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 25-year-old woman with a two-year history of diagnostic and statistical manual of mental disorders, 5th edition (dsm-5)–diagnosed, treatment-resistant sad who declined psychotherapy and did not respond to pharmacotherapy. she received 15 sessions of high-frequency (10 hz) repetitive transcranial magnetic stimulation (rtms) to the left dorsolateral prefrontal cortex (dlpfc) (100% motor threshold; 40 trains; 2,000 pulses per session). results: symptom severity measured by the social phobia inventory (spin), decreased from 59 (baseline) to 27 (post-treatment) and remained at 33 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.