A Secondary Analysis on Effects of Theta Burst Transcranial Magnetic Stimulation to Reduce Anger in Veterans With Posttraumatic Stress Disorder

Wout-Frank, Mascha van ’t; Shea, M. Tracie; Sorensen, David O.; Faucher, Christiana R.; Greenberg, Benjamin D.; Philip, Noah S.

doi:10.1111/ner.13256

Cited by 7 publications

(7 citation statements)

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“…A secondary analysis showed significant reductions in anger. 54 Resting-state fMRI was performed at baseline for a convenience subset of the sample ( n = 26) and ultimately demonstrated two major predictors for PTSD symptom response on the PCL: (1) increased positive connectivity within the default-mode network (DMN), and (2) increased negative connectivity (anticorrelation) between the DMN and externally oriented networks, that is, executive control network (ECN). A naturalistic clinical outcomes study over the following year showed a dose-dependent effect on duration of response, that is, sham participants (who had less cumulative TBS exposure compared with active) were 3.5 times more likely to relapse within 1 year and did so sooner (mean 182 days versus 296 days).…”

Section: Tms Monotherapymentioning

confidence: 99%

Transcranial magnetic stimulation for post-traumatic stress disorder

Petrosino

Cosmo

Berlow

et al. 2021

Therapeutic Advances in Psychopharmacology

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Post-traumatic stress disorder (PTSD) is a debilitating psychiatric disorder. While current treatment options are effective for some, many individuals fail to respond to first-line psychotherapies and pharmacotherapy. Transcranial magnetic stimulation (TMS) has emerged over the past several decades as a noninvasive neuromodulatory intervention for psychiatric disorders including depression, with mounting evidence for its safety, tolerability, and efficacy in treating PTSD. While several meta-analyses of TMS for PTSD have been published to date showing large effect sizes on PTSD overall, there is marked variability between studies, making it difficult to draw simple conclusions about how best to treat patients. The following review summarizes over 20 years of the existing literature on TMS as a PTSD treatment, and includes nine randomized controlled trials and many other prospective studies of TMS monotherapy, as well as five randomized controlled trials investigating TMS combined with psychotherapy. While the majority of studies utilize repetitive TMS targeted to the right dorsolateral prefrontal cortex (DLPFC) at low frequency (1 Hz) or high frequency (10 or 20 Hz), others have used alternative frequencies, targeted other regions (most commonly the left DLPFC), or trialed different stimulation protocols utilizing newer TMS modalities such as synchronized TMS and theta-burst TMS (TBS). Although it is encouraging that positive outcomes have been shown, there is a paucity of studies directly comparing available approaches. Biomarkers, such as functional imaging and electroencephalography, were seldomly incorporated yet remain crucial for advancing our knowledge of how to predict and monitor treatment response and for understanding mechanism of action of TMS in this population. Effects on PTSD are often sustained for up to 2–3 months, but more long-term studies are needed in order to understand and predict duration of response. In short, while TMS appears safe and effective for PTSD, important steps are needed to operationalize optimal approaches for patients suffering from this disorder.

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Section: Tms Monotherapymentioning

confidence: 99%

Transcranial magnetic stimulation for post-traumatic stress disorder

Petrosino

Cosmo

Berlow

et al. 2021

Therapeutic Advances in Psychopharmacology

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“…Six narrative reviews, two systematic reviews, six meta-analyses, one Master-level dissertation, three book chapters, one commentary, and one preprint were also kept out of this work. Overall, 31 studies met the inclusion criteria for the data extraction process and, thus, were included in this systematic review [ 26 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ].…”

Section: Resultsmentioning

confidence: 99%

“…Apart from high- and low-frequency rTMS protocols, theta-burst stimulation has also been proven to be effective in ameliorating PTSD symptomatology. Indeed, ten sessions of active versus sham iTBS over the right dlPFC of fifty veterans with PTSD produced a significant reduction in the overall PTSD symptoms’ severity among the active iTBS group compared to the sham iTBS group [ 54 , 70 , 75 ]. Also, twenty sessions of bilateral iTBS over the dlPFC effectively decreased PTSD-related symptoms among a smaller cohort consisting of eight Australian veterans [ 66 ].…”

Section: Resultsmentioning

confidence: 99%

“…Besides high- and low-frequency rTMS protocols, TBS has also appeared to be effective in lowering the severity of the depressive symptoms self-reported by patients with PTSD. Indeed, ten sessions of sham-controlled iTBS over the right dlPFC resulted in a meaningful reduction in depressive symptoms’ severity among the active iTBS group compared to the sham iTBS group at the end of the treatment [ 54 , 70 , 75 ]. Furthermore, twenty sessions of bilateral iTBS over the dlPFC consistently ameliorated veterans’ depressive symptoms in [ 66 ].…”

Section: Resultsmentioning

confidence: 99%

“…Also, the anxiety and depression that often occur alongside PTSD faced a significant reduction following high- or low-frequency rTMS application (e.g., [ 26 , 61 , 63 , 71 , 78 ]). Not only continuous protocols but also intermittent ones, such as iTBS, generated positive effects on PTSD-related symptoms, including avoidance and negative alterations in mood and cognition, as well as on depressive symptoms [ 54 , 66 , 70 , 75 ]. Although TMS consistently produced a relevant amelioration in patients’ clinical conditions, the protocols’ specifics, e.g., stimulation intensity, number of sessions, and number of pulses administered per session, were highly heterogenous, thus complicating the individuation of a precise protocol for the treatment of PTSD.…”

Section: Discussionmentioning

confidence: 99%

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Novel Approaches for the Treatment of Post-Traumatic Stress Disorder: A Systematic Review of Non-Invasive Brain Stimulation Interventions and Insights from Clinical Trials

Saccenti,

Lodi,

Moro

et al. 2024

Brain Sciences

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First-line treatments for post-traumatic stress disorder (PTSD) encompass a wide range of pharmacotherapies and psychotherapies. However, many patients fail to respond to such interventions, highlighting the need for novel approaches. Due to its ability to modulate cortical activity, non-invasive brain stimulation (NIBS) could represent a valuable therapeutic tool. Therefore, the aim of this systematic review is to summarize and discuss the existing evidence on the ameliorative effects of NIBS on PTSD and comorbid anxiety and depressive symptoms. Our goal is also to debate the effectiveness of an integrated approach characterized by the combination of NIBS and psychotherapy. This search was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines in the PubMed, PsycINFO, PsycARTICLES, PSYINDEX, MEDLINE, and ERIC databases. Overall, 31 studies met the eligibility criteria, yielding a total of 26 clinical trials employing transcranial magnetic stimulation (TMS) and 5 making use of transcranial direct-current stimulation (tDCS). From these studies, it emerged that NIBS consistently reduced overall PTSD symptoms’ severity as well as comorbid anxiety and depressive symptoms. Moreover, we speculate that combining NIBS with prolonged exposure or cognitive processing therapy might represent a promising therapeutic approach for consistently ameliorating subjects’ clinical conditions.

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