Case Report of a 24-Year-Old Man With Resolution of Treatment-Resistant Major Depressive Disorder and Comorbid PTSD Using rTMS

Nakama, Helenna; Garcia, Alissa; O'Brien, Kendra; Ellis, Nathan A.

doi:10.1097/yct.0b013e182a2705d

Cited by 11 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several unblinded studies have examined left-sided high-frequency TMS for patients with both MDD and PTSD considering the very high rate of comorbidity, and have consistently found improvements not only in depressive but also in PTSD symptoms. In one case report, 41 a standard 10 Hz depression protocol was applied to an individual with comorbid PTSD and MDD, and this led to remission on both the Beck Depression Inventory (BDI 50 ) and the PCL. Building on prior work that showed efficacy of an intermediate stimulation frequency of 5 Hz for both depression and anxiety symptoms, two studies found significant improvement in both depression and PTSD with left-sided 5 Hz TMS.…”

Section: Tms Monotherapymentioning

confidence: 99%

Transcranial magnetic stimulation for post-traumatic stress disorder

Petrosino

Cosmo

Berlow

et al. 2021

Therapeutic Advances in Psychopharmacology

View full text Add to dashboard Cite

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.

show abstract

Section: Tms Monotherapymentioning

confidence: 99%

Transcranial magnetic stimulation for post-traumatic stress disorder

Petrosino

Cosmo

Berlow

et al. 2021

Therapeutic Advances in Psychopharmacology

View full text Add to dashboard Cite

show abstract

“…Gene array analyses of post-mortem tissue show dysregulated mitochondrial function in the dlPFC of patients with PTSD ( Su et al., 2008 ). Preliminary evidence suggests that rTMS to strengthen left dlPFC may aid treatment of PTSD, at least in those with depression ( Nakama et al., 2014 ). Functional imaging has also shown altered patterns of PFC activity to emotional charged words in abused women with PTSD ( Bremner et al., 2003 ), although the pattern of changes was more complex.…”

Section: Role Of Dlpfc Dysfunction In Ptsdmentioning

confidence: 99%

The effects of stress exposure on prefrontal cortex: Translating basic research into successful treatments for post-traumatic stress disorder

Arnsten

Raskind

Taylor³

et al. 2015

Neurobiology of Stress

295

207

View full text Add to dashboard Cite

Research on the neurobiology of the stress response in animals has led to successful new treatments for Post-Traumatic Stress Disorder (PTSD) in humans. Basic research has found that high levels of catecholamine release during stress rapidly impair the top-down cognitive functions of the prefrontal cortex (PFC), while strengthening the emotional and habitual responses of the amygdala and basal ganglia. Chronic stress exposure leads to dendritic atrophy in PFC, dendritic extension in the amygdala, and strengthening of the noradrenergic (NE) system. High levels of NE release during stress engage low affinity alpha-1 adrenoceptors, (and likely beta-1 adrenoceptors), which rapidly reduce the firing of PFC neurons, but strengthen amygdala function. In contrast, moderate levels of NE release during nonstress conditions engage higher affinity alpha-2A receptors, which strengthen PFC, weaken amygdala, and regulate NE cell firing. Thus, either alpha-1 receptor blockade or alpha-2A receptor stimulation can protect PFC function during stress. Patients with PTSD have signs of PFC dysfunction. Clinical studies have found that blocking alpha-1 receptors with prazosin, or stimulating alpha-2A receptors with guanfacine or clonidine can be useful in reducing the symptoms of PTSD. Placebo-controlled trials have shown that prazosin is helpful in veterans, active duty soldiers and civilians with PTSD, including improvement of PFC symptoms such as impaired concentration and impulse control. Open label studies suggest that guanfacine may be especially helpful in treating children and adolescents who have experienced trauma. Thus, understanding the neurobiology of the stress response has begun to help patients with stress disorders.

show abstract

“…With this rationale, several studies evaluated the feasibility and the clinical benefits of using TMS or tDCS alone or combined with psychotherapy. In this review, we evaluated 13 RCTs [9,10,18,[21][22][23][24][25][26][27][28][29][30], 11 case series [8,[31][32][33][34][35][36][37][38][39][40], and 6 case reports [7,21,[41][42][43][44] on neuromodulation for PTSD, focusing on TMS, tDCS, and DBS. Details of the articles pooled for analysis in our review are summarized in Tables 1 (TMS), 2 (tDCS), and 3 (DBS).…”

Section: Resultsmentioning

confidence: 99%

Treating Post-traumatic Stress Disorder with Neuromodulation Therapies: Transcranial Magnetic Stimulation, Transcranial Direct Current Stimulation, and Deep Brain Stimulation

et al. 2020

View full text Add to dashboard Cite

Post-traumatic stress disorder (PTSD) is a prevalent and debilitating illness. While standard treatment with pharmacotherapy and psychotherapy may be effective, approximately 20 to 30% of patients remain symptomatic. These individuals experience depression, anxiety, and elevated rates of suicide. For treatment-resistant patients, there is a growing interest in the use of neuromodulation therapies, including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). We conducted a systematic review on the use of neuromodulation strategies for PTSD and pooled 13 randomized clinical trials (RCTs), 11 case series, and 6 case reports for analysis. Overall, most studies reported favorable outcomes in alleviating both PTSD and depressive symptoms. Although several RCTs described significant differences when active and sham stimulations were compared, others found marginal or nonsignificant differences between groups. Also positive were studies comparing PTSD symptoms before and after treatment. The side effect profile with all 3 modalities was found to be low, with mostly mild adverse events being reported. Despite these encouraging data, several aspects remain unknown. Given that PTSD is a highly heterogeneous condition that can be accompanied by distinct psychiatric diagnoses, defining a unique treatment for this patient population can be quite challenging. There has also been considerable variation across trials regarding stimulation parameters, symptomatic response, and the role of adjunctive psychotherapy. Future studies are needed to address these issues.

show abstract

Case Report of a 24-Year-Old Man With Resolution of Treatment-Resistant Major Depressive Disorder and Comorbid PTSD Using rTMS

Cited by 11 publications

References 0 publications

Transcranial magnetic stimulation for post-traumatic stress disorder

Transcranial magnetic stimulation for post-traumatic stress disorder

The effects of stress exposure on prefrontal cortex: Translating basic research into successful treatments for post-traumatic stress disorder

Treating Post-traumatic Stress Disorder with Neuromodulation Therapies: Transcranial Magnetic Stimulation, Transcranial Direct Current Stimulation, and Deep Brain Stimulation

Contact Info

Product

Resources

About