.
6. Dilkov D, Hawken ER, Kaludiev E, et al. Repetitive transcranial magnetic stimulation of the right dorsal lateral prefrontal cortex in the treatment of generalized anxiety disorder: a randomized, double-blind sham controlled clinical trial. Prog Neuropsychopharmacol Biol Psychiatry. 2017;78:61-65. doi:10.1016/j.pnpbp.2017.05.018
Nonpharmacologic modalities, including rTMS, may be effective alternatives for treating GAD. Dilkov et al17 examined whether excitatory rTMS is an effective treatment option for GAD.
Study design
In this double-blind, sham-controlled trial, adults who met DSM-IV criteria for GAD were randomized to excitatory rTMS of the right dorsolateral prefrontal cortex therapy (n = 15) or a sham procedure (n = 25).
rTMS settings included a frequency of 20 Hz, 110% intensity of resting motor threshold, 20 trains, 9 seconds/train, and 51-second intertrain intervals.
Outcomes were measured by HAM-A, CGI, and 21-item HAM-D.
Outcomes
At the conclusion of 25 treatments, the rTMS group experienced a statistically significant reduction in GAD symptoms as measured by HAM-A.
Improvements were also noted in the CGI and HAM-D scores in the rTMS group compared to the sham group.
The benefits continued at the Week 4 follow-up visit.
Conclusions/limitations
Participants in the rTMS group experienced a significant decrease in anxiety symptoms, which suggests that rTMS may be an effective treatment for GAD.
The benefits appear sustainable even after the conclusion of the rTMS sessions.
This study had a small sample size and excluded patients with comorbid psychiatric conditions.
