The primary side effects of iTBS include headaches, dizziness, neck and shoulder pain, nausea, paresthesia, and facial twitching. Additionally, a case report has docu­mented the induction of seizures in a child with schizophrenia following iTBS treat­ment [33]. While a separate case series has highlighted the potential for treatment-induced manic symptoms [34]. These ndings underscore the importance of continued monitoring to fully assess and ensure the safety of iTBS.

Accelerated iTBS has been extensively studied for the treatment of depressive dis­orders; however, its application in anxiety disorders remains limited, necessitating further research to establish its efcacy in managing anxiety symptoms.

Accelerated iTBS has not yet been incorporated into clinical treatment guide­lines for anxiety disorders. However, preliminary studies suggest it may hold potential for alleviating anxiety symptoms (Table10.1). Under specic condi­tions, accelerated iTBS can be considered an experimental treatment option for anxiety disorders; however, its efcacy and safety require further validation through additional research. Before clinical application, its potential benets and risks should be carefully weighed, and it should not be regarded as a stan­dard treatment approach.

Similarly, Littman etal. recruited nine patients with severe depression or bipolar depression from a private TMS clinic to receive off-label cTBS targeting the right DLPFC. Following treatment, anxiety symptoms in eight out of nine patients decreased by more than 50% on the HAMA scale [41].

Bilateral TBS is an advanced neuromodulation approach designed to target both hemispheres of the brain, either simultaneously or sequentially. This technique aims to enhance therapeutic outcomes by leveraging the functional connectivity between hemispheric regions implicated in mood and anxiety regulation.

Chen etal. performed a three-arm, single-blind, randomized controlled mul­ticenter trial to evaluate the effects of bilateral TBS on anxiety. Participants were randomly assigned to one of three groups: a control group receiving 10Hz rTMS applied to the left DLPFC, a low-intensity bilateral group receiving cTBS and iTBS applied to the right and left DLPFC, respectively, and a high-intensity bilateral group using the same stimulation protocol but at higher intensities. All groups underwent 20 treatment sessions. While signicant reductions in BAI scores were observed across all groups from baseline to weeks 4 and 8, no sig­nicant differences in anxiety reduction were found between the three treatment modalities [51].

Tavares etal. conducted a 6-week, single-center, double-blind, randomized, par­allel-group, sham-controlled trial to assess the efcacy of bilateral TBS in anxiety treatment. The protocol involved cTBS applied to the right DLPFC, followed by iTBS applied to the left DLPFC.However, no signicant differences in HAMA scores were observed between the active and sham groups, further highlighting the need for additional investigation [52].

Conventional tDCS administers a continuous, low-intensity direct current to spe­cic brain regions, altering neural activity and modulating cortical excitability.

However, conicting results were reported by Aksu etal., who conducted a tri­ple-blind, randomized, sham-controlled trial involving 30 PD patients. The active stimulation group received tDCS with the anode placed over the left DLPFC (F3) and the cathode over the right DLPFC (F4) for 20min per session over 10 consecu­tive days. While both the active and sham stimulation groups showed improvements in anxiety scores, no signicant differences were observed between them, and the active stimulation group did not demonstrate superior therapeutic effects [61].