SUCCESSFUL TREATMENT OF A PATIENT WITH GENERALIZED ANXIETY DISORDER USING DUAL-SITE TRANSCRANIAL MAGNETIC STIMULATION

The use of Transcranial Magnetic Stimulation (TMS) in treatment-resistant cases of certain psychiatric illnesses is an ever-expanding field of research. As our understanding of the neurobiological underpinnings of psychiatric illness increases, abnormal function in neurocircuits guides the choice of unique targets for neurostimulation therapy. Generalized Anxiety Disorder (GAD) is a common psychiatric disorder with high rates of treatment-resistance and putative functional abnormalities in a variety of frontal and limbic circuits. This case highlights the results of a novel, dual-site TMS protocol in a 25-year-old female with treatment-resistant GAD. The seven week course of treatment combined low frequency TMS over the dorsolateral right prefrontal cortex and high frequency TMS over the dorsolateral left prefrontal cortex. This method of treatment resulted in a 91% improvement in GAD symptoms based on by the Hamilton Anxiety Rating Scale and considerable overall functional improvement based on the Clinical Global Impression-Severity scale. We propose that TMS may prove useful for treatment-resistant GAD and that targeting multiple sites with TMS may improve outcomes compared to TMS targeting a single site.