Grant: Project Grant

Anxiety disorders are the most common psychiatric disorders and affect close to 6% of older adults in Canada. Late-life generalized anxiety disorder (LL-GAD) is associated with decreased quality of life, increased disability, cognitive impairment, and increased health care utilization. As such, it is a major public health concern. There are evidence-based treatments for anxiety disorders, but a significant proportion of patients (50-60%) do not respond to existing treatments. There are also increased tolerability concerns and barriers to treatments in older adults. Therefore, novel, effective, and more tolerable treatments are needed. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation that uses magnetic fields to stimulate specific areas of the brain. There are previous studies that suggest rTMS may be effective in treating GAD younger adults, but there have been no studies on older adults, which is a critical knowledge gap. This will be a pilot randomized controlled trial conducted at the Centre of Addiction and Mental Health in Toronto, ON. Sixty older adults (age 60 and older) with GAD will be randomly assigned to receive active rTMS or sham stimulation. Treatments will be delivered once daily, 5 times a week, for 6 weeks (30 treatments). The main goal for this trial is to assess the feasibility, safety, and tolerability of rTMS in older adults with GAD. It will also explore the effects of rTMS on anxiety and cognition. If it is found that rTMS for LL-GAD is feasible, safe, and well-tolerated, this will be followed by a larger clinical trial to establish the efficacy of the treatment. If it is found to be effective, this will have a profound impact on older adults living with anxiety disorder, particularly those who have not responded to, or have difficulties tolerating existing treatments. It could significantly reduce the socioeconomic burden associated with late life generalized anxiety disorder.