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Agathos J, Putica A, Steward T, Felmingham KL, O'Donnell ML, Davey C, Harrison BJ. Neuroimaging evidence of disturbed self-appraisal in posttraumatic stress disorder: A systematic review. Psychiatry Res Neuroimaging 2024; 344:111888. [PMID: 39236486 DOI: 10.1016/j.pscychresns.2024.111888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 08/23/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND The experience of self-hood in posttraumatic stress disorder (PTSD) is altered cognitively and somatically. Dysfunctional negative cognitions about the self are a central mechanism of PTSD symptomatology and treatment. However, while higher-order brain models of disturbances in self-appraisal (i.e., cognitive processes relating to evaluating the self) have been examined in other psychiatric disorders, it is unclear how normative brain function during self-appraisal is impaired in PTSD. METHODS This paper presents a PRISMA systematic review of functional neuroimaging studies (n = 5), to establish a neurobiological account of how self-appraisal processes are disturbed in PTSD. The review was prospectively registered with PROSPERO (CRD42023450509). RESULTS Self-appraisal in PTSD is linked to disrupted activity in core self-processing regions of the Default Mode Network (DMN); and regions involved in cognitive control and emotion regulation, salience and valuation. LIMITATIONS Because self-appraisal in PTSD is relatively under-studied, only a small number of studies could be included for review. Cross-study heterogeneity in analytic approaches and trauma-exposure history prohibited a quantitative meta-analysis. CONCLUSIONS This paper proposes a mechanistic account of how neural dysfunctions may manifest clinically in PTSD and inform targeted selection of appropriate treatment options. We present a research agenda for future work to advance the field.
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Affiliation(s)
- J Agathos
- Department of Psychiatry, The University of Melbourne, Level 3, 161 Barry Street, Parkville, Victoria 3053, Australia.
| | - A Putica
- Department of Psychology, Counselling and Therapy, La Trobe University, Bundoora, Victoria, Australia
| | - T Steward
- Department of Psychiatry, The University of Melbourne, Level 3, 161 Barry Street, Parkville, Victoria 3053, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - K L Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - M L O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | - C Davey
- Department of Psychiatry, The University of Melbourne, Level 3, 161 Barry Street, Parkville, Victoria 3053, Australia
| | - B J Harrison
- Department of Psychiatry, The University of Melbourne, Level 3, 161 Barry Street, Parkville, Victoria 3053, Australia.
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Alizadehgoradel J, Shirani Z, Razavi SD, Amini M, Taherifard M, Kranz GS. Safety and Treatment Efficacy of Intensified Transcranial Direct Current Stimulation for Posttraumatic Stress Disorder After Sexual Assault: A Case Report. J ECT 2024; 40:e13-e15. [PMID: 38373181 DOI: 10.1097/yct.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
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Yang C, Jung B, Lee SH. Transcranial Electrical Stimulation: Clinical Implication and Practice for Treatment of Psychiatric Illness. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:391-404. [PMID: 39069679 PMCID: PMC11289600 DOI: 10.9758/cpn.23.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/09/2023] [Indexed: 07/30/2024]
Abstract
Brain electrical stimulation, particularly non-invasive brain stimulation (NIBS) techniques such as transcranial electrical stimulation (tES), have emerged as a promising treatment for various psychiatric disorders, including depression, anxiety, and post-traumatic stress disorder. tES techniques, such as transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), and transcranial random noise stimulation (tRNS), are cost-effective and safe interventions that are designed to affect neuronal circuits in the brain using various modalities. Although tES has shown effectiveness in the treatment of psychiatric disorders, there is a lack of comprehensive papers that consider its clinical implications. Therefore, this review aims to evaluate the clinical implications of tES and provide practical guidance for the treatment of psychiatric illnesses. Moreover, this review provides an overview of tES techniques and their mechanisms of action and summarizes recent clinical studies that have examined the use of tES for psychiatric disorders.
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Affiliation(s)
- Chaeyeon Yang
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Korea
| | - Bori Jung
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Korea
- Department of Psychology, Sogang University, Seoul, Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Korea
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Claverie D, Cressant A, Thomasson J, Castellarin C, Grandperret V, Barbier L, Troubat R, Canini F, Belzung C, El-Hage W. rTMS mechanisms for posttraumatic stress disorder treatment in a mouse model. J Psychiatr Res 2024; 179:33-43. [PMID: 39241409 DOI: 10.1016/j.jpsychires.2024.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 07/23/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a psychiatric disease that may follow traumatic exposure. Current treatments fail in about 30% of patients. Although repeated transcranial magnetic stimulation (rTMS) applied to the prefrontal cortex has been shown to be effective in the treatment of PTSD, the mechanisms need further investigation. OBJECTIVE Using a PTSD animal model, we verify the beneficial effect of rTMS, and explore the changes it induces on two putative PTSD mechanisms, GABA/glutamate neurotransmission and neuroinflammation. METHODS PTSD-like symptoms were elicited in twenty-six mice using a foot-shock conditioning procedure. Fourteen of the 26 were then treated using rTMS (12 were untreated). In the control group (n = 30), 18 were treated with rTMS and 12 were untreated. Animals were sacrificed after re-exposure. The infralimbic (IL) cortex, basolateral amygdala (BLA) and ventral CA1 (vCA1) were isolated using laser microdissection. mRNA was then investigated using PCR array analysis targeting GABA/glutamate and inflammatory pathways. RESULTS The rTMS treatment significantly decreased the contextual fear memory phenotype. These changes were associated with reduced mRNA expression related to inflammation in the IL cortex and the vCA1, and lowered mRNA-related glutamate neurotransmission and increased GABA neurotransmission in the BLA. CONCLUSION Our results suggest that our rTMS treatment was associated with local anti-inflammatory effects and limbic effects, which seemed to counteract PTSD effects. Several of these changes (both stress- and rTMS-induced) have implications for the drug sensitivity of limbic brain areas, and may help in the design of future therapeutic protocols.
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Affiliation(s)
- Damien Claverie
- Unité de Neurophysiologie du Stress, Département Neurosciences & Contraintes Opérationnelles, Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France; Réseau ABC des Psychotraumas, France(2).
| | - Arnaud Cressant
- Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Tours, France; Equipe Neurobiologie de la prise de décision, Département Neurosciences cognitives et des réseaux, Institut des Neurosciences de Paris-Saclay, Saclay, France
| | - Julien Thomasson
- Unité de Neurophysiologie du Stress, Département Neurosciences & Contraintes Opérationnelles, Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France
| | - Cédric Castellarin
- Unité d'Imagerie, Département Plateformes et Recherche Technologique, Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France
| | - Vincent Grandperret
- Unité de Biologie Moléculaire, Département Plateformes et Recherche Technologique, Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France
| | - Laure Barbier
- Unité de Biologie Moléculaire, Département Plateformes et Recherche Technologique, Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France
| | - Romain Troubat
- Unité de Neurophysiologie du Stress, Département Neurosciences & Contraintes Opérationnelles, Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France; Réseau ABC des Psychotraumas, France(2); Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Tours, France
| | - Frédéric Canini
- Laboratoire Inter-Universitaire de Psychologie. Personnalité, Cognition, Changement Social (LIP - PC2S), Université Grenoble Alpes, Université Savoie Mont Blanc, Grenoble, France
| | - Catherine Belzung
- Réseau ABC des Psychotraumas, France(2); Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Tours, France
| | - Wissam El-Hage
- Réseau ABC des Psychotraumas, France(2); Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Tours, France
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Pedraz-Petrozzi B, Insan S, Spangemacher M, Reinwald J, Lamadé EK, Gilles M, Deuschle M, Sartorius A. Association between rTMS-induced changes in inflammatory markers and improvement in psychiatric diseases: a systematic review. Ann Gen Psychiatry 2024; 23:31. [PMID: 39192245 DOI: 10.1186/s12991-024-00514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 08/05/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has recently gained relevance in treating different psychiatric disorders. Limited evidence suggests that the beneficial effects of rTMS on psychopathology could be at least partly mediated through changes in inflammatory response. This systematic review summarizes the literature on whether rTMS can modulate inflammatory markers and thus positively influence the course of psychiatric illnesses. MATERIALS AND METHODS A systematic review of rTMS and inflammatory markers in psychiatric diseases was conducted according to PRISMA guidelines. Information on the association between rTMS treatment response and changes of inflammatory markers was extracted. The quality of the studies was assessed using the National Heart, Lung, and Blood Institute for human studies and the Systematic Review Center for Laboratory Animal Experimentation for animal studies. RESULTS This review includes 17 studies (2 animal and 15 human studies) on the relationship between rTMS treatment response and changes of inflammatory markers. Positive changes in microglial activity and anti-inflammatory effects were associated with behavioral improvement in animal models of depression. However, these findings have not been consistently replicated in human studies focusing on treatment-resistant depression. While several studies reported rTMS-induced alterations in peripheral inflammatory markers, only two could demonstrate their association to clinical treatment response. Notably, most studies showed poor or moderate quality in the bias assessment. CONCLUSIONS While certain human studies suggest an association between rTMS-induced anti-inflammatory effects and improvement in psychopathology, heterogeneity, and underpowered analyses constrain the generalizability of these results. The discrepancy between animal and human findings highlights the need for larger, standardized human studies. TRIAL REGISTRATION (PROSPERO Registration: CRD42023492732).
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Affiliation(s)
- Bruno Pedraz-Petrozzi
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany.
- Research Group of Stress-related Disorders, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany.
| | - Shrabon Insan
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany
| | - Moritz Spangemacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
- Department of Molecular Neuroimaging, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany
| | - Jonathan Reinwald
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany
- Research Group of Translational Imaging, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Research Group Systems Neuroscience and Mental Health, Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Eva Kathrin Lamadé
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
- Research Group of Stress-related Disorders, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany
| | - Maria Gilles
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
- Research Group of Stress-related Disorders, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
- Research Group of Stress-related Disorders, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany
- Research Group of Translational Imaging, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
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Xie L, Hu P, Guo Z, Chen M, Wang X, Du X, Li Y, Chen B, Zhang J, Zhao W, Liu S. Immediate and long-term efficacy of transcranial direct current stimulation (tCDS) in obsessive-compulsive disorder, posttraumatic stress disorder and anxiety disorders: a systematic review and meta-analysis. Transl Psychiatry 2024; 14:343. [PMID: 39183315 PMCID: PMC11345433 DOI: 10.1038/s41398-024-03053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024] Open
Abstract
Currently, there is still debate over the effectiveness of transcranial direct current stimulation (tDCS) in treating obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD) and anxiety disorders (ADs). To investigate the immediate and long-term effectiveness of tDCS in these diseases, we conducted a systematic review and quantitative analysis of existing literature on the treatment of OCD, PTSD, and ADs with tDCS. Following the PRISMA guidelines, we searched seven electronic databases and systematically retrieved articles published from May 2012 to June 2024 that compared the effects of active tDCS with sham stimulation in the treatment of these disorders. We included primary outcome measures such as the change scores in disorder-specific and general anxiety symptoms before and after treatment, as well as secondary outcomes such as changes in disorder-specific and general anxiety symptoms at follow-up. We also assessed the impact of tDCS on depressive symptoms. Fifteen papers met the eligibility criteria. Overall, the results of meta-analysis indicated that tDCS had a high effect in improving specific symptoms (SMD = -0.73, 95% CI: -1.09 to -0.37) and general anxiety symptoms (SMD = -0.75; 95% CI: -1.23 to -0.26) in OCD, PTSD and ADs, with effects lasting up to 1 month and showing a moderate effect size. Furthermore, tDCS demonstrated immediate and significant alleviation of depressive symptoms in these diseases. This study concludes that tDCS can serve as a non-invasive brain stimulation technology for treating these disorders, and the therapeutic effects can be maintained for a period of time.
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Affiliation(s)
- Luxin Xie
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
- School of Humanities and Social Sciences, Shanxi Medical University, Jinzhong, China
| | - Peina Hu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
- School of Humanities and Social Sciences, Shanxi Medical University, Jinzhong, China
| | - Zhenglong Guo
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Miao Chen
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao Wang
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinzhe Du
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yue Li
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Bo Chen
- Department of Mental Health, Sinopharm North Hospital, Baotou, China
| | - Jihui Zhang
- Department of Mental Health, Sinopharm North Hospital, Baotou, China
| | - Wentao Zhao
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China.
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China.
| | - Sha Liu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China.
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China.
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Brown R, Cherian K, Jones K, Wickham R, Gomez R, Sahlem G. Repetitive transcranial magnetic stimulation for post-traumatic stress disorder in adults. Cochrane Database Syst Rev 2024; 8:CD015040. [PMID: 39092744 PMCID: PMC11295260 DOI: 10.1002/14651858.cd015040.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND The estimated lifetime prevalence of post-traumatic stress disorder (PTSD) in adults worldwide has been estimated at 3.9%. PTSD appears to contribute to alterations in neuronal network connectivity patterns. Current pharmacological and psychotherapeutic treatments for PTSD are associated with inadequate symptom improvement and high dropout rates. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive therapy involving induction of electrical currents in cortical brain tissue, may be an important treatment option for PTSD to improve remission rates and for people who cannot tolerate existing treatments. OBJECTIVES To assess the effects of repetitive transcranial magnetic stimulation (rTMS) on post-traumatic stress disorder (PTSD) in adults. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase, three other databases, and two clinical trials registers. We checked reference lists of relevant articles. The most recent search was January 2023. SELECTION CRITERIA We included randomized controlled trials (RCTs) assessing the efficacy and safety of rTMS versus sham rTMS for PTSD in adults from any treatment setting, including veterans. Eligible trials employed at least five rTMS treatment sessions with both active and sham conditions. We included trials with combination interventions, where a pharmacological agent or psychotherapy was combined with rTMS for both intervention and control groups. We included studies meeting the above criteria regardless of whether they reported any of our outcomes of interest. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias in accordance with Cochrane standards. Primary outcomes were PTSD severity immediately after treatment and serious adverse events during active treatment. Secondary outcomes were PTSD remission, PTSD response, PTSD severity at two follow-up time points after treatment, dropouts, and depression and anxiety severity immediately after treatment. MAIN RESULTS We included 13 RCTs in the review (12 published; 1 unpublished dissertation), with 577 participants. Eight studies included stand-alone rTMS treatment, four combined rTMS with an evidence-based psychotherapeutic treatment, and one investigated rTMS as an adjunctive to treatment-as-usual. Five studies were conducted in the USA, and some predominantly included white, male veterans. Active rTMS probably makes little to no difference to PTSD severity immediately following treatment (standardized mean difference (SMD) -0.14, 95% confidence interval (CI) -0.54 to 0.27; 3 studies, 99 participants; moderate-certainty evidence). We downgraded the certainty of evidence by one level for imprecision (sample size insufficient to detect a difference of medium effect size). We deemed one study as having a low risk of bias and the remaining two as having 'some concerns' for risk of bias. A sensitivity analysis of change-from-baseline scores enabled inclusion of a greater number of studies (6 studies, 252 participants). This analysis yielded a similar outcome to our main analysis but also indicated significant heterogeneity in efficacy across studies, including two studies with a high risk of bias. Reported rates of serious adverse events were low, with seven reported (active rTMS: 6; sham rTMS: 1). The evidence is very uncertain about the effect of active rTMS on serious adverse events (odds ratio (OR) 5.26, 95% CI 0.26 to 107.81; 5 studies, 251 participants; very low-certainty evidence [Active rTMS: 23/1000, sham rTMS: 4/1000]). We downgraded the evidence by one level for risk of bias and two levels for imprecision. We rated four of five studies as having a high risk of bias, and the fifth as 'some concerns' for bias. We were unable to assess PTSD remission immediately after treatment as none of the included studies reported this outcome. AUTHORS' CONCLUSIONS Based on moderate-certainty evidence, our review suggests that active rTMS probably makes little to no difference to PTSD severity immediately following treatment compared to sham stimulation. However, significant heterogeneity in efficacy was detected when we included a larger number of studies in sensitivity analysis. We observed considerable variety in participant and protocol characteristics across studies included in this review. For example, studies tended to be weighted towards inclusion of either male veterans or female civilians. Studies varied greatly in terms of the proportion of the sample with comorbid depression. Study protocols differed in treatment design and stimulation parameters (e.g. session number/duration, treatment course length, stimulation intensity/frequency, location of stimulation). These differences may affect efficacy, particularly when considering interactions with participant factors. Reported rates of serious adverse events were very low (< 1%) across active and sham conditions. It is uncertain whether rTMS increases the risk of serious adverse event occurrence, as our certainty of evidence was very low. Studies frequently lacked clear definitions for serious adverse events, as well as detail on tracking/assessment of data and information on the safety population. Increased reporting on these elements would likely aid the advancement of both research and clinical recommendations of rTMS for PTSD. Currently, there is insufficient evidence to meta-analyze PTSD remission, PTSD treatment response, and PTSD severity at different periods post-treatment. Further research into these outcomes could inform the clinical use of rTMS. Additionally, the relatively large contribution of data from trials that focused on white male veterans may limit the generalizability of our conclusions. This could be addressed by prioritizing recruitment of more diverse participant samples.
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Affiliation(s)
- Randi Brown
- Clinical Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Kirsten Cherian
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine Jones
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert Wickham
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Rowena Gomez
- Clinical Psychology, Palo Alto University, Palo Alto, CA, USA
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory Sahlem
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Zhang Y, Peng Z, Tang N, Zhang Y, Liu N, Lv R, Meng Y, Cai M, Wang H. Efficacy of MRI-guided rTMS for post-traumatic stress disorder by modulating amygdala activity: study protocol for a randomised controlled trial. BMJ Open 2024; 14:e081751. [PMID: 38960463 PMCID: PMC11227799 DOI: 10.1136/bmjopen-2023-081751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/17/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a prevalent and severe psychiatric disorder. Repetitive transcranial magnetic stimulation (rTMS) targeting the dorsolateral prefrontal cortex provides limited relief for symptoms of PTSD. This study will be conducted to validate the efficacy of MRI-guided rTMS in targeting the sites most closely associated with the amygdala for patients with PTSD. We hypothesise that the intervention will improve clinical symptoms by decreasing amygdala activity in patients. METHODS AND ANALYSIS A randomised, double-blind, sham-controlled trial will be conducted. Forty-eight eligible patients with PTSD will be randomly assigned to receive either active or sham MRI-guided rTMS for 10 consecutive days after the initial MRI scans. MRI scans will be recollected at the end of the intervention. Clinical assessments will be performed at baseline, treatment day 5, treatment day 10, and 2 weeks, 4 weeks, 8 weeks after completion of the intervention to monitor changes in clinical symptoms. The primary assessment outcome is the change in PTSD symptoms between baseline and treatment day 10, as measured by the PTSD Checklist for DSM-5. Repeated measures analysis of variance will be performed using statistical software SPSS V.26.0. The significance level will be set at 0.05. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Xijing Hospital in Xi'an, China (KY20222176-X-1), and the trial has been registered on ClinicalTrials.gov. The findings of this trial will be disseminated at academic conferences or published in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT05544110.
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Affiliation(s)
- Yaochi Zhang
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Zhengwu Peng
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Nailong Tang
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Yuyu Zhang
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Nian Liu
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Runxin Lv
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Yumeng Meng
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Min Cai
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
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Tseng PT, Zeng BY, Wang HY, Zeng BS, Liang CS, Chen YCB, Stubbs B, Carvalho AF, Brunoni AR, Su KP, Tu YK, Wu YC, Chen TY, Li DJ, Lin PY, Chen YW, Hsu CW, Hung KC, Shiue YL, Li CT. Efficacy and acceptability of noninvasive brain stimulation for treating posttraumatic stress disorder symptoms: A network meta-analysis of randomized controlled trials. Acta Psychiatr Scand 2024; 150:5-21. [PMID: 38616056 DOI: 10.1111/acps.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Despite its high lifetime prevalence rate and the elevated disability caused by posttraumatic stress disorder (PTSD), treatments exhibit modest efficacy. In consideration of the abnormal connectivity between the dorsolateral prefrontal cortex (DLPFC) and amygdala in PTSD, several randomized controlled trials (RCTs) addressing the efficacy of different noninvasive brain stimulation (NIBS) modalities for PTSD management have been undertaken. However, previous RCTs have reported inconsistent results. The current network meta-analysis (NMA) aimed to compare the efficacy and acceptability of various NIBS protocols in PTSD management. METHODS We systematically searched ClinicalKey, Cochrane Central Register of Controlled Trials, Embase, ProQuest, PubMed, ScienceDirect, Web of Science, and ClinicalTrials.gov to identify relevant RCTs. The targeted RCTs was those comparing the efficacy of NIBS interventions, such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and transcutaneous cervical vagal nerve stimulation, in patients with PTSD. The NMA was conducted using a frequentist model. The primary outcomes were changes in the overall severity of PTSD and acceptability (to be specific, rates of dropouts for any reason). RESULTS We identified 14 RCTs that enrolled 686 participants. The NMA demonstrated that among the investigated NIBS types, high-frequency rTMS over bilateral DLPFCs was associated with the greatest reduction in overall PTSD severity. Further, in comparison with the sham controls, excitatory stimulation over the right DLPFC with/without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD-related symptoms, including depression and anxiety symptoms, and overall PTSD severity. CONCLUSIONS This NMA demonstrated that excitatory stimulation over the right DLPFC with or without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD-related symptoms. TRIAL REGISTRATION PROSPERO CRD42023391562.
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Affiliation(s)
- Ping-Tao Tseng
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing-Yan Zeng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hung-Yu Wang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Bing-Syuan Zeng
- Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yang-Chieh Brian Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, National Institute of Biomarkers in Psychiatry, Laboratory of Neurosciences (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil
- Departamento de Ciências Médicas, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil
| | - Kuan-Pin Su
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
- An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yu-Kang Tu
- Institute of Health Data Analytics & Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taiwan
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yow-Ling Shiue
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taiwan
- Institute of Brain Science and Brain Research Center, School of Medicine, National Yang Ming Chiao Tung University, Taiwan
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10
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Davis LL, Hamner MB. Post-traumatic stress disorder: the role of the amygdala and potential therapeutic interventions - a review. Front Psychiatry 2024; 15:1356563. [PMID: 38903645 PMCID: PMC11187309 DOI: 10.3389/fpsyt.2024.1356563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/16/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is a psychiatric disorder triggered by exposure to a life-threatening or sexually violent traumatic event, and is characterized by symptoms involving intrusive re-experiencing, persistent avoidance of associated stimuli, emotional and cognitive disturbances, and hyperarousal for long periods after the trauma has occurred. These debilitating symptoms induce occupational and social impairments that contribute to a significant clinical burden for PTSD patients, and substantial socioeconomic costs, reaching approximately $20,000 dollars per individual with PTSD each year in the US. Despite increased translational research focus in the field of PTSD, the development of novel, effective pharmacotherapies for its treatment remains an important unmet clinical need. Observations In this review, we summarize the evidence implicating dysfunctional activity of the amygdala in the pathophysiology of PTSD. We identify the transient receptor potential canonical (TRPC) ion channels as promising drug targets given their distribution in the amygdala, and evidence from animal studies demonstrating their role in fear response modulation. We discuss the evidence-based pharmacotherapy and psychotherapy treatment approaches for PTSD. Discussion In view of the prevalence and economic burden associated with PTSD, further investigation is warranted into novel treatment approaches based on our knowledge of the involvement of brain circuitry and the role of the amygdala in PTSD, as well as the potential added value of combined pharmacotherapy and psychotherapy to better manage PTSD symptoms.
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Affiliation(s)
- Lori L. Davis
- Mental Health Service, Birmingham VA Health Care System, Birmingham, AL, United States
- Department of Psychiatry, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
- Department of Psychiatry, University of Alabama College of Community Health Science, Tuscaloosa, AL, United States
| | - Mark B. Hamner
- Department of Veterans Affairs, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
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11
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Tanaka M, Battaglia S, Giménez-Llort L, Chen C, Hepsomali P, Avenanti A, Vécsei L. Innovation at the Intersection: Emerging Translational Research in Neurology and Psychiatry. Cells 2024; 13:790. [PMID: 38786014 PMCID: PMC11120114 DOI: 10.3390/cells13100790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
Translational research in neurological and psychiatric diseases is a rapidly advancing field that promises to redefine our approach to these complex conditions [...].
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Affiliation(s)
- Masaru Tanaka
- HUN-REN-SZTE Neuroscience Research Group, Hungarian Research Network, University of Szeged (HUN-REN-SZTE), Danube Neuroscience Research Laboratory, Tisza Lajos krt. 113, H-6725 Szeged, Hungary;
| | - Simone Battaglia
- Center for Studies and Research in Cognitive Neuroscience, Department of Psychology “Renzo Canestrari”, Cesena Campus, Alma Mater Studiorum Università di Bologna, 47521 Cesena, Italy;
- Department of Psychology, University of Turin, 10124 Turin, Italy
| | - Lydia Giménez-Llort
- Institut de Neurociències, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain;
- Department of Psychiatry & Forensic Medicine, Faculty of Medicine, Campus Bellaterra, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain
| | - Chong Chen
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan;
| | - Piril Hepsomali
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6ET, UK;
| | - Alessio Avenanti
- Center for Studies and Research in Cognitive Neuroscience, Department of Psychology “Renzo Canestrari”, Cesena Campus, Alma Mater Studiorum Università di Bologna, 47521 Cesena, Italy;
- Neuropsychology and Cognitive Neuroscience Research Center (CINPSI Neurocog), Universidad Católica del Maule, Talca 3460000, Chile
| | - László Vécsei
- HUN-REN-SZTE Neuroscience Research Group, Hungarian Research Network, University of Szeged (HUN-REN-SZTE), Danube Neuroscience Research Laboratory, Tisza Lajos krt. 113, H-6725 Szeged, Hungary;
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
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12
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Lisoni J, Nibbio G, Baldacci G, Cicale A, Zucchetti A, Bertoni L, Calzavara Pinton I, Necchini N, Deste G, Barlati S, Vita A. What impact can brain stimulation interventions have on borderline personality disorder? Expert Rev Neurother 2024; 24:343-360. [PMID: 38349069 DOI: 10.1080/14737175.2024.2316133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severe mental disorder characterized by emotion dysregulation, impulsivity, neuropsychological impairment, and interpersonal instability, presenting with multiple psychiatric comorbidities, functional disability and reduced life expectancy due suicidal behaviors. AREAS COVERED In this perspective, the authors explore the application of noninvasive brain stimulation (NIBS) (rTMS, tDCS, and MST) in BPD individuals by considering a symptom-based approach, focusing on general BPD psychopathology, impulsivity and neuropsychological impairments, suicidality and depressive/anxious symptoms, and emotion dysregulation. EXPERT OPINION According to a symptoms-based approach, NIBS interventions (particularly rTMS and tDCS) are promising treatment options for BPD individuals improving core symptoms such as emotional and behavioral dysregulation, neuropsychological impairments and depressive symptoms. However, the heterogeneity of stimulation protocols and of assessment tools used to detect these changes limits the possibility to provide definitive recommendations according to a symptom-based approach. To implement such armamentarium in clinical practice, future NIIBS studies should further consider a lifespan perspective due to clinical variability over time, the role of psychiatric comorbidities affecting BPD individuals and the need to combine NIBS with specialized psychotherapeutic approaches for BPD patients and with functional neuroimaging studies.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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13
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Pereira FES, Jagatheesaperumal SK, Benjamin SR, Filho PCDN, Duarte FT, de Albuquerque VHC. Advancements in non-invasive microwave brain stimulation: A comprehensive survey. Phys Life Rev 2024; 48:132-161. [PMID: 38219370 DOI: 10.1016/j.plrev.2024.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
This survey provides a comprehensive insight into the world of non-invasive brain stimulation and focuses on the evolving landscape of deep brain stimulation through microwave research. Non-invasive brain stimulation techniques provide new prospects for comprehending and treating neurological disorders. We investigate the methods shaping the future of deep brain stimulation, emphasizing the role of microwave technology in this transformative journey. Specifically, we explore antenna structures and optimization strategies to enhance the efficiency of high-frequency microwave stimulation. These advancements can potentially revolutionize the field by providing a safer and more precise means of modulating neural activity. Furthermore, we address the challenges that researchers currently face in the realm of microwave brain stimulation. From safety concerns to methodological intricacies, this survey outlines the barriers that must be overcome to fully unlock the potential of this technology. This survey serves as a roadmap for advancing research in microwave brain stimulation, pointing out potential directions and innovations that promise to reshape the field.
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Affiliation(s)
| | - Senthil Kumar Jagatheesaperumal
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza, 60455-970, Ceará, Brazil; Department of Electronics and Communication Engineering, Mepco Schlenk Engineering College, Sivakasi, 626005, Tamilnadu, India
| | - Stephen Rathinaraj Benjamin
- Department of Pharmacology and Pharmacy, Laboratory of Behavioral Neuroscience, Faculty of Medicine, Federal University of Ceará, Fortaleza, 60430-160, Ceará, Brazil
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14
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Rezaei M, Bagheri MMS. Clinical effects of anodal tDCS and identifying response markers in post-traumatic stress disorder (PTSD): An open-label study. Behav Brain Res 2024; 458:114751. [PMID: 37931705 DOI: 10.1016/j.bbr.2023.114751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a promising treatment for post-traumatic stress disorder (PTSD). However, not all patients respond to this type of treatment. The first aim of present study was to examine efficacy of tDCS for PTSD, depression, anxiety, and anhedonia in patients with PTSD. The second aim of this study was to examine the demographic, clinical, and psychological factors that may predict response to tDCS. In this open-label study, 103 PTSD patients underwent 10 sessions of tDCS (2 mA, 20 min). The anodal and cathodal electrodes were placed over the left dorsolateral prefrontal cortex (DLPFC; F3) and right supra-orbital (FP2) Respectively. Clinical outcome measures included Posttraumatic the Stress Disorder Checklist for DSM-5 (PCL-5), the Beck Depression Inventory (BDI-II), the Beck Anxiety Inventory (BAI), and the Snaith-Hamilton Pleasure Scale (SHAPS). There was an overall significant improvement in symptoms of PTSD, depression, anxiety, and anhedonia from pre- to post-treatment. Results also revealed that non-responders had higher severity at baseline for depression, anxiety, and anhedonia. However, higher severity of depression and anhedonia at baseline predicted response status, with higher severity associated with greater likelihood of non-response. tDCS of the left dLPFC and right supra-orbital appears to have a positive effect in reducing PTSD and related symptoms. These initial results could have an important influence on the adoption of anodal tDCS over the left DLPFC for PTSD, by enabling the early identification of patients who respond to tDCS.
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Affiliation(s)
- Mehdi Rezaei
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Birjand, Birjand, Iran.
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15
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Burback L, Brémault-Phillips S, Nijdam MJ, McFarlane A, Vermetten E. Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. Curr Neuropharmacol 2024; 22:557-635. [PMID: 37132142 PMCID: PMC10845104 DOI: 10.2174/1570159x21666230428091433] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 05/04/2023] Open
Abstract
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.
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Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | | | - Mirjam J. Nijdam
- ARQ National Psychotrauma Center, Diemen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, New York University Grossman School of Medicine, New York, USA
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16
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Sabé M, Chen C, El-Hage W, Leroy A, Vaiva G, Monari S, Premand N, Bartolomei J, Caiolo S, Maercker A, Pietrzak RH, Cloître M, Kaiser S, Solmi M. Half a Century of Research on Posttraumatic Stress Disorder: A Scientometric Analysis. Curr Neuropharmacol 2024; 22:736-748. [PMID: 37888890 PMCID: PMC10845098 DOI: 10.2174/1570159x22666230927143106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 10/28/2023] Open
Abstract
We conducted a scientometric analysis to outline clinical research on posttraumatic stress disorder (PTSD). Our primary objective was to perform a broad-ranging scientometric analysis to evaluate key themes and trends over the past decades. Our secondary objective was to measure research network performance. We conducted a systematic search in the Web of Science Core Collection up to 15 August 2022 for publications on PTSD. We identified 42,170 publications published between 1945 and 2022. We used CiteSpace to retrieve the co-cited reference network (1978-2022) that presented significant modularity and mean silhouette scores, indicating highly credible clusters (Q = 0.915, S = 0.795). Four major trends of research were identified: 'war veterans and refugees', 'treatment of PTSD/neuroimaging', 'evidence syntheses', and 'somatic symptoms of PTSD'. The largest cluster of research concerned evidence synthesis for genetic predisposition and environmental exposures leading to PTSD occurrence. Research on war-related trauma has shifted from battlefield-related in-person exposure trauma to drone operator trauma and is being out published by civilian-related trauma research, such as the 'COVID-19' pandemic impact, 'postpartum', and 'grief disorder'. The focus on the most recent trends in the research revealed a burst in the 'treatment of PTSD' with the development of Mhealth, virtual reality, and psychedelic drugs. The collaboration networks reveal a central place for the USA research network, and although relatively isolated, a recent surge of publications from China was found. Compared to other psychiatric disorders, we found a lack of high-quality randomized controlled trials for pharmacological and nonpharmacological treatments. These results can inform funding agencies and future research.
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Affiliation(s)
- Michel Sabé
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland
| | - Chaomei Chen
- College of Computing & Informatics, Drexel University, Philadelphia, PA, USA
| | - Wissam El-Hage
- CHRU de Tours, Clinique Psychiatrique Universitaire, Centre Régional de Psychotraumatologie CVL, 37540 Saint-Cyr-sur-Loire, France; UMR 1253, iBrain, INSERM, Université de Tours, 37000 Tours, France
| | - Arnaud Leroy
- Univ Lille, INSERM, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CHU Lille, Fontan Hospital, General Psychiatry Department & Centre National de Ressources et Résilience Pour les Psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France
| | - Guillaume Vaiva
- CNRS UMR 9193-PsyCHIC-SCALab, & CHU Lille, Department of Psychiatry, Univ. Lille, F-59000, Lille, France
| | - Silvia Monari
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland
| | - Natacha Premand
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland
| | - Javier Bartolomei
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland
| | - Stefano Caiolo
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Andreas Maercker
- Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Marylène Cloître
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, USA; and Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ontario, Ottawa
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Department of Child and Adolescent Psychiatry, Charité Universit¨atsmedizin, Berlin, Germany
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17
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Tillman GD, Morris EE, Bass C, Turner M, Watson K, Brooks JT, Rawlinson T, Kozel FA, Kraut MA, Motes MA, Hart J. P3a amplitude to trauma-related stimuli reduced after successful trauma-focused PTSD treatment. Biol Psychol 2023; 182:108648. [PMID: 37482132 DOI: 10.1016/j.biopsycho.2023.108648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
An elevated P3a amplitude to trauma-related stimuli is strongly associated with posttraumatic stress disorder (PTSD), yet little is known about whether this response to trauma-related stimuli is affected by treatment that decreases PTSD symptoms. As an analysis of secondary outcome measures from a randomized controlled trial, we investigated the latency and amplitude changes of the P3a in responses in a three-condition oddball visual task that included trauma-related (combat scenes) and trauma-unrelated (threatening animals) distractors. Fifty-five U.S. veterans diagnosed with combat-related PTSD were randomized to receive either active or sham repetitive transcranial magnetic stimulation (rTMS). All received cognitive processing therapy, CPT+A, which requires a written account of the index trauma. They were tested before and 6 months after protocol completion. P3a amplitude and response time decreases were driven largely by the changes in the responses to the trauma-related stimuli, and this decrease correlated to the decrease in PTSD symptoms. The amplitude changes were greater in those who received rTMS + CPT than in those who received sham rTMS + CPT, suggesting that rTMS plays beneficial role in reducing arousal and threat bias, which may allow for more effective engagement in trauma-focused PTSD treatment.
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Affiliation(s)
- Gail D Tillman
- Callier Center, University of Texas at Dallas, Dallas, TX, USA.
| | | | - Christina Bass
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - Mary Turner
- Departments of Psychiatry University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kelsey Watson
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - Jared T Brooks
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - Tyler Rawlinson
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - F Andrew Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Michael A Kraut
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Motes
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - John Hart
- Callier Center, University of Texas at Dallas, Dallas, TX, USA; Departments of Psychiatry University of Texas Southwestern Medical Center, Dallas, TX, USA; Departments of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ferreri F, Mouchabac S, Sylvestre V, Millet B, El Hage W, Adrien V, Bourla A. Repetitive Transcranial Magnetic Stimulation (rTMS) in Post-Traumatic Stress Disorder: Study Protocol of a Nationwide Randomized Controlled Clinical Trial of Neuro-Enhanced Psychotherapy "TraumaStim". Brain Sci 2023; 13:1274. [PMID: 37759875 PMCID: PMC10526173 DOI: 10.3390/brainsci13091274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
The use of high-frequency Transcranial Magnetic Stimulation (HF-rTMS) of the right dorsolateral prefrontal cortex (DLPFC) in treating Post-traumatic Stress Disorder (PTSD) is currently regarded as a level B intervention (probable effectiveness). HF-rTMS has attracted interest as a neuromodulation therapeutic method for PTSD. Prolonged exposure and reactivation therapy are also regarded as first-line treatments for PTSD. Randomized controlled clinical studies examining the effectiveness of several HF-rTMS sessions coupled with psychotherapy have not yet been completed. In total, 102 patients with refractory PTSD will be randomly assigned (1:1) to reactivation therapy, in addition to either active HF-rTMS (20 Hz) or sham HF-rTMS, for 12 sessions in a nationwide, multicenter, double-blind controlled trial. The impact on PTSD symptoms and neurocognitive functioning will be assessed. The primary outcome is the PTSD severity score measured based on the Clinician-Administered PTSD Scale (CAPS-5) at one month. If this additional therapy is successful, it may strengthen the case for regulatory authorities to approve this additional technique of treating PTSD. Additionally, it expands the field of neurostimulation-assisted psychotherapy.
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Affiliation(s)
- Florian Ferreri
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, 75012 Paris, France; (F.F.); (S.M.); (V.A.)
- ICRIN—Psychiatry (Infrastructure of Clinical Research in Neurosciences—Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France;
| | - Stephane Mouchabac
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, 75012 Paris, France; (F.F.); (S.M.); (V.A.)
- ICRIN—Psychiatry (Infrastructure of Clinical Research in Neurosciences—Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France;
| | - Vincent Sylvestre
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, 75012 Paris, France; (F.F.); (S.M.); (V.A.)
| | - Bruno Millet
- ICRIN—Psychiatry (Infrastructure of Clinical Research in Neurosciences—Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France;
- Service de Psychiatrie Adulte de la Pitié-Salpêtrière, Sorbonne Université, AP-HP, 75013 Paris, France
| | - Wissam El Hage
- Centre Régional de Psychotraumatologie CVL, CHRU de Tours, UMR 1253, iBrain, Université de Tours, INSERM, 37000 Tours, France;
| | - Vladimir Adrien
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, 75012 Paris, France; (F.F.); (S.M.); (V.A.)
- ICRIN—Psychiatry (Infrastructure of Clinical Research in Neurosciences—Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France;
| | - Alexis Bourla
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, 75012 Paris, France; (F.F.); (S.M.); (V.A.)
- ICRIN—Psychiatry (Infrastructure of Clinical Research in Neurosciences—Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France;
- Clariane, Medical Strategy and Innovation Department, 75008 Paris, France
- NeuroStim Psychiatry Practice, 75005 Paris, France
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Li Y, Zhi W, Qi B, Wang L, Hu X. Update on neurobiological mechanisms of fear: illuminating the direction of mechanism exploration and treatment development of trauma and fear-related disorders. Front Behav Neurosci 2023; 17:1216524. [PMID: 37600761 PMCID: PMC10433239 DOI: 10.3389/fnbeh.2023.1216524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Fear refers to an adaptive response in the face of danger, and the formed fear memory acts as a warning when the individual faces a dangerous situation again, which is of great significance to the survival of humans and animals. Excessive fear response caused by abnormal fear memory can lead to neuropsychiatric disorders. Fear memory has been studied for a long time, which is of a certain guiding effect on the treatment of fear-related disorders. With continuous technological innovations, the study of fear has gradually shifted from the level of brain regions to deeper neural (micro) circuits between brain regions and even within single brain regions, as well as molecular mechanisms. This article briefly outlines the basic knowledge of fear memory and reviews the neurobiological mechanisms of fear extinction and relapse, which aims to provide new insights for future basic research on fear emotions and new ideas for treating trauma and fear-related disorders.
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Affiliation(s)
- Ying Li
- College of Education, Hebei University, Baoding, China
- Laboratory of Experimental Pathology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Weijia Zhi
- Laboratory of Experimental Pathology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Bing Qi
- College of Education, Hebei University, Baoding, China
| | - Lifeng Wang
- Laboratory of Experimental Pathology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Xiangjun Hu
- College of Education, Hebei University, Baoding, China
- Laboratory of Experimental Pathology, Beijing Institute of Radiation Medicine, Beijing, China
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20
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Makale MT, Abbasi S, Nybo C, Keifer J, Christman L, Fairchild JK, Yesavage J, Blum K, Gold MS, Baron D, Cadet JL, Elman I, Dennen CA, Murphy KT. Personalized repetitive transcranial magnetic stimulation (prtms®) for post-traumatic stress disorder (ptsd) in military combat veterans. Heliyon 2023; 9:e18943. [PMID: 37609394 PMCID: PMC10440537 DOI: 10.1016/j.heliyon.2023.e18943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Emerging data suggest that post-traumatic stress disorder (PTSD) arises from disrupted brain default mode network (DMN) activity manifested by dysregulated encephalogram (EEG) alpha oscillations. Hence, we pursued the treatment of combat veterans with PTSD (n = 185) using an expanded form of repetitive transcranial magnetic stimulation (rTMS) termed personalized-rTMS (PrTMS). In this treatment methodology spectral EEG based guidance is used to iteratively optimize symptom resolution via (1) stimulation of multiple motor sensory and frontal cortical sites at reduced power, and (2) adjustments of cortical treatment loci and stimulus frequency during treatment progression based on a proprietary frequency algorithm (PeakLogic, Inc. San Diego) identifying stimulation frequency in the DMN elements of the alpha oscillatory band. Following 4 - 6 weeks of PrTMS® therapy in addition to routine PTSD therapy, veterans exhibited significant clinical improvement accompanied by increased cortical alpha center frequency and alpha oscillatory synchronization. Full resolution of PTSD symptoms was attained in over 50% of patients. These data support DMN involvement in PTSD pathophysiology and suggest a role in therapeutic outcomes. Prospective, sham controlled PrTMS® trials may be warranted to validate our clinical findings and to examine the contribution of DMN targeting for novel preventive, diagnostic, and therapeutic strategies tailored to the unique needs of individual patients with both combat and non-combat PTSD.
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Affiliation(s)
- Milan T. Makale
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Shaghayegh Abbasi
- Department of Electrical Engineering, University of Portland, Portland, OR, 97203, USA
| | - Chad Nybo
- CrossTx Inc., Bozeman, MT, 59715, USA
| | | | | | - J. Kaci Fairchild
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, VA Medical Center, Palo Alto, CA, 94304, USA
| | - Jerome Yesavage
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Kenneth Blum
- Division of Addiction Research & Education, Center for Sports, Exercise & Global Mental Health, Western University Health Sciences, Pomona, USA
- Department of Clinical Psychology and Addiction, Institute of Psychology, Faculty of Education and Psychology, Eötvös Loránd University, Hungary
- Department of Psychiatry, Wright University, Boonshoft School of Medicine, Dayton, OH, USA
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - David Baron
- Division of Addiction Research & Education, Center for Sports, Exercise & Global Mental Health, Western University Health Sciences, Pomona, USA
| | - Jean Lud Cadet
- Molecular Neuropsychiatry Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Igor Elman
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Catherine A. Dennen
- Department of Family Medicine, Jefferson Health Northeast, Philadelphia, PA, USA
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21
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Nestor SM, Giacobbe P, Abrahao A, Davidson B, Rabin JS, Lipsman N, Hamani C. Advances in deep brain stimulation for the treatment of post-traumatic stress disorder. Expert Rev Med Devices 2023; 20:995-998. [PMID: 37930275 DOI: 10.1080/17434440.2023.2280023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Sean M Nestor
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Davidson
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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22
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Sauvaget A, Bulteau S, Omon E, Ghazi E, Prévotel A, Laurin A. Transcranial Direct Current Stimulation for Depression in Transgender Patient. Cureus 2023; 15:e38476. [PMID: 37273331 PMCID: PMC10236903 DOI: 10.7759/cureus.38476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/06/2023] Open
Abstract
Transgender and gender-diverse (TGD) individuals experience higher rates of mood and anxiety disorders than the general public. Transcranial direct current stimulation (tDCS) is an effective and well-tolerated treatment for major depressive disorder, in cisgender patients. With the very recent exception of electroconvulsive therapy (ECT), neuromodulation in TGD patients is not addressed in the literature. We described here the efficacy and tolerability of tDCS in a 22-year-old Caucasian female-to-male transgender individual (hereafter referred to as a male) suffering from a severe non-treatment-resistant major depressive disorder. This case report suggests that combined tDCS and antidepressant therapy have the potential to treat depressive disorders in patients of all gender identities.
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Affiliation(s)
| | - Samuel Bulteau
- Faculté de Médecine, Nantes Université, Université de Tours, Nantes, FRA
| | - Edith Omon
- General Practice, Nantes Université, Nantes, FRA
| | - Eleonore Ghazi
- Psychiatry, Centre Hospitalier Universitaire de Nantes, Nantes, FRA
| | | | - Andrew Laurin
- Faculté de Médecine, Nantes Université, Centre Hospitalier Universitaire de Nantes, Nantes, FRA
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23
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Shenasa MA, Ellerman-Tayag E, Canet P, Martis B, Mishra J, Ramanathan DS. Theta Burst Stimulation Is Not Inferior to High-Frequency Repetitive Transcranial Magnetic Stimulation in Reducing Symptoms of Posttraumatic Stress Disorder in Veterans With Depression: A Retrospective Case Series. Neuromodulation 2023:S1094-7159(23)00135-6. [PMID: 37015842 DOI: 10.1016/j.neurom.2023.02.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVES Two commonly used forms of repetitive transcranial magnetic stimulation (rTMS) were recently shown to be equivalent for the treatment of depression: high-frequency stimulation (10 Hz), a protocol that lasts between 19 and 38 minutes, and intermittent theta burst stimulation (iTBS), a protocol that can be delivered in just three minutes. However, it is unclear whether iTBS treatment offers the same benefits as those of standard 10-Hz rTMS for comorbid symptoms such as those seen in posttraumatic stress disorder (PTSD). MATERIALS AND METHODS In this retrospective case series, we analyzed treatment outcomes in veterans from the Veterans Affairs San Diego Healthcare System who received 10-Hz (n = 47) or iTBS (n = 51)-rTMS treatments for treatment-resistant depression between February 2018 and June 2022. We compared outcomes between these two stimulation protocols in symptoms of depression (using changes in the Patient Health Questionnaire-9 [PHQ-9]) and PTSD (using changes in the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or Patient Checklist [PCL]-5). RESULTS There was an imbalance of sex between groups (p < 0.05). After controlling for sex, we found no significant difference by stimulation protocol for depression (PHQ-9, F [1,94] = 0.16, p = 0.69, eta-squared = 0.002), confirming the original study previously noted. We also showed no difference by stimulation protocol of changes in PTSD symptoms (PCL-5, F [1,94] = 3.46, p = 0.067, eta-squared = 0.036). The iTBS group showed a decrease from 41.9 ± 4.4 to 25.1 ± 4.9 (a difference of 16.8 points) on the PCL-5 scale whereas the 10-Hz group showed a decrease from 43.6 ± 2.9 to 35.2 ± 3.2 on this scale (a difference of 8.4 points). Follow-up analyses restricting the sample in various ways did not meaningfully change these results (no follow-up analyses showed that there was a significant difference between stimulation protocols). CONCLUSIONS Although limited by small sample size, nonblind, and pseudorandomized assignment, our data suggest that iTBS is similar to 10-Hz stimulation in inducing reductions in PTSD symptoms and depression in military veterans.
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Affiliation(s)
- Mohammad Ali Shenasa
- Mental Health Care Line, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Em Ellerman-Tayag
- Mental Health Care Line, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Philippe Canet
- Mental Health Care Line, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Brian Martis
- Mental Health Care Line, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Jyoti Mishra
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Dhakshin S Ramanathan
- Mental Health Care Line, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
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24
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Sá KN, Baptista RF, Shirahige L, Razza LB, Nogueira M, Coura MHF, Afonso-Santos L, Tanaka C, Baptista AF, Monte-Silva K, Brunoni AR. Evidence-based umbrella review of non-invasive brain stimulation in anxiety disorders. THE EUROPEAN JOURNAL OF PSYCHIATRY 2023. [DOI: 10.1016/j.ejpsy.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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25
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Zaizar ED, Papini S, Gonzalez-Lima F, Telch MJ. Singular and combined effects of transcranial infrared laser stimulation and exposure therapy on pathological fear: a randomized clinical trial. Psychol Med 2023; 53:908-917. [PMID: 34284836 PMCID: PMC9976021 DOI: 10.1017/s0033291721002270] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/16/2021] [Accepted: 05/21/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preclinical findings suggest that transcranial infrared laser stimulation (TILS) improves fear extinction learning and cognitive function by enhancing prefrontal cortex (PFC) oxygen metabolism. These findings prompted our investigation of treating pathological fear using this non-invasive stimulation approach either alone to the dorsolateral PFC (dlPFC), or to the ventromedial PFC (vmPFC) in combination with exposure therapy. METHODS Volunteers with pathological fear of either enclosed spaces, contamination, public speaking, or anxiety-related bodily sensations were recruited for this randomized, single-blind, sham-controlled trial with four arms: (a) Exposure + TILS_vmPFC (n = 29), (b) Exposure + sham TILS_vmPFC (n = 29), (c) TILS_dlPFC alone (n = 26), or (d) Sham TILS _dlPFC alone (n = 28). Post-treatment assessments occurred immediately following treatment. Follow-up assessments occurred 2 weeks after treatment. RESULTS A total of 112 participants were randomized [age range: 18-63 years; 96 females (85.71%)]. Significant interactions of Group × Time and Group × Context indicated differential treatment effects on retention (i.e. between time-points, averaged across contexts) and on generalization (i.e. between contexts, averaged across time-points), respectively. Among the monotherapies, TILS_dlPFC outperformed SHAM_dlPFC in the initial context, b = -13.44, 95% CI (-25.73 to -1.15), p = 0.03. Among the combined treatments, differences between EX + TILS_vmPFC and EX + SHAM_vmPFC were non-significant across all contrasts. CONCLUSIONS TILS to the dlPFC, one of the PFC regions implicated in emotion regulation, resulted in a context-specific benefit as a monotherapy for reducing fear. Contrary to prediction, TILS to the vmPFC, a region implicated in fear extinction memory consolidation, did not enhance exposure therapy outcome.
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Affiliation(s)
- Eric D. Zaizar
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
- Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
| | - Santiago Papini
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
- Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
| | - F. Gonzalez-Lima
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
- Institute for Neuroscience, The University of Texas at Austin, Austin, TX, USA
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Michael J. Telch
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
- Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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26
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Chen JM, Li XL, Pan QH, Yang Y, Xu SM, Xu JW. Effects of non-invasive brain stimulation on motor function after spinal cord injury: a systematic review and meta-analysis. J Neuroeng Rehabil 2023; 20:3. [PMID: 36635693 PMCID: PMC9837916 DOI: 10.1186/s12984-023-01129-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 01/07/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In recent years, non-invasive brain stimulation (NIBS) has been used for motor function recovery. However, the effects of NIBS in populations with spinal cord injury (SCI) remain unclear. This study aims to conduct a meta-analysis of the existing evidence on the effects and safety of NIBS against sham groups for motor dysfunction after SCI to provide a reference for clinical decision-making. METHODS Two investigators systematically screened English articles from PubMed, MEDLINE, Embase, and Cochrane Library for prospective randomized controlled trials regarding the effects of NIBS in motor function recovery after SCI. Studies with at least three sessions of NIBS were included. We assessed the methodological quality of the selected studies using the evidence-based Cochrane Collaboration's tool. A meta-analysis was performed by pooling the standardized mean difference (SMD) with 95% confidence intervals (CI). RESULTS A total of 14 randomized control trials involving 225 participants were included. Nine studies used repetitive transcranial magnetic stimulation (rTMS) and five studies used transcranial direct current stimulation (tDCS). The meta-analysis showed that NIBS could improve the lower extremity strength (SMD = 0.58, 95% CI = 0.02-1.14, P = 0.004), balance (SMD = 0.64, 95% CI = 0.05-1.24, P = 0.03), and decrease the spasticity (SMD = - 0.64, 95% CI = - 1.20 to - 0.03, P = 0.04). However, the motor ability of the upper extremity in the NIBS groups was not statistically significant compared with those in the control groups (upper-extremity strength: P = 0.97; function: P = 0.56; and spasticity: P = 0.12). The functional mobility in the NIBS groups did not reach statistical significance when compared with the sham NIBS groups (sham groups). Only one patient reported seizures that occurred during stimulation, and no other types of serious adverse events were reported. CONCLUSION NIBS appears to positively affect the motor function of the lower extremities in SCI patients, despite the marginal P-value and the high heterogeneity. Further high-quality clinical trials are needed to support or refute the use and optimize the stimulation parameters of NIBS in clinical practice.
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Affiliation(s)
- Jian-Min Chen
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China ,grid.412683.a0000 0004 1758 0400Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiao-Lu Li
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Qin-He Pan
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Ye Yang
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Sen-Ming Xu
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Jian-Wen Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
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27
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Subramaniam A, Liu S, Lochhead L, Appelbaum LG. A systematic review of transcranial direct current stimulation on eye movements and associated psychological function. Rev Neurosci 2022; 34:349-364. [PMID: 36310385 DOI: 10.1515/revneuro-2022-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/07/2022] [Indexed: 11/05/2022]
Abstract
Abstract
The last decades have seen a rise in the use of transcranial direct current stimulation (tDCS) approaches to modulate brain activity and associated behavior. Concurrently, eye tracking (ET) technology has improved to allow more precise quantitative measurement of gaze behavior, offering a window into the mechanisms of vision and cognition. When combined, tDCS and ET provide a powerful system to probe brain function and measure the impact on visual function, leading to an increasing number of studies that utilize these techniques together. The current pre-registered, systematic review seeks to describe the literature that integrates these approaches with the goal of changing brain activity with tDCS and measuring associated changes in eye movements with ET. The literature search identified 26 articles that combined ET and tDCS in a probe-and-measure model and are systematically reviewed here. All studies implemented controlled interventional designs to address topics related to oculomotor control, cognitive processing, emotion regulation, or cravings in healthy volunteers and patient populations. Across these studies, active stimulation typically led to changes in the number, duration, and timing of fixations compared to control stimulation. Notably, half the studies addressed emotion regulation, each showing hypothesized effects of tDCS on ET metrics, while tDCS targeting the frontal cortex was widely used and also generally produced expected modulation of ET. This review reveals promising evidence of the impact of tDCS on eye movements and associated psychological function, offering a framework for effective designs with recommendations for future studies.
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Affiliation(s)
- Ashwin Subramaniam
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
| | - Sicong Liu
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Liam Lochhead
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Lawrence Gregory Appelbaum
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
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28
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Giron CG, Lin TTZ, Kan RLD, Zhang BBB, Yau SY, Kranz GS. Non-Invasive Brain Stimulation Effects on Biomarkers of Tryptophan Metabolism: A Scoping Review and Meta-Analysis. Int J Mol Sci 2022; 23:ijms23179692. [PMID: 36077088 PMCID: PMC9456364 DOI: 10.3390/ijms23179692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Abnormal activation of the kynurenine and serotonin pathways of tryptophan metabolism is linked to a host of neuropsychiatric disorders. Concurrently, noninvasive brain stimulation (NIBS) techniques demonstrate high therapeutic efficacy across neuropsychiatric disorders, with indications for modulated neuroplasticity underlying such effects. We therefore conducted a scoping review with meta-analysis of eligible studies, conforming with the PRISMA statement, by searching the PubMed and Web of Science databases for clinical and preclinical studies that report the effects of NIBS on biomarkers of tryptophan metabolism. NIBS techniques reviewed were electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS). Of the 564 search results, 65 studies were included with publications dating back to 1971 until 2022. The Robust Bayesian Meta-Analysis on clinical studies and qualitative analysis identified general null effects by NIBS on biomarkers of tryptophan metabolism, but moderate evidence for TMS effects on elevating serum serotonin levels. We cannot interpret this as evidence for or against the effects of NIBS on these biomarkers, as there exists several confounding methodological differences in this literature. Future controlled studies are needed to elucidate the effects of NIBS on biomarkers of tryptophan metabolism, an under-investigated question with substantial implications to clinical research and practice.
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Affiliation(s)
- Cristian G. Giron
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Tim T. Z. Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Rebecca L. D. Kan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Bella B. B. Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Suk Yu Yau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Mental Health Research Center (MHRC), The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Georg S. Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Mental Health Research Center (MHRC), The Hong Kong Polytechnic University, Hong Kong SAR, China
- Department of Psychiatry and Psychotherapy, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, 1090 Vienna, Austria
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Correspondence:
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Neacsiu AD, Szymkiewicz V, Galla JT, Li B, Kulkarni Y, Spector CW. The neurobiology of misophonia and implications for novel, neuroscience-driven interventions. Front Neurosci 2022; 16:893903. [PMID: 35958984 PMCID: PMC9359080 DOI: 10.3389/fnins.2022.893903] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Decreased tolerance in response to specific every-day sounds (misophonia) is a serious, debilitating disorder that is gaining rapid recognition within the mental health community. Emerging research findings suggest that misophonia may have a unique neural signature. Specifically, when examining responses to misophonic trigger sounds, differences emerge at a physiological and neural level from potentially overlapping psychopathologies. While these findings are preliminary and in need of replication, they support the hypothesis that misophonia is a unique disorder. In this theoretical paper, we begin by reviewing the candidate networks that may be at play in this complex disorder (e.g., regulatory, sensory, and auditory). We then summarize current neuroimaging findings in misophonia and present areas of overlap and divergence from other mental health disorders that are hypothesized to co-occur with misophonia (e.g., obsessive compulsive disorder). Future studies needed to further our understanding of the neuroscience of misophonia will also be discussed. Next, we introduce the potential of neurostimulation as a tool to treat neural dysfunction in misophonia. We describe how neurostimulation research has led to novel interventions in psychiatric disorders, targeting regions that may also be relevant to misophonia. The paper is concluded by presenting several options for how neurostimulation interventions for misophonia could be crafted.
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Affiliation(s)
- Andrada D. Neacsiu
- Duke Center for Misophonia and Emotion Regulation, Duke Brain Stimulation Research Center, Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Duke University, Durham, NC, United States
| | - Victoria Szymkiewicz
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Jeffrey T. Galla
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Brenden Li
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Yashaswini Kulkarni
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Cade W. Spector
- Department of Philosophy, Duke University, Durham, NC, United States
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De Filippi E, Marins T, Escrichs A, Gilson M, Moll J, Tovar-Moll F, Deco G. One session of fMRI-Neurofeedback training on motor imagery modulates whole-brain effective connectivity and dynamical complexity. Cereb Cortex Commun 2022; 3:tgac027. [PMID: 36072710 PMCID: PMC9441014 DOI: 10.1093/texcom/tgac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 06/28/2022] [Accepted: 07/03/2022] [Indexed: 11/23/2022] Open
Abstract
In the past decade, several studies have shown that Neurofeedback (NFB) by functional magnetic resonance imaging can alter the functional coupling of targeted and non-targeted areas. However, the causal mechanisms underlying these changes remain uncertain. Here, we applied a whole-brain dynamical model to estimate Effective Connectivity (EC) profiles of resting-state data acquired before and immediately after a single-session NFB training for 17 participants who underwent motor imagery NFB training and 16 healthy controls who received sham feedback. Within-group and between-group classification analyses revealed that only for the NFB group it was possible to accurately discriminate between the 2 resting-state sessions. NFB training-related signatures were reflected in a support network of direct connections between areas involved in reward processing and implicit learning, together with regions belonging to the somatomotor, control, attention, and default mode networks, identified through a recursive-feature elimination procedure. By applying a data-driven approach to explore NFB-induced changes in spatiotemporal dynamics, we demonstrated that these regions also showed decreased switching between different brain states (i.e. metastability) only following real NFB training. Overall, our findings contribute to the understanding of NFB impact on the whole brain’s structure and function by shedding light on the direct connections between brain areas affected by NFB training.
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Affiliation(s)
- Eleonora De Filippi
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Carrer de Ramon Trias Fargas , 25-27, 08005 Barcelona, Catalonia, Spain
| | - Theo Marins
- D’Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, Botafogo-Rio de Janeiro , 22281-100, Brazil
- Post-Graduate Program in Morphological Sciences, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Citade universitaria da Universidade Federal do Rio de Janeiro , 21941-590, Brazil
| | - Anira Escrichs
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Carrer de Ramon Trias Fargas , 25-27, 08005 Barcelona, Catalonia, Spain
| | - Matthieu Gilson
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Carrer de Ramon Trias Fargas , 25-27, 08005 Barcelona, Catalonia, Spain
| | - Jorge Moll
- D’Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, Botafogo-Rio de Janeiro , 22281-100, Brazil
| | - Fernanda Tovar-Moll
- D’Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, Botafogo-Rio de Janeiro , 22281-100, Brazil
- Post-Graduate Program in Morphological Sciences, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Citade universitaria da Universidade Federal do Rio de Janeiro , 21941-590, Brazil
| | - Gustavo Deco
- Institució Catalana de la Recerca i Estudis Avançats (ICREA), Passeig de Lluis Companys , 23, 08010, Barcelona, Catalonia, Spain
- Department of Neuropsychology, Max Planck Institute for human Cognitive and Brain Sciences , Stephanstrasse 1a, 04103, Leipzig, Germany
- Turner Institute for Brain and Mental Health, Monash University level 5 , 18 Innovation Walk, Clayton Campus. Wellington Road, Clayton VIC 3800, Australia
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Zhang Q, Li X, Liu X, Liu S, Zhang M, Liu Y, Zhu C, Wang K. The Effect of Non-Invasive Brain Stimulation on the Downregulation of Negative Emotions: A Meta-Analysis. Brain Sci 2022; 12:brainsci12060786. [PMID: 35741671 PMCID: PMC9221395 DOI: 10.3390/brainsci12060786] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/26/2022] [Accepted: 06/11/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Emotion regulation (ER) is regarded as a core treatment target for depression and other mental illnesses. In recent years, non-invasive brain stimulation (NIBS) has been extensively used as an intervention for mental illnesses, but there has been no systematic review conducted regarding its effect on emotion regulation. Therefore, we conducted a meta-analysis of the effectiveness of NIBS for emotion regulation; (2) Methods: Systematic searches were conducted in Embase, Web of Science, PubMed, and Cochrane Library. We analyzed the effects of NIBS on tasks assessing emotion regulation using a random-effects model, and further explored the moderating role of the following factors on transcranial direct current stimulation (tDCS) studies by conducting subgroup analyses and meta-regression: target electrode placement, return electrode placement, current intensity, target electrode size, and duration of intervention; (3) Results: A total of 17 studies were included. Our meta-analysis indicated a small but significant effect of NIBS on the downregulation of negative emotions. Separate analyses indicated that repetitive transcranial magnetic stimulation (rTMS) had a medium and significant effect on the downregulation of negative emotions, whereas tDCS had no significant effect. Subgroup analyses showed that the effect of tDCS was moderated by target and return electrode placemen; (4) Conclusions: These results indicate that NIBS had a positive effect on the downregulation of negative emotions. The stimulation protocols should be carefully considered and the underlying mechanisms should be further explored.
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Affiliation(s)
- Qingqing Zhang
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Xiaoming Li
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Xinying Liu
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Shanshan Liu
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Mengzhu Zhang
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Yueling Liu
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Chunyan Zhu
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei 230011, China
- Correspondence:
| | - Kai Wang
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei 230011, China
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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Formation of False Context Fear Memory Is Regulated by Hypothalamic Corticotropin-Releasing Factor in Mice. Int J Mol Sci 2022; 23:ijms23116286. [PMID: 35682965 PMCID: PMC9181353 DOI: 10.3390/ijms23116286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 12/10/2022] Open
Abstract
Traumatic events frequently produce false fear memories. We investigated the effect of hypothalamic corticotropin-releasing factor (CRF) knockdown (Hy-Crf-KD) or overexpression (Hy-CRF-OE) on contextual fear memory, as fear stress-released CRF and hypothalamic-pituitary-adrenal axis activation affects the memory system. Mice were placed in a chamber with an electric footshock as a conditioning stimulus (CS) in Context A, then exposed to a novel chamber without CS, as Context B, at 3 h (B-3h) or 24 h (B-24h). The freezing response in B-3h was intensified in the experimental mice, compared to control mice not exposed to CS, indicating that a false fear memory was formed at 3 h. The within-group freezing level at B-24h was higher than that at B-3h, indicating that false context fear memory was enhanced at B-24h. The difference in freezing levels between B-3h and B-24h in Hy-Crf-KD mice was larger than that of controls. In Hy-CRF-OE mice, the freezing level at B-3h was higher than that of control and Hy-Crf-KD mice, while the freezing level in B-24h was similar to that in B-3h. Locomotor activity before CS and freezing level during CS were similar among the groups. Therefore, we hypothesized that Hy-Crf-KD potentiates the induction of false context fear memory, while Hy-CRF-OE enhances the onset of false fear memory formation.
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Hyde J, Carr H, Kelley N, Seneviratne R, Reed C, Parlatini V, Garner M, Solmi M, Rosson S, Cortese S, Brandt V. Efficacy of neurostimulation across mental disorders: systematic review and meta-analysis of 208 randomized controlled trials. Mol Psychiatry 2022; 27:2709-2719. [PMID: 35365806 PMCID: PMC8973679 DOI: 10.1038/s41380-022-01524-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 01/29/2023]
Abstract
Non-invasive brain stimulation (NIBS), including transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS), is a potentially effective treatment strategy for a number of mental conditions. However, no quantitative evidence synthesis of randomized controlled trials (RCTs) of TMS or tDCS using the same criteria including several mental conditions is available. Based on 208 RCTs identified in a systematic review, we conducted a series of random effects meta-analyses to assess the efficacy of NIBS, compared to sham, for core symptoms and cognitive functioning within a broad range of mental conditions. Outcomes included changes in core symptom severity and cognitive functioning from pre- to post-treatment. We found significant positive effects for several outcomes without significant heterogeneity including TMS for symptoms of generalized anxiety disorder (SMD = -1.8 (95% CI: -2.6 to -1), and tDCS for symptoms of substance use disorder (-0.73, -1.00 to -0.46). There was also significant effects for TMS in obsessive-compulsive disorder (-0.66, -0.91 to -0.41) and unipolar depression symptoms (-0.60, -0.78 to -0.42) but with significant heterogeneity. However, subgroup analyses based on stimulation site and number of treatment sessions revealed evidence of positive effects, without significant heterogeneity, for specific TMS stimulation protocols. For neurocognitive outcomes, there was only significant evidence, without significant heterogeneity, for tDCS for improving attention (-0.3, -0.55 to -0.05) and working memory (-0.38, -0.74 to -0.03) in individuals with schizophrenia. We concluded that TMS and tDCS can benefit individuals with a variety of mental conditions, significantly improving clinical dimensions, including cognitive deficits in schizophrenia which are poorly responsive to pharmacotherapy.
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Affiliation(s)
- Joshua Hyde
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK.
| | - Hannah Carr
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Nicholas Kelley
- Centre for Research on Self and Identity, School of Psychology, University of Southampton, Southampton, UK
| | - Rose Seneviratne
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Claire Reed
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Valeria Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Garner
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
| | - Stella Rosson
- Department of Mental Health, Azienda AULSS 3 Serenissima, Venice, Italy
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
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The Use of Repetitive Transcranial Magnetic Stimulations for the Treatment of Post-Traumatic Stress Disorder: A Scoping Review. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive procedure in which brain neural activity is stimulated by the direct application of a magnetic field to the scalp. Despite its wide and continuous usage for the management of psychiatric disorders, the use of rTMS for post-traumatic stress disorder (PTSD) is not well established and evaluated by researchers. This scoping review seeks to explore the relevant literature available regarding the use of rTMS as a mode of treatment for PTSD, to map evidence in support of the use of rTMS for PTSD, and recommendations on future clinical and research work. Five databases were searched (MEDLINE, CINAHL, Psych INFO, SCOPUS, and EMBASE) to identify empirical studies and randomized controlled trials aimed at the treatment of PTSD with rTMS. A total of 10 studies were eligible for this review. The search results are up to date as of the date of the electronic data search of 20 December 2020. The frequencies applied in the studies ranged from low (1 Hz) to high (10 Hz) at different thresholds. Nine reported significant positive outcomes and PTSD symptoms improvement. rTMS was reported as well tolerated with no significant side effects. The application of rTMS for PTSD looks promising despite the diversity in terms of its outcomes and its clinical significance. Studies with well-defined stimulation parameters need to be conducted in the future.
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Miranda O, Fan P, Qi X, Yu Z, Ying J, Wang H, Brent DA, Silverstein JC, Chen Y, Wang L. DeepBiomarker: Identifying Important Lab Tests from Electronic Medical Records for the Prediction of Suicide-Related Events among PTSD Patients. J Pers Med 2022; 12:524. [PMID: 35455640 PMCID: PMC9025406 DOI: 10.3390/jpm12040524] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
Identifying patients with high risk of suicide is critical for suicide prevention. We examined lab tests together with medication use and diagnosis from electronic medical records (EMR) data for prediction of suicide-related events (SREs; suicidal ideations, attempts and deaths) in post-traumatic stress disorder (PTSD) patients, a population with a high risk of suicide. We developed DeepBiomarker, a deep-learning model through augmenting the data, including lab tests, and integrating contribution analysis for key factor identification. We applied DeepBiomarker to analyze EMR data of 38,807 PTSD patients from the University of Pittsburgh Medical Center. Our model predicted whether a patient would have an SRE within the following 3 months with an area under curve score of 0.930. Through contribution analysis, we identified important lab tests for suicide prediction. These identified factors imply that the regulation of the immune system, respiratory system, cardiovascular system, and gut microbiome were involved in shaping the pathophysiological pathways promoting depression and suicidal risks in PTSD patients. Our results showed that abnormal lab tests combined with medication use and diagnosis could facilitate predicting SRE risk. Moreover, this may imply beneficial effects for suicide prevention by treating comorbidities associated with these biomarkers.
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Affiliation(s)
- Oshin Miranda
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15206, USA; (O.M.); (P.F.); (X.Q.)
| | - Peihao Fan
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15206, USA; (O.M.); (P.F.); (X.Q.)
| | - Xiguang Qi
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15206, USA; (O.M.); (P.F.); (X.Q.)
| | - Zeshui Yu
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15206, USA;
| | - Jian Ying
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, USA;
| | - Haohan Wang
- Language Technologies Institute, School of Computer Science, Carnegie Mellon University, Pittsburgh, PA 15213, USA;
| | - David A. Brent
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Jonathan C. Silverstein
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Yu Chen
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, USA
| | - Lirong Wang
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15206, USA; (O.M.); (P.F.); (X.Q.)
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Vaithianathan T, Blair M, Soares V, Rybak YE, Palaniyappan L, Richardson JD, Burhan AM. Bilateral sequential theta burst stimulation in depressed veterans with service related posttraumatic stress disorder: a feasibility study. BMC Psychiatry 2022; 22:81. [PMID: 35114979 PMCID: PMC8811967 DOI: 10.1186/s12888-022-03729-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression comorbid with posttraumatic stress disorder (PTSD) can be disabling and treatment resistant. Preliminary evidence suggests that repetitive transcranial magnetic stimulation (rTMS), may have a role in helping these patients. There are only few published studies using different rTMS paradigms including bilateral intermittent theta burst (iTBS) and low frequency rTMS. METHODS In this small cohort observation study, we examined the efficacy of bilateral sequential theta-burst stimulation (bsTBS) in 8 treatment resistant depression (TRD) military veterans with PTSD comorbidity stemming from military service experience. RESULTS bsTBS was generally well tolerated and resulted in 25% and 38% remission and response rates on Depression scores respectively; 25% remission and response rate on PTSD scores. DISCUSSION This study demonstrates preliminary feasibility and safety of bsTBS in TRD with comorbid military service related PTSD. We concluded that this paradigm might hold promise as a therapeutic tool to help patients with TRD co-morbid with military service related PTSD. Further adequately powered studies to compare rTMS treatment paradigms in this patient group are warranted.
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Affiliation(s)
- Thelepa Vaithianathan
- grid.490416.e0000000089931637Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 9X4 Canada
| | - Mervin Blair
- grid.490416.e0000000089931637Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 9X4 Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, Ontario Canada
| | - Vanessa Soares
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, Ontario Canada ,grid.55614.330000 0001 1302 4958MacDonald Franklin OSI Research Centre, London, Ontario Canada
| | - Yuri E. Rybak
- grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada
| | - Lena Palaniyappan
- grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada ,grid.39381.300000 0004 1936 8884Robarts Research Institute, University of Western Ontario, London, Ontario Canada
| | - J Don Richardson
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, Ontario Canada ,grid.55614.330000 0001 1302 4958MacDonald Franklin OSI Research Centre, London, Ontario Canada ,grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada
| | - Amer M. Burhan
- grid.490416.e0000000089931637Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 9X4 Canada ,grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
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Madore MR, Kozel FA, Williams LM, Green LC, George MS, Holtzheimer PE, Yesavage JA, Philip NS. Prefrontal transcranial magnetic stimulation for depression in US military veterans - A naturalistic cohort study in the veterans health administration. J Affect Disord 2022; 297:671-678. [PMID: 34687780 PMCID: PMC8667345 DOI: 10.1016/j.jad.2021.10.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (TMS) is an evidence-based treatment for pharmacoresistant major depressive disorder (MDD), however, the evidence in veterans has been mixed. To this end, VA implemented a nationwide TMS program that included evaluating clinical outcomes within a naturalistic design. TMS was hypothesized to be safe and provide clinically meaningful reductions in MDD and posttraumatic stress disorder (PTSD) symptoms. METHODS Inclusion criteria were MDD diagnosis and standard clinical TMS eligibility. Of the 770 patients enrolled between October 2017 and March 2020, 68.4% (n = 521) met threshold-level PTSD symptom criteria. Treatments generally used standard parameters (e.g., left dorsolateral prefrontal cortex, 120% motor threshold, 10 Hz, 3000 pulses/treatment). Adequate dose was operationally defined as 30 sessions. MDD and PTSD symptoms were measured using the 9-item patient health questionnaire (PHQ-9) and PTSD checklist for DSM-5 (PCL-5), respectively. RESULTS Of the 770 who received at least one session, TMS was associated with clinically meaningful (Cohen's d>1.0) and statistically significant (all p<.001) reductions in MDD and PTSD. Of the 340 veterans who received an adequate dose, MDD response and remission rates were 41.4% and 20%, respectively. In veterans with comorbid PTSD, 65.3% demonstrated clinically meaningful reduction and 46.1% no longer met PTSD threshold criteria after TMS. Side effects were consistent with the known safety profile of TMS. LIMITATIONS Include those inherent to retrospective observational cohort study in Veterans. CONCLUSIONS These multisite, large-scale data supports the effectiveness and safety of TMS for veterans with MDD and PTSD using standard clinical approaches.
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Affiliation(s)
- Michelle R Madore
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA
| | - F Andrew Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA; Mental Health and Behavioral Sciences, James A. Haley Veterans’ Administration Hospital and Clinics, Tampa, FL, USA; Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Leanne M Williams
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA
| | - L Chauncey Green
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA
| | - Mark S George
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA; Brain Stimulation Laboratory, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Paul E Holtzheimer
- National Center for PTSD, White River Junction, VT, United States; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jerome A Yesavage
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
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Bak S, Shin J, Jeong J. Subdividing Stress Groups into Eustress and Distress Groups Using Laterality Index Calculated from Brain Hemodynamic Response. BIOSENSORS 2022; 12:bios12010033. [PMID: 35049661 PMCID: PMC8773747 DOI: 10.3390/bios12010033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 12/28/2022]
Abstract
A stress group should be subdivided into eustress (low-stress) and distress (high-stress) groups to better evaluate personal cognitive abilities and mental/physical health. However, it is challenging because of the inconsistent pattern in brain activation. We aimed to ascertain the necessity of subdividing the stress groups. The stress group was screened by salivary alpha-amylase (sAA) and then, the brain’s hemodynamic reactions were measured by functional near-infrared spectroscopy (fNIRS) based on the near-infrared biosensor. We compared the two stress subgroups categorized by sAA using a newly designed emotional stimulus-response paradigm with an international affective picture system (IAPS) to enhance hemodynamic signals induced by the target effect. We calculated the laterality index for stress (LIS) from the measured signals to identify the dominantly activated cortex in both the subgroups. Both the stress groups exhibited brain activity in the right frontal cortex. Specifically, the eustress group exhibited the largest brain activity, whereas the distress group exhibited recessive brain activity, regardless of positive or negative stimuli. LIS values were larger in the order of the eustress, control, and distress groups; this indicates that the stress group can be divided into eustress and distress groups. We built a foundation for subdividing stress groups into eustress and distress groups using fNIRS.
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Affiliation(s)
- SuJin Bak
- Department of Brain and Cognitive Engineering, Korea University, Seoul 02841, Korea;
| | - Jaeyoung Shin
- Department of Electronic Engineering, Wonkwang University, Iksan 54538, Korea;
| | - Jichai Jeong
- Department of Brain and Cognitive Engineering, Korea University, Seoul 02841, Korea;
- Correspondence:
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Florian G, Singier A, Aouizerate B, Salvo F, Bienvenu TCM. Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:910897. [PMID: 35845453 PMCID: PMC9283719 DOI: 10.3389/fpsyt.2022.910897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pathological anxiety is responsible for major functional impairments and resistance to conventional treatments in anxiety disorders (ADs), posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Focal neuromodulation therapies such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) are being developed to treat those disorders. METHODS We performed a dimensional systematic review and meta-analysis to assess the evidence of the efficacy of TMS, tDCS and DBS in reducing anxiety symptoms across ADs, PTSD and MDD. Reports were identified through systematic searches in PubMed/Medline, Scopus and Cochrane library (inception to November 2020), followed by review according to the PRISMA guidelines. Controlled clinical trials examining the effectiveness of brain stimulation techniques on generic anxiety symptoms in patients with ADs, PTSD or MDD were selected. RESULTS Nineteen studies (RCTs) met inclusion criteria, which included 589 participants. Overall, focal brain activity modulation interventions were associated with greater reduction of anxiety levels than controls [SMD: -0.56 (95% CI, -0.93 to-0.20, I 2 = 77%]. Subgroup analyses revealed positive effects for TMS across disorders, and of focal neuromodulation in generalized anxiety disorder and PTSD. Rates of clinical responses and remission were higher in the active conditions. However, the risk of bias was high in most studies. CONCLUSIONS There is moderate quality evidence for the efficacy of neuromodulation in treating pathological anxiety. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=233084, identifier: PROSPERO CRD42021233084. It was submitted on January 29th, 2021, and registered on March 1st, 2021. No amendment was made to the recorded protocol. A change was applied for the subgroup analyses based on target brain regions, we added the putative nature (excitatory/inhibitory) of brain activity modulation.
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Affiliation(s)
- Gay Florian
- Université de Bordeaux, Bordeaux, France.,Centre de Référence Régional des Pathologies Anxieuses et de la Dépression, Pôle de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Allison Singier
- Université de Bordeaux, Bordeaux, France.,Bordeaux Population Health, Inserm U1219, Bordeaux, France
| | - Bruno Aouizerate
- Université de Bordeaux, Bordeaux, France.,Centre de Référence Régional des Pathologies Anxieuses et de la Dépression, Pôle de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, France.,NutriNeuro, UMR 1286, INRAE, Bordeaux INP, Bordeaux, France
| | - Francesco Salvo
- Université de Bordeaux, Bordeaux, France.,Bordeaux Population Health, Inserm U1219, Bordeaux, France.,CHU de Bordeaux, Bordeaux, France
| | - Thomas C M Bienvenu
- Université de Bordeaux, Bordeaux, France.,Centre de Référence Régional des Pathologies Anxieuses et de la Dépression, Pôle de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, France.,Neurocentre Magendie, Inserm U1215, Bordeaux, France
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Edinoff AN, Hegefeld TL, Petersen M, Patterson JC, Yossi C, Slizewski J, Osumi A, Cornett EM, Kaye A, Kaye JS, Javalkar V, Viswanath O, Urits I, Kaye AD. Transcranial Magnetic Stimulation for Post-traumatic Stress Disorder. Front Psychiatry 2022; 13:701348. [PMID: 35711594 PMCID: PMC9193572 DOI: 10.3389/fpsyt.2022.701348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric disorder that causes significant functional impairment and is related to altered stress response and reinforced learned fear behavior. PTSD has been found to impact three functional networks in the brain: default mode, executive control, and salience. The executive control network includes the dorsolateral prefrontal cortex (DLPFC) and lateral PPC. The salience network involves the anterior cingulate cortex, anterior insula, and amygdala. This latter network has been found to have increased functional connectivity in PTSD. Transcranial Magnetic Stimulation (TMS) is a technique used in treating PTSD and involves stimulating specific portions of the brain through electromagnetic induction. Currently, high-frequency TMS applied to the left dorsolateral prefrontal cortex (DLPFC) is approved for use in treating major depressive disorder (MDD) in patients who have failed at least one medication trial. In current studies, high-frequency stimulation has been shown to be more effective in PTSD rating scales posttreatment than low-frequency stimulation. The most common side effect is headache and scalp pain treated by mild analgesics. Seizures are a rare side effect and are usually due to predisposing factors. Studies have been done to assess the overall efficacy of TMS. However, results have been conflicting, and sample sizes were small. More research should be done with larger sample sizes to test the efficacy of TMS in the treatment of PTSD. Overall, TMS is a relatively safe treatment. Currently, the only FDA- approved to treat refractory depression, but with the potential to treat many other conditions.
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Affiliation(s)
- Amber N Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - Tanner L Hegefeld
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - Murray Petersen
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - James C Patterson
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | | | - Jacob Slizewski
- Creighton University School of Medicine, Omaha, NE, United States
| | - Ashley Osumi
- Creighton University School of Medicine, Omaha, NE, United States
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, United States
| | - Adam Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, United States
| | - Jessica S Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, United States
| | - Vijayakumar Javalkar
- Department of Neurology, Louisiana State University Shreveport, Shreveport, LA, United States
| | - Omar Viswanath
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, United States.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, United States.,Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, United States
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, United States.,Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA, United States
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, United States
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Faucher CR, Doherty RA, Philip NS, Harle ASM, Cole JJE, van ’t Wout-Frank M. Is there a neuroscience-based, mechanistic rationale for transcranial direct current stimulation as an adjunct treatment for posttraumatic stress disorder? Behav Neurosci 2021; 135:702-713. [PMID: 34338547 PMCID: PMC8648962 DOI: 10.1037/bne0000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is well-known that there is considerable variation in the effectiveness of evidence-based treatments for psychiatric disorders, and a continued need to improve the real-world effectiveness of these treatments. In the last 20+ years the examination of noninvasive brain stimulation techniques for psychiatric treatment has increased dramatically. However, in order to test these techniques for effective therapeutic use, it is critical to understand (a) (what are) the key neural circuits to engage for specific disorders or clusters of symptoms, and (b) (how) can these circuits be reached effectively using neurostimulation? Here we focus on the research toward the application of transcranial direct current stimulation (tDCS) for posttraumatic stress disorder (PTSD). tDCS is a portable and inexpensive technique that lends itself well to be combined with, and thus potentially augment, exposure-based treatment for PTSD. In this review, we discuss the behavioral model of threat and safety learning and memory as it relates to PTSD, the underlying neurobiology of PTSD, as well as the current understandings of tDCS action, including its limitations and opportunities. Through this lens, we summarize the research on the application of tDCS to modulated threat and safety learning and memory to date, and propose new directions for its future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- C. R. Faucher
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence
- COBRE Center for Neuromodulation, Butler Hospital, Providence
| | - R. A. Doherty
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence
- COBRE Center for Neuromodulation, Butler Hospital, Providence
| | - N. S. Philip
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence
- COBRE Center for Neuromodulation, Butler Hospital, Providence
| | - A. S. M Harle
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence
- COBRE Center for Neuromodulation, Butler Hospital, Providence
| | - J. J. E. Cole
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence
- COBRE Center for Neuromodulation, Butler Hospital, Providence
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Deep Transcranial Magnetic Stimulation Combined With Brief Exposure for Posttraumatic Stress Disorder: A Prospective Multisite Randomized Trial. Biol Psychiatry 2021; 90:721-728. [PMID: 34274108 DOI: 10.1016/j.biopsych.2021.04.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is both prevalent and debilitating. While deep transcranial magnetic stimulation (dTMS) has shown preliminary efficacy, exposure therapy remains the most efficacious, though limited, treatment in PTSD. The medial prefrontal cortex (mPFC) is implicated in extinction learning, suggesting that concurrent mPFC stimulation may enhance exposure therapy. In this randomized controlled multicenter trial, the efficacy and safety of mPFC dTMS combined with a brief exposure procedure were studied in patients with PTSD. METHODS Immediately following exposure to their trauma narrative, 125 outpatients were randomly assigned to receive dTMS or sham. Twelve sessions were administered over 4 weeks, with a primary end point of change in 5-week Clinician-Administered PTSD Scale for DSM-5 score. This clinical study did not include biological markers. RESULTS Clinician-Administered PTSD Scale for DSM-5 score improved significantly in both groups at 5 weeks, though the improvement was smaller in the dTMS group (16.32) compared with the sham group (20.52; p = .027). At 9 weeks, improvement continued in Clinician-Administered PTSD Scale for DSM-5 score in both groups but remained smaller in dTMS (19.0) versus sham (24.4; p = .024). CONCLUSIONS Both groups showed significant PTSD symptom improvement, possibly from the brief script-driven imagery exposure. While our design was unable to rule out placebo effects, the magnitude and durability of improvement suggest that repeated ultrabrief exposure therapy alone may be an effective treatment for PTSD, warranting additional study. The surprising and unexpected effect in the dTMS group also suggests that repeated mPFC stimulation with the H7 coil may interfere with trauma memory-mediated extinction. Our results provide new insight for dTMS approaches for possible future avenues to treat PTSD.
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Petrosino NJ, Cosmo C, Berlow YA, Zandvakili A, van ’t Wout-Frank M, Philip NS. Transcranial magnetic stimulation for post-traumatic stress disorder. Ther Adv Psychopharmacol 2021; 11:20451253211049921. [PMID: 34733479 PMCID: PMC8558793 DOI: 10.1177/20451253211049921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/09/2021] [Indexed: 01/14/2023] Open
Abstract
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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Affiliation(s)
- Nicholas J. Petrosino
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Camila Cosmo
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Yosef A. Berlow
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Amin Zandvakili
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Mascha van ’t Wout-Frank
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Noah S. Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, 830 Chalkstone Avenue, Providence, RI 02908, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Liu JJW, Nazarov A, Easterbrook B, Plouffe RA, Le T, Forchuk C, Brandwood A, St Cyr K, Auger E, Balderson K, Bilodeau M, Burhan AM, Enns MW, Smith P, Hosseiny F, Dupuis G, Roth M, Mota N, Lavoie V, Richardson JD. Four Decades of Military Posttraumatic Stress: Protocol for a Meta-analysis and Systematic Review of Treatment Approaches and Efficacy. JMIR Res Protoc 2021; 10:e33151. [PMID: 34694228 PMCID: PMC8576591 DOI: 10.2196/33151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Over 85% of active members of the Canadian Armed Forces have been exposed to potentially traumatic events linked to the development of posttraumatic stress disorder (PTSD). At the time of transition to civilian life, as high as 1 in 8 veterans may be diagnosed with PTSD. Given the high prevalence of PTSD in military and veteran populations, the provision of effective treatment considering their unique challenges and experiences is critical for mental health support and the well-being of these populations. OBJECTIVE This paper presents the protocol for a meta-analysis and systematic review that will examine the effectiveness of treatment approaches for military-related PTSD. METHODS This PROSPERO-preregistered meta-analysis is being conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. A comprehensive search of the literature was conducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertation & Theses. Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multilevel meta-analysis will examine the overall effects, between-study effects, and within-study effects of available evidence for PTSD treatments in military populations. Effect sizes will be compared between pharmacotherapeutic, psychotherapeutic, and alternative/emerging treatment interventions. Finally, meta-regression and subgroup analyses will explore the moderating roles of clinical characteristics (eg, PTSD symptom clusters), treatment approaches (eg, therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), as well as treatment characteristics (eg, length of intervention) on treatment outcomes. RESULTS The literature search was completed on April 14, 2021. After the removal of duplicates, a total of 12,002 studies were screened for inclusion. As of July 2021, title and abstract screening has been completed, with 1469 out of 12,002 (12.23%) studies included for full-text review. Full review is expected to be completed in the summer of 2021, with initial results expected for publication by early winter of 2021. CONCLUSIONS This meta-analysis will provide information on the current state of evidence on the efficacy and effectiveness of various treatment approaches for military-related PTSD and identify factors that may influence treatment outcomes. The results will inform clinical decision-making for service providers and service users. Finally, the findings will provide insights into future treatment development and practice recommendations to better support the well-being of military and veteran populations. TRIAL REGISTRATION PROSPERO CRD42021245754; https://tinyurl.com/y9u57c59. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33151.
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Affiliation(s)
- Jenny J W Liu
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Anthony Nazarov
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Bethany Easterbrook
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Rachel A Plouffe
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Tri Le
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Callista Forchuk
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Alec Brandwood
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Kate St Cyr
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Edouard Auger
- Clinique pour traumatismes liés au stress opérationnel, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Ken Balderson
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- St. Joseph's Operational Stress Injury Clinic, Toronto, ON, Canada
| | - Mathieu Bilodeau
- Clinique pour traumatismes liés au stress opérationnel, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Amer M Burhan
- Ontario Shores Centre of Mental Health Sciences, Whitby, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Murray W Enns
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Winnipeg Operational Stress Injury Clinic, Winnipeg, ON, Canada
| | - Patrick Smith
- Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions, Ottawa, ON, Canada
| | - Fardous Hosseiny
- Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions, Ottawa, ON, Canada
| | - Gabrielle Dupuis
- Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions, Ottawa, ON, Canada
| | - Maya Roth
- St. Joseph's Operational Stress Injury Clinic, Toronto, ON, Canada
- Yeates School of Graduate Studies, Ryerson University, Toronto, ON, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, ON, Canada
| | - Vicky Lavoie
- Clinique pour traumatismes liés au stress opérationnel, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - J Don Richardson
- The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- St. Joseph's Operational Stress Injury Clinic, London, ON, Canada
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Intermittent Theta Burst Stimulation in Veterans with Mild Alcohol Use Disorder. J Affect Disord 2021; 293:314-319. [PMID: 34229284 PMCID: PMC8349789 DOI: 10.1016/j.jad.2021.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly comorbid with depression and posttraumatic stress disorder (PTSD) and can complicate their treatment. Transcranial magnetic stimulation is a promising treatment for these disorders, yet prior research often excluded AUD patients out of concern for safety or poorer outcomes. To this end, we revisited a prior study of intermittent theta burst stimulation (iTBS) for PTSD, to evaluate whether mild AUD impacted safety and clinical outcomes. METHODS Fifty veterans with PTSD (n=17, with comorbid AUD) received 10 days of sham-controlled iTBS, followed by 10 unblinded sessions. Stimulation was delivered at 80% of the motor threshold for 1800 pulses to the right dorsolateral prefrontal cortex. Safety, PTSD and depressive outcomes were evaluated with repeated measures analysis of variance, to examine the effects of time, treatment group and comorbid AUD. RESULTS iTBS was safe, although AUD patients reported more adverse events, regardless of whether they received active or sham stimulation. Regarding clinical outcomes, patients with AUD who received active stimulation demonstrated a greater rate of improvement in depression symptoms than those without comorbid AUD. The presence of AUD did not impact PTSD symptom change. LIMITATIONS Limitations include a modest sample size and use of a categorical, rather than continuous, index of AUD diagnosis. CONCLUSION While these results require replication, they indicate that iTBS is likely safe in patients with mild comorbid AUD. We propose that comorbid AUD should not preclude clinical use of iTBS, and that iTBS should be further investigated as a novel treatment option for AUD.
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Belsher BE, Beech EH, Reddy MK, Smolenski DJ, Rauch SAM, Kelber M, Issa F, Lewis C, Bisson JI. Advances in repetitive transcranial magnetic stimulation for posttraumatic stress disorder: A systematic review. J Psychiatr Res 2021; 138:598-606. [PMID: 33992983 DOI: 10.1016/j.jpsychires.2021.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/01/2021] [Accepted: 05/01/2021] [Indexed: 01/18/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) as a treatment for posttraumatic stress disorder (PTSD) has gained interest over the past two decades. However, it has yet to be recommended in major treatment guidelines. We conducted a systematic review of randomized controlled trials to examine the efficacy of rTMS for PTSD. Thirteen studies with 549 participants were included in this review. We compared the effects of (1) rTMS versus sham, and (2) high-frequency (HF) versus low-frequency (LF) rTMS, on posttreatment PTSD scores and other secondary outcomes. We calculated the standardized mean differences (SMD) to determine the direction of effects, and unstandardized mean differences to estimate the magnitude of efficacy. At post-treatment, rTMS was superior to sham comparison in reducing PTSD (SMD = -1.13, 95% CI: -2.10 to -0.15) and depression severity (SMD = -0.83, 95% CI: -1.30 to -0.36). The quality of evidence, however, was rated very low due to small samples sizes, treatment heterogeneity, inconsistent results, and an imprecise pooled effect. HF rTMS was associated with slightly improved, albeit imprecise, outcomes compared to LF rTMS on PTSD (SMD = -0.19, 95% CI: -1.39 to 1.00) and depression (SMD = -1.09, 95% CI: -1.65 to -0.52) severity. Further research is required to advance the evidence on this treatment.
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Affiliation(s)
- Bradley E Belsher
- Carl T Hayden Veterans Medical Center, 650 E Indian School Rd, Phoenix, AZ, 85012, USA; Uniformed Services University of the Health Sciences, 4310 Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - Erin H Beech
- Psychological Health Center of Excellence, Defense Health Agency, 1335 East West Highway, Silver Spring, MD, 20910, USA
| | - Madhavi K Reddy
- Psychological Health Center of Excellence, Defense Health Agency, 1335 East West Highway, Silver Spring, MD, 20910, USA
| | - Derek J Smolenski
- Psychological Health Center of Excellence, Defense Health Agency, 1335 East West Highway, Silver Spring, MD, 20910, USA
| | - Sheila A M Rauch
- Atlanta VA Healthcare System, 1670 Clairmont Road, Decatur, GA, 300233, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park, 3rd Floor, Atlanta, GA, 30329, USA
| | - Marija Kelber
- Psychological Health Center of Excellence, Defense Health Agency, 1335 East West Highway, Silver Spring, MD, 20910, USA
| | - Fuad Issa
- Psychological Health Center of Excellence, Defense Health Agency, 1335 East West Highway, Silver Spring, MD, 20910, USA
| | - Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
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van Rooij SJ, Sippel LM, McDonald WM, Holtzheimer PE. Defining focal brain stimulation targets for PTSD using neuroimaging. Depress Anxiety 2021; 38:10.1002/da.23159. [PMID: 33876868 PMCID: PMC8526638 DOI: 10.1002/da.23159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/17/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Focal brain stimulation has potential as a treatment for posttraumatic stress disorder (PTSD). In this review, we aim to inform selection of focal brain stimulation targets for treating PTSD by examining studies of the functional neuroanatomy of PTSD and treatment response. We first briefly review data on brain stimulation interventions for PTSD. Although published data suggest good efficacy overall, the neurobiological rationale for each stimulation target is not always clear. METHODS Therefore, we assess pre- and post-treatment (predominantly psychotherapy) functional neuroimaging studies in PTSD to determine which brain changes seem critical to treatment response. Results of these studies are presented within a previously proposed functional neural systems model of PTSD. RESULTS While not completely consistent, research suggests that downregulating the fear learning and threat and salience detection circuits (i.e., amygdala, dorsal anterior cingulate cortex and insula) and upregulating the emotion regulation and executive function and contextual processing circuits (i.e., prefrontal cortical regions and hippocampus) may mediate PTSD treatment response. CONCLUSION This literature review provides some justification for current focal brain stimulation targets. However, the examination of treatment effects on neural networks is limited, and studies that include the stimulation targets are lacking. Further, additional targets, such as the cingulate, medial prefrontal cortex, and inferior parietal lobe, may also be worth investigation, especially when considering how to achieve network level changes. Additional research combining PTSD treatment with functional neuroimaging will help move the field forward by identifying and validating novel targets, providing better rationale for specific treatment parameters and personalizing treatment for PTSD.
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Affiliation(s)
- Sanne J.H. van Rooij
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA
| | - Lauren M. Sippel
- National Center for PTSD, U.S. Department of Veterans Affairs, White River Junction, VT
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - William M. McDonald
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA
| | - Paul E. Holtzheimer
- National Center for PTSD, U.S. Department of Veterans Affairs, White River Junction, VT
- Geisel School of Medicine at Dartmouth, Hanover, NH
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