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Published on: October 4, 2016
Repetitive Transcranial Magnetic Stimulation in Adjustment Disorder With Mixed Anxiety and Depressed Mood
Dan-Alexandru Constantin1, Daniela Elena Spanu1, Vlad Monescu2
1Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania ; and.
Background:
Adjustment disorder with mixed anxiety and depressed mood lacks established treatment protocols, despite its clinical significance. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated efficacy in stress-related conditions, yet its application in adjustment disorder remains limited.
Study Question:
This retrospective chart review examined the safety and clinical benefit of rTMS for this condition in a Romanian health care context.
Study Design:
Sixty adults with adjustment disorder with mixed anxiety and depressed mood were identified from outpatient clinic records and grouped by treatment received: rTMS alone (n = 20), rTMS with medication (n = 10), or medication only (n = 30).
Measures And Outcomes:
Low-frequency 1-Hz stimulation at 110% of the motor threshold was applied to the right dorsolateral prefrontal cortex in 10 sessions over 2 weeks. Depressive and anxiety symptoms were measured at baseline and at day 30 using the Hamilton Depression Rating Scale and the Hamilton Anxiety Scale. Logistic regression analysis was used to identify factors associated with treatment outcomes.
Results And Discussion:
Significant symptom improvements occurred across all groups ( P < 0.001). Complete remission rates varied substantially: rTMS monotherapy achieved 80% remission, medication alone 40%, and combined treatment 20% (χ 2 = 13.714, P = 0.008). Sixty percent of participants showed clinical response. Treatment modality predicted response, with rTMS monotherapy increasing odds of improvement 5.7-fold versus medication alone ( P = 0.017). Lower baseline anxiety predicted combined remission (OR = 0.779, P = 0.001), while demographic factors showed no predictive value. Adverse events were mild and transient, with no serious complications or discontinuations. Urban residence significantly influenced rTMS uptake ( P = 0.011).
Conclusions:
rTMS seems effective and may be considered alongside conventional pharmacotherapy for adjustment disorder with mixed anxiety and depressed mood. The intervention showed good tolerability. Geographic barriers to access warrant attention in service planning. Larger randomized controlled trials with extended follow-up are needed to confirm these findings and establish optimal protocols.
