High-frequency Repetitive Transcranial Magnetic Stimulation for Treatment-resistant Social Anxiety Disorder: A Case Report and Literature Review

Objective: Social anxiety disorder (SAD) is characterized by an intense fear of social evaluation and marked avoidance of social situations.  Methods: We report a ۲۵-year-old woman with a two-year history of diagnostic and statistical manual of mental disorders, ۵th edition (DSM-۵)–diagnosed, treatment-resistant SAD who declined psychotherapy and did not respond to pharmacotherapy. She received ۱۵ sessions of high-frequency (۱۰ Hz) repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) (۱۰۰% motor threshold; ۴۰ trains; ۲,۰۰۰ pulses per session).  Results: Symptom severity measured by the social phobia inventory (SPIN), decreased from ۵۹ (baseline) to ۲۷ (post-treatment) and remained at ۳۳ at the three-month follow-up. Clinician-rated clinical global impression (CGI) scores corroborated this substantial improvement. No adverse events were observed.  Conclusion: We place this case in the context of prior reports that used different targets and polarities (e.g. inhibitory medial prefrontal protocols) and discuss the possible mechanisms by which excitatory left DLPFC stimulation may modulate fronto-limbic circuits involved in social threat processing. This single case is hypothesis-generating: while the results are encouraging, limitations include the uncontrolled design, reliance on a primary self-report outcome, and limited follow-up. Controlled trials with standardized clinician ratings and multimodal imaging are required to confirm efficacy and elucidate mechanisms.

کلیدواژه ها:

Social anxiety disorder (SAD) ، Repetitive transcranial magnetic stimulation (rTMS) ، Dorsolateral prefrontal cortex (DLPFC) ، High-frequency stimulation