LAUSR

Introduction Anxiety disorders are the most frequent psychiatric disorders worldwide. The most severe form is panic disorder with a very unfavourable spontaneous course. Although state-of-the art treatment with cognitive behavioural therapy, pharmacotherapy or a combination of both is effective, roughly one third of patients can not be treated sufficiently. Methods In the past years, several attempts have been made to improve standard treatment of panic disorders by means of non-invasive brain stimulation, in particular Transcranial Magnetic Stimulation (rTMS) to the prefrontal cortex. Results In a pilot study, we investigated whether 15 sessions of intermittent Theta Burst Stimulation (iTBS) to the left dorsolateral prefrontal cortex applied as add-on treatment to cognitive behavioural therapy might have a beneficial therapeutic effect. Patients with panic disorder ( n  = 44) were randomly assigned to verum or sham stimulation groups. Although we did not find significantly different reduction in anxiety symptoms, exploratory analyses pointed to a possible beneficial effect (reduction of medication during the treatment phase only in the verum stimulation group). Neurophysiological effects as assessed with Near-Infrared Spectroscopy (NIRS) in terms of a normalized function of the lateral prefrontal cortex during emotional paradigms were found only in the verum stimulated patients. Conclusions We provide hints for a beneficial effect of additional iTBS in the treatment of patients with panic disorders mainly on the neurophysiological and, to a lesser extent, on the clinical level.