Targeting cravings in substance addiction with transcranial direct current stimulation: insights from a meta-analysis of sham-controlled trials

Cathodal Transcranial Direct Current Stimulation Does Not Change Implicit Associations Against Alcohol in Alcohol Use Disorder: A Preregistered Clinical Trial

Addictive behaviour is shaped by the dynamic interaction of implicit, bottom-up and explicit, top-down cognitive processes. In alcohol use disorder (AUD), implicit alcohol-related associations have been shown to predict increased subsequent alcohol consumption and are linked to the risk of relapse. Explicit cognitive processes, exerting prefrontal top-down control, are particularly significant during the critical period following the decision to abstain. This study aims to map implicit and explicit cognitive processes in recently abstinent individuals with AUD and to explore the effect of cathodal transcranial direct current stimulation (tDCS) on implicit associations by modulating top-down control. In this preregistered, double-blind, sham-controlled clinical trial, 30 abstinent individuals with AUD participated in two experimental sessions. They received either 2 mA cathodal tDCS to the left dorsolateral prefrontal cortex (dlPFC) or sham tDCS in a crossover design. During tDCS, participants completed the alcohol approach implicit association test (IAT) and the drinking identity IAT, along with two control tasks. Additionally, we collected explicit ratings of the IAT stimuli and assessed craving before and after each experimental session. Preregistered ANOVAs revealed significant implicit alcohol-avoidance and non-drinking identity biases. Cathodal tDCS did not modulate IAT scores. Explicit ratings showed a preference for non-alcoholic drinks and non-drinking identity, correlating moderately with IAT scores. Exploratory analyses indicated that cathodal tDCS mitigated the increase in nicotine craving during the experimental session. This preregistered clinical trial provides robust evidence that single-session cathodal tDCS to the left dorsolateral prefrontal cortex does not modulate implicit associations in AUD, with Bayesian analyses corroborating the absence of tDCS effects. Our results emphasize the impact of contextual factors on the interplay between explicit and implicit cognitive processes and underscore the importance of investigating multisession stimulation paradigms in future research.

Subthreshold electric fields bidirectionally modulate neurotransmitter release through axon polarization

Subthreshold electric fields modulate brain activity and demonstrate potential in several therapeutic applications. Electric fields are known to generate heterogenous membrane polarization within neurons due to their complex morphologies. While the effects of somatic and dendritic polarization in postsynaptic neurons have been characterized, the functional consequences of axonal polarization on neurotransmitter release from the presynapse are unknown. Here, we combined noninvasive optogenetic indicators of voltage, calcium and neurotransmitter release to study the subcellular response within single neurons to subthreshold electric fields. We first captured the detailed spatiotemporal polarization profile produced by uniform electric fields within individual neurons. Small polarization of presynaptic boutons produces rapid and powerful modulation of neurotransmitter release, with the direction - facilitation or inhibition - depending on the direction of polarization. We determined that subthreshold electric fields drive this effect by rapidly altering the number of synaptic vesicles participating in neurotransmission, producing effects which resemble short-term plasticity akin to presynaptic homeostatic plasticity. These results provide key insights into the mechanisms of subthreshold electric fields at the cellular level.

Abstract Figure

Efficacy of brain stimulation therapies across psychiatric, movement, and cognitive disorders: an umbrella review synthesizing meta-analyses of randomized controlled trials

Background

Brain stimulation therapy (BST) has significant potential in treating psychiatric, movement, and cognitive disorders. Given the high prevalence of comorbidities among these disorders, we conducted an umbrella review to comprehensively assess the efficacy of BSTs in treating the core symptoms across these three categories of disorders.

Methods

We systematically searched for meta-analyses and network meta-analyses of randomized controlled trials with sham controls up to September 25, 2024, from databases including PubMed, PsycINFO, Embase, and the Cochrane Library. Our primary outcome was improvements in core symptoms. We evaluated quality using 11 criteria. We calculated pooled effect estimates for core symptoms based on the largest meta-analyses, then conducted sensitivity and subgroup analyses, and assessed heterogeneity, publication bias, and small-study effects. Finally, we synthesized effect sizes from all meta-analyses to provide a comprehensive overview of BSTs' efficacy. PROSPERO registration: CRD42023439090.

Findings

We included 198 articles with 108,377 patients evaluating 14 BSTs across 21 disorders. The largest meta-analysis showed a moderate standardized mean difference (SMD) of 0.56 (95% CI: 0.49, 0.64; I2 = 70%). Subgroup analyses revealed significant SMDs for psychiatric disorders (0.60; 95% CI: 0.49, 0.71; I2 = 66%), movement disorders (0.56; 95% CI: 0.42, 0.69; I2 = 79%), and cognitive disorders (0.46; 95% CI: 0.32, 0.61; I2 = 48%). SMDs were 0.44 (95% CI: 0.23, 0.65; I2 = 70%) for follow-up ≤1 month and 0.69 (95% CI: 0.43, 0.94; I2 = 84%) for follow-up >1 month. Compared to other conditions, BSTs show better therapeutic effects in treating depression, post-traumatic stress disorder, obsessive-compulsive disorder, pain, fibromyalgia, and post-stroke motor recovery.

Interpretation

This review explored the potential of BSTs for comorbidities of the three disorders from a disorder-specific perspective, providing a roadmap for their clinical application and future research.

Funding

This work was supported by the Anhui Natural Science Foundation (2023AH040086), Key Laboratory of Philosophy and Social Science of Anhui Province on Adolescent Mental Health and Crisis Intelligence Intervention (SYS2023B08), and the Joint Funds of the National Natural Science Foundation of China (U23A20424).

Developing a utility value set for the Gambling Quality of Life Scale-Brief (GQoLS-Brief) using a discrete choice experiment

OBJECTIVES

The Gambling Quality of Life Scale -brief (GQoLS-Brief) assesses the impact of gambling disorder (GD) on quality of life (QoL). Preference-based measures are essential for obtaining the quality adjustment weight (i.e. utility score) needed to calculate quality-adjusted life years (QALYs) in economic evaluations. We aimed to derive a value set for the GQoLS-Brief.

METHODS

We employed a discrete choice experiment for preference elicitation. An online survey was administered (n = 928). Respondents completed 10 choice tasks, each presenting two GQoLS-Brief health states alongside life expectancy. Conditional logit regression, parameterized to fit the QALY framework, was used for data analysis. QALY weights for each health state defined by the GQoLS-Brief were calculated.

RESULTS

The estimated coefficients from the conditional logit models aligned with expectations: utility increased with survival time and decreased with QoL impairment. Utility values for health states ranged from - 1.48 (worse than death) to 1.0. "Financial difficulties" exhibited the highest utility decrement, followed by "Sleep disturbance related to financial difficulties."

CONCLUSIONS

This reference set facilitates the calculation of QALYs for economic evaluations of GD interventions. The weight of subjective financial difficulties underscores the need for therapeutic interventions to target this aspect.

Exploring Cortical Interneurons in Substance Use Disorder: From Mechanisms to Therapeutic Perspectives

Interneurons (INs) play a crucial role in the regulation of neural activity within the medial prefrontal cortex (mPFC), a brain region critically involved in executive functions and behavioral control. In recent preclinical studies, dysregulation of INs in the mPFC has been implicated in the pathophysiology of substance use disorder, characterized by vulnerability to chronic drug use. Here, we explore the diversity of mPFC INs and their connectivity and roles in vulnerability to addiction. We also discuss how these INs change over time with drug exposure. Finally, we focus on noninvasive brain stimulation as a therapeutic approach for targeting INs in substance use disorder, highlighting its potential to restore neural circuits.

Exploring the therapeutic potential of tDCS, TMS and DBS in overcoming tobacco use disorder: an umbrella review

The purpose of the present study was to investigate the effects of neuromodulation techniques, including transcranial direct current stimulation, transcranial magnetic stimulation, and deep brain stimulation, on the treatments of nicotine dependence. Specifically, our objective was to assess the existing evidence by conducting an umbrella review of systematic reviews. The quality of the included studies was evaluated using the standardized tools designed to evaluate systematic reviews. The PubMed/MEDLINE database was queried for systematic reviews, and yielded 7 systematic reviews with a substantial sample size (N = 4,252), some of which included meta-analyses. A significant finding across these studies was the effectiveness of neuromodulation techniques to reduce nicotine cravings and consumption, through the evidence remains not yet conclusive. A significant efficacy of transcranial direct current stimulation and repetitive transcranial magnetic stimulation that targeted the dorsolateral prefrontal cortex was found, as well as the lateral prefrontal cortex and insula bilaterally, on smoking frequency and craving. Moreover, smoking behaviors may also be positively affected by the use of deep brain stimulation (DBS) targeting the nucleus accumbens. In conclusion, neuromodulation approaches hold promise as effective treatments for tobacco use disorder. Nonetheless, further research is required to comprehensively understand their effectiveness and to determine if combining them with other treatments can aid individuals to successfully quit smoking.

Is Transcranial Direct Current Stimulation Effective for Cognitive Dysfunction in Substance Use Disorders? A Systematic Review

Patients with substance use disorders (SUDs) often suffer from cognitive dysfunction (CD), affecting their quality of life and daily functioning. Current treatments, including pharmacotherapy and psychotherapy, have limited efficacy and notable side effects. Transcranial direct current stimulation (tDCS), a non-invasive technique that modulates cortical activity, shows promise in improving cognitive function with minimal side effects and low cost, and could potentially serve as a valuable adjunct to existing therapies. This systematic review aims to evaluate the literature on the effectiveness of tDCS for CD in SUD patients to inform clinical practice and future research. Following PRISMA guidelines, the review includes studies that used tDCS for SUD-related CD. The criteria for inclusion encompassed participants aged 18 and older with a diagnosis of SUD, the use of tDCS (either conventional or high-definition), control groups receiving sham stimulation or no intervention, and cognitive outcome measures for substance-related cognitive function using validated tools. Databases searched were Ovid MEDLINE, PubMed, Web of Science, Embase, Scopus, and PsycINFO, with specific keywords. Twenty-two studies met the criteria, suggesting tDCS can improve cognitive functions in SUD patients, though results varied. Effectiveness may depend on the brain area targeted, stimulation parameters, task requirements, and individual differences. tDCS shows potential in treating SUD-related CD, but further research is needed to optimize stimulation protocols and address study variability. Future studies should use functional magnetic resonance imaging to explore the brain mechanisms by which tDCS improves cognitive function in SUDs and focus on larger, long-term trials to confirm efficacy and refine tDCS treatment parameters.

Concurrent self-administered transcranial direct current stimulation and attention bias modification training in binge eating disorder: feasibility randomised sham-controlled trial

BACKGROUND

Binge eating disorder (BED) is a common and disabling condition, typically presenting with multiple psychiatric and obesity-related comorbidities. Evidence-based treatments are either resource-intensive (psychotherapies) or have side-effects (medications): these achieve remission in around 50% of cases. Novel treatments are needed.

AIMS

This randomised sham-controlled trial aimed to assess feasibility, acceptability and preliminary efficacy of at-home, self-administered transcranial direct current stimulation (tDCS) and attention bias modification training (ABMT) in adults with binge eating disorder.

METHOD

Eighty-two participants with binge eating disorder were randomly allocated to real tDCS with ABMT, sham tDCS with ABMT, ABMT only or waitlist control. Intervention groups received ten sessions of their allocated treatment over 2-3 weeks. tDCS (2 mA, 20 min) was self-administered using a bilateral (anode right/cathode left) montage targeting the dorsolateral prefrontal cortex. Outcomes were assessed at baseline, post-treatment and 6-week follow-up.

RESULTS

Prespecified feasibility criteria (recruitment ≥80 participants and retention rate ≥75%) were exceeded, and treatment completion rates were high (98.7%). All interventions reduced binge eating episodes, eating disorder symptoms and related psychopathology between baseline and follow-up, relative to waitlist control (medium-to-large between-group effect sizes for change scores). Small-to-medium effect sizes for change scores favoured real tDCS with ABMT versus comparators, suggesting the verum intervention produces superior outcomes.

CONCLUSIONS

At-home, self-administered tDCS with ABMT is feasible and acceptable, and preliminary data on efficacy are promising. This approach could be a useful and scalable alternative or adjunct to established treatments for binge eating disorder. Confirmatory trials can, and should, be pursued.