Next-Generation Neuromodulation for Anxiety: Circuit-Based and Personalized Approaches

PURPOSE OF REVIEW: We provide an update on the current psychiatric research for DBS and TMS and what the field has learned about causal circuitry implicated in anxiety and anxiety-related disorders. RECENT FINDINGS: Recent refinement of DBS and TMS techniques have both improved their safety and efficacy as anxiety treatments and elucidated the pathological circuitry and areas causally involved in psychiatric disease. Anxiety is a debilitating hallmark of many psychiatric disorders. A significant portion of patients do not achieve sufficient benefit from psychotherapy and medication, so other therapies are being investigated. Neuromodulation, which involves targeted stimulation of neural circuitry, is FDA cleared for obsessive compulsive disorder (OCD) and depression and is an option for some patients whose anxiety have not responded to standard therapy. Over the past several years, neuromodulation protocol and technology advancements have continued to evolve the psychiatric treatment paradigm. Transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) are two of the most extensively studied neuromodulation techniques in psychiatry.