Personalized and Accelerated Transcranial Magnetic Stimulation for Treatment-resistant Anxiety Related Disorders

Personalized and Accelerated Transcranial Magnetic Stimulation for Treatment-resistant Anxiety Related Disorders

This proposal seeks to carry out an open-label single arm study to examine the neurobehavioral changes induced by personalized, causal network mapping guided accelerated intermittent theta burst stimulation (aiTBS) in patients with treatment-resistant anxiety-related disorders.

Inclusion Criteria:

• Male/ female aged ≥ 21 years and ≤ 70 years
• Diagnosis of an anxiety-related disorder as validated by the MINI (Specifically, the types of anxiety-related disorders are: generalized anxiety disorder; panic disorderl social anxiety disorder; obsessive compulsive disorder; post-traumatic stress disorder; agoraphobia; anxiety disorder due to another medical condition; other specified anxiety disorders; and unspecified anxiety disorder.)
• Non-response to adequate trial (4 weeks) of at least two anxiety medication as verified by the study clinician, or psychotherapy for anxiety
• BAI score of 16 or above
• Able to give informed consent
• Able to understand English

Exclusion Criteria:

• DSM-5 psychotic disorder
• Significant personality disorder which may hinder the progress of this study
• Drug or alcohol abuse or dependency (preceding 3 months)
• Rapid clinical response required, e.g., high suicide risk
• Significant neurological disorder, which may pose increased risks with TMS, e.g., epilepsy
• Metal in the cranium, skull defects, pacemaker, cochlear implant, medication infusion pumps or any other electronic implants/ devices
• Tattoos containing derromagnetic ink or permanent piercings
• Currently wearing dental braces
• Pregnancy
• Unsuitable for MRI or TMS for any other reasons
• With recent TMS or ECT treatment within the past 3 months
• Currently on multiple stimulant medications (2 or more)
• Participant does not have the capacity to provide consent