Continuous Theta Burst Stimulation for Generalized Anxiety Disorder

Effects of Continuous Theta Burst Stimulation Combined With Pharmacotherapy in Generalized Anxiety Disorder

This randomized clinical trial evaluates the effectiveness of continuous theta burst stimulation (cTBS) combined with background pharmacotherapy in patients with generalized anxiety disorder. Participants will be randomly assigned to receive cTBS targeting either the right posterior parietal cortex or the right dorsolateral prefrontal cortex. The study will compare changes in anxiety symptoms between the two treatment strategies and will also assess quality of life, sleep, cognitive function, electroencephalographic measures, and transcranial magnetic stimulation-electroencephalography measures.

Inclusion Criteria:

• Adults aged 18 to 59 years.
• Diagnosis of generalized anxiety disorder (GAD; ICD-10 F41.1) according to DSM-5 diagnostic criteria.
• Hamilton Anxiety Rating Scale (HAM-A) total score >18 at screening.
• Able to understand the study procedures and provide written informed consent.

Exclusion Criteria:

• History of epilepsy or seizures.
• Presence of metal or implanted electronic devices that are contraindications to transcranial magnetic stimulation (TMS), including relevant intracranial metallic implants or cardiac pacemakers.
• Pregnancy.
• Acute psychotic symptoms or high suicide risk.
• Current substance abuse or dependence that may interfere with study participation.
• Major structural brain lesions that, in the investigator's judgment, may affect study participation or outcome assessment.
• Any other medical or neurological condition that, in the investigator's judgment, makes participation unsafe or may substantially interfere with study procedures.