Brain stimulation in the treatment of anxiety disorders
Introduction Brain stimulation represents a growing family of interventions that alter brain function using electrical fields that are either directly applied or indirectly induced using rapidly alternating magnetic fields. Brain stimulation techniques include transcranial electrical approaches (e.g., electroconvulsive therapy, ECT), magnetic approaches (e.g., transcranial magnetic stimulation, TMS), and surgical approaches (e.g., vagus nerve stimulation, VNS; and deep brain stimulation, DBS) (Table 28.1). These modalities differ in their means of application, focality, invasiveness, mechanism of action, side-effect profile, and clinical spectrum. They have in common the use of electrical stimulation to modulate neuronal functioning. Here we review research to date on these approaches in the treatment of anxiety disorders and discuss how this work may advance knowledge and test hypotheses about the neural circuitry underlying anxiety disorders. Electroconvulsive therapy (ECT) Electroconvulsive therapy (ECT) uses pulsed electrical fields applied to the scalp to induce a generalized seizure. Abundant literature supports the efficacy of ECT as a highly successful therapy for patients with major depressive disorder (MDD), especially with the psychotic subtype, melancholia, and catatonia. However, there is limited controlled evidence regarding its use in patients with anxiety or the many disorders in which anxiety is prominent (Carney et al. 1965, Pande et al. 1988).
