title: Repetitive Transcranial Magnetic Stimulation (rTMS) to Treat Social Anxiety Disorder: Case Reports and a Review of the Literature.
abstract: OBJECTIVE
  Social anxiety disorder (SAD) is a common and debilitating anxiety disorders. However, few studies had been dedicated to the neurobiology underlying SAD until the last decade. Rates of non-responders to standard methods of treatment remain unsatisfactorily high of approximately 25%, including SAD. Advances in our understanding of SAD could lead to new treatment strategies. A potential non invasive therapeutic option is repetitive transcranial magnetic stimulation (rTMS). Thus, we reported two cases of SAD treated with rTMS Methods: The bibliographical search used Pubmed/Medline, ISI Web of Knowledge and Scielo databases. The terms chosen for the search were: anxiety disorders, neuroimaging, repetitive transcranial magnetic stimulation.
  
  
  RESULTS
  In most of the studies conducted on anxiety disorders, except SAD, the right prefrontal cortex (PFC), more specifically dorsolateral PFC was stimulated, with marked results when applying high-rTMS compared with studies stimulating the opposite side. However, according to the "valence hypothesis", anxiety disorders might be characterized by an interhemispheric imbalance associated with increased right-hemispheric activity. With regard to the two cases treated with rTMS, we found a decrease in BDI, BAI and LSAS scores from baseline to follow-up.
  
  
  CONCLUSIONS
  We hypothesize that the application of low-rTMS over the right medial PFC (mPFC; the main structure involved in SAD circuitry) combined with high-rTMS over the left mPFC, for at least 4 weeks on consecutive weekdays, may induce a balance in brain activity, opening an attractive therapeutic option for the treatment of SAD.
authors.affiliation: Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, RJ, Brazil ; National Institute for Translational Medicine (INCT-TM), Brazil.
authors.forename: Flávia
authors.initials: F
authors.lastname: Paes
authors.forename: Tathiana
authors.initials: T
authors.lastname: Baczynski
authors.forename: Felipe
authors.initials: F
authors.lastname: Novaes
authors.forename: Tamires
authors.initials: T
authors.lastname: Marinho
authors.forename: Oscar
authors.initials: O
authors.lastname: Arias-Carrión
authors.forename: Henning
authors.initials: H
authors.lastname: Budde
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Sack
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Huston
authors.forename: Leonardo Ferreira
authors.initials: LF
authors.lastname: Almada
authors.forename: Mauro
authors.initials: M
authors.lastname: Carta
authors.forename: Adriana Cardoso
authors.initials: AC
authors.lastname: Silva
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Nardi
authors.forename: Sergio
authors.initials: S
authors.lastname: Machado
keywords: Dorsolateral prefrontal cortex; medial prefrontal cortex; repetitive transcranial magnetic stimulation; social anxiety disorders; valence hypothesis.