Article Text

Download PDFPDF

Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis
  1. Huiru Cui1,
  2. Lijuan Jiang1,
  3. Yanyan Wei1,
  4. Wei Li1,
  5. Hui Li1,
  6. Junjuan Zhu1,
  7. Jiaoyan Pang2,
  8. Jijun Wang1,3,4 and
  9. Chunbo Li1,3,4,5
  1. 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  2. 2 School of government, Shanghai University of Political Science and Law, Shanghai, China
  3. 3 Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
  4. 4 Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China
  5. 5 Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
  1. Correspondence to Dr Chunbo Li, Shanghai, China; licb{at}


Background Pharmacological and conventional non-pharmacological treatments are only moderately effective in treating generalised anxiety disorder (GAD). Recently, repetitive transcranial magnetic stimulation (rTMS) has attracted interest because of its potential therapeutic value.

Aim To investigate the efficacy and safety of rTMS treatment for GAD.

Methods Literature studies published in English or Chinese were screened in 10 electronic databases up to 5 December 2018. The included studies’ bias risk was assessed using Cochrane risk of bias assessment tool. Meta-analysis was performed to compute the standardised mean difference (SMD) and risk ratio (RR) along with its 95% CIs through using RevMan V.5.3. Heterogeneity was inspected by I2 and the χ2 test. We performed subgroup analysis and meta-regression to investigate heterogeneity. We used funnel plot to assess publication bias. We used the GRADE approach to assess the whole quality of evidence.

Results Twenty-one studies, with a total sample size of 1481, were analysed. The risk of bias in most studies included is moderate, the majority of which are lacking of blinding methods of treatment allocation. The treatment had beneficial effects in the rTMS group compared with the control group in mean anxiety score (SMD=−0.68; 95% CI −0.89 to −0.46). None of the 21 studies included here reported severe adverse events. As for dropout rates, there are no statistically significant differences between the two groups (RR 1.14, 95% CI 0.72 to 1.82) or adverse events (RR 0.95, 95% CI 0.77 to 1.18). No particular influence on the heterogeneity of any variable was observed. The risk of publication bias was low. According to the GRADE approach, the evidence levels of primary outcome (treatment effects) and secondary outcomes (acceptability and safety) were rated as ‘medium’.

Conclusion The use of rTMS combined with medication treatment may have a significant positive anti-anxiety effect on patients with GAD. However, we should interpret the results cautiously due to the relatively high heterogeneity of the meta-analysis. Future high-quality clinical trials are needed to confirm our results.

  • repetitive transcranial magnetic stimulation
  • rtms
  • generalized anxiety disorder
  • anxiety
  • meta-analysis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • HC and LJ contributed equally.

  • Contributors HC and LJ were responsible for the literature screening. LJ and JZ were responsible for data extraction. HL, YW, JP and WL were responsible for risk of bias assessment. HC and LJ were responsible for statistical analysis and writing up the article. JW and CL were responsible for planning and guidance on this paper.

  • Funding Shanghai Science and Technology Committee (18411952400, 19411968600, 16411965000), Shanghai Municipal Natural Science Foundation (18ZR1432600), Shanghai Municipal Commission of Health and Family Planning Foundation (20164Y0215, 20174Y0021),and SHSMU-ION Research Centre for Brain Disorders (2015NKX004).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.