1
|
DePamphilis GM, Tirrell E, Kronenberg EF, Brown JC, Fukuda AM, Carpenter LL. Adverse events with concurrent cannabis use during transcranial magnetic stimulation therapy for major depressive disorder: A case series analysis. Brain Stimul 2024; 17:1140-1141. [PMID: 39303809 DOI: 10.1016/j.brs.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 09/05/2024] [Accepted: 09/13/2024] [Indexed: 09/22/2024] Open
Affiliation(s)
- Gian M DePamphilis
- Butler Hospital TMS/Neuromodulation Research Facility, 345 Blackstone Blvd., Providence, RI, 02906, USA
| | - Eric Tirrell
- Butler Hospital TMS/Neuromodulation Research Facility, 345 Blackstone Blvd., Providence, RI, 02906, USA
| | - E Frances Kronenberg
- Butler Hospital TMS/Neuromodulation Research Facility, 345 Blackstone Blvd., Providence, RI, 02906, USA; New York Medical College, School of Medicine, 40 Sunshine Cottage Rd., Valhalla, NY, 10595, USA
| | - Joshua C Brown
- Psychiatric Neurotherapeutics Program, Division of Depression and Anxiety Disorder, McLean Hospital, 115 Mill St., Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Andrew M Fukuda
- Psychiatric Neurotherapeutics Program, Division of Depression and Anxiety Disorder, McLean Hospital, 115 Mill St., Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Linda L Carpenter
- Butler Hospital TMS/Neuromodulation Research Facility, 345 Blackstone Blvd., Providence, RI, 02906, USA; Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School at Brown University, 222 Richmond St., Providence, RI, 02903, USA.
| |
Collapse
|
2
|
Ngoy A, Tang VM, Xiao K, Blumberger DM, George TP, Gowin JL, Le Foll B, Sloan ME. Neuromodulation for Cannabis Use: A Scoping Review. Brain Sci 2024; 14:356. [PMID: 38672008 PMCID: PMC11048669 DOI: 10.3390/brainsci14040356] [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: 02/08/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
This scoping review explores the use of neuromodulation techniques in individuals with cannabis use. Our goal was to determine whether cannabis use alters cortical excitation and inhibition in the context of neuromodulation and to determine whether neuromodulation affects craving and cannabis use patterns. A systematic search was conducted using PubMed, OVID Medline, and PsycINFO from inception to 20 December 2022. Our review identified ten relevant studies, eight of which used Transcranial Magnetic Stimulation (TMS), while two employed Transcranial Direct Current Stimulation (tDCS). Findings from TMS studies suggest that cannabis users exhibit altered cortical inhibition, with decreased short interval intracortical inhibition (SICI) compared to non-users. Single sessions of rTMS did not have any impact on cannabis craving. By contrast, two studies found that multiple sessions of rTMS reduced cannabis use, but these changes did not meet the threshold for statistical significance and both studies were limited by small sample sizes. The two included tDCS studies found contradictory results, with one showing reduced cannabis craving with active treatment and another showing no effect of active treatment on craving compared to sham. Future studies should further explore the effects of multiple treatment sessions and different neuromodulation modalities.
Collapse
Affiliation(s)
- Anthony Ngoy
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
| | - Victor M. Tang
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (V.M.T.); (D.M.B.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
| | - Kebin Xiao
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (V.M.T.); (D.M.B.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Tony P. George
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Joshua L. Gowin
- Departments of Radiology and Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON L9M 1G3, Canada
| | - Matthew E. Sloan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, ON M1C 1A4, Canada
| |
Collapse
|
3
|
Mehta DD, Praecht A, Ward HB, Sanches M, Sorkhou M, Tang VM, Steele VR, Hanlon CA, George TP. A systematic review and meta-analysis of neuromodulation therapies for substance use disorders. Neuropsychopharmacology 2024; 49:649-680. [PMID: 38086901 PMCID: PMC10876556 DOI: 10.1038/s41386-023-01776-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024]
Abstract
While pharmacological, behavioral and psychosocial treatments are available for substance use disorders (SUDs), they are not always effective or well-tolerated. Neuromodulation (NM) methods, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) may address SUDs by targeting addiction neurocircuitry. We evaluated the efficacy of NM to improve behavioral outcomes in SUDs. A systematic literature search was performed on MEDLINE, PsychINFO, and PubMed databases and a list of search terms for four key concepts (SUD, rTMS, tDCS, DBS) was applied. Ninety-four studies were identified that examined the effects of rTMS, tDCS, and DBS on substance use outcomes (e.g., craving, consumption, and relapse) amongst individuals with SUDs including alcohol, tobacco, cannabis, stimulants, and opioids. Meta-analyses were performed for alcohol and tobacco studies using rTMS and tDCS. We found that rTMS reduced substance use and craving, as indicated by medium to large effect sizes (Hedge's g > 0.5). Results were most encouraging when multiple stimulation sessions were applied, and the left dorsolateral prefrontal cortex (DLPFC) was targeted. tDCS also produced medium effect sizes for drug use and craving, though they were highly variable and less robust than rTMS; right anodal DLPFC stimulation appeared to be most efficacious. DBS studies were typically small, uncontrolled studies, but showed promise in reducing misuse of multiple substances. NM may be promising for the treatment of SUDs. Future studies should determine underlying neural mechanisms of NM, and further evaluate extended treatment durations, accelerated administration protocols and long-term outcomes with biochemical verification of substance use.
Collapse
Affiliation(s)
- Dhvani D Mehta
- Addictions Division, CAMH, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Angela Praecht
- Addictions Division, CAMH, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Heather B Ward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Maryam Sorkhou
- Addictions Division, CAMH, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Victor M Tang
- Addictions Division, CAMH, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vaughn R Steele
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Tony P George
- Addictions Division, CAMH, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
4
|
Sahlem GL, Kim B, Baker NL, Wong BL, Caruso MA, Campbell LA, Kaloani I, Sherman BJ, Ford TJ, Musleh AH, Kim JP, Williams NR, Manett AJ, Kratter IH, Short EB, Killeen TK, George MS, McRae-Clark AL. A preliminary randomized controlled trial of repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex in treatment seeking participants with cannabis use disorder. Drug Alcohol Depend 2024; 254:111035. [PMID: 38043228 PMCID: PMC10837319 DOI: 10.1016/j.drugalcdep.2023.111035] [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: 08/28/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Cannabis use disorder (CUD) is a common and consequential disorder. When applied to the dorsolateral prefrontal cortex (DLPFC), repetitive transcranial magnetic stimulation (rTMS) reduces craving across substance use disorders and may have therapeutic clinical effects when applied in serial-sessions. The present study sought to preliminarily determine whether serial-sessions of rTMS applied to the DLPFC had a therapeutic effect in CUD. METHODS This study was a two-site, phase-2, double-blind, randomized-controlled-trial. Seventy-two treatment-seeking participants (37.5% Women, mean age 30.2±9.9SD) with ≥moderate-CUD were randomized to active or sham rTMS (Beam-F3, 10Hz, 20-total-sessions, two-sessions-per-visit, two-visits-per-week, with cannabis cues) while undergoing a three-session motivational enhancement therapy intervention. The primary outcome was the change in craving between pre- and post- treatment (Marijuana Craving Questionnaire Short-Form-MCQ-SF). Secondary outcomes included the number of weeks of abstinence and the number of days-per-week of cannabis use during 4-weeks of follow-up. RESULTS There were no significant differences in craving between conditions. Participants who received active-rTMS reported numerically, but not significantly, more weeks of abstinence in the follow-up period than those who received sham-rTMS (15.5%-Active; 9.3%-Sham; rate ratio = 1.66 [95% CI: 0.84, 3.28]; p=0.14). Participants who received active-rTMS reported fewer days-per-week of cannabis use over the final two-weeks of the follow-up period than those receiving sham-rTMS (Active vs. Sham: -0.72; Z=-2.33, p=0.02). CONCLUSIONS This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use, though further study is needed with additional rTMS-sessions and a longer follow-up period.
Collapse
Affiliation(s)
- Gregory L Sahlem
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
| | - Bohye Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Nathaniel L Baker
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brendan L Wong
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Margaret A Caruso
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Lauren A Campbell
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Irakli Kaloani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Brian J Sherman
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Tiffany J Ford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Ahmad H Musleh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Jane P Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Andrew J Manett
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Ian H Kratter
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Edward B Short
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Terese K Killeen
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S George
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Aimee L McRae-Clark
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| |
Collapse
|
5
|
Soleimani G, Towhidkhah F, Saviz M, Ekhtiari H. Cortical Morphology in Cannabis Use Disorder: Implications for Transcranial Direct Current Stimulation Treatment. Basic Clin Neurosci 2023; 14:647-662. [PMID: 38628838 PMCID: PMC11016884 DOI: 10.32598/bcn.2021.3400.1] [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: 05/17/2021] [Revised: 09/18/2021] [Accepted: 05/27/2023] [Indexed: 04/19/2024] Open
Abstract
Introduction Transcranial direct current stimulation (tDCS) has been studied as an adjunctive treatment option for substance use disorders (SUDs). Alterations in brain structure following SUD may change tDCS-induced electric field (EF) and subsequent responses; however, group-level differences between healthy controls (HC) and participants with SUDs in terms of EF and its association with cortical architecture have not yet been modeled quantitatively. This study provides a methodology for group-level analysis of computational head models to investigate the influence of cortical morphology metrics on EFs. Methods Whole-brain surface-based morphology was conducted, and cortical thickness, volume, and surface area were compared between participants with cannabis use disorders (CUD) (n=20) and age-matched HC (n=22). Meanwhile, EFs were simulated for bilateral tDCS over the dorsolateral prefrontal cortex. The effects of structural alterations on EF distribution were investigated based on individualized computational head models. Results Regarding EF, no significant difference was found within the prefrontal cortex; however, EFs were significantly different in left-postcentral and right-superior temporal gyrus (P<0.05) with higher levels of variance in CUD compared to HC [F(39, 43)=5.31, P<0.0001, C=0.95]. Significant differences were observed in cortical area (caudal anterior cingulate and rostral middle frontal), thickness (lateral orbitofrontal), and volume (paracentral and fusiform) between the two groups. Conclusion Brain morphology and tDCS-induced EFs may be changed following CUD; however, differences between CUD and HCs in EFs do not always overlap with brain areas that show structural alterations. To sufficiently modulate stimulation targets, whether individuals with CUD need different stimulation doses based on tDCS target location should be checked.
Collapse
Affiliation(s)
- Ghazaleh Soleimani
- Department of Biomedical Engineering, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Farzad Towhidkhah
- Department of Biomedical Engineering, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Mehrdad Saviz
- Department of Biomedical Engineering, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Hamed Ekhtiari
- Laureate Institute of Brain Research, Tulsa, United States of America
| |
Collapse
|
6
|
Harmelech T, Hanlon CA, Tendler A. Transcranial Magnetic Stimulation as a Tool to Promote Smoking Cessation and Decrease Drug and Alcohol Use. Brain Sci 2023; 13:1072. [PMID: 37509004 PMCID: PMC10377606 DOI: 10.3390/brainsci13071072] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive, drug-free, neural-circuit-based therapeutic tool that was recently cleared by the United States Food and Drug Associate for the treatment of smoking cessation. TMS has been investigated as a tool to reduce consumption and craving for many other substance use disorders (SUDs). This review starts with a discussion of neural networks involved in the addiction process. It then provides a framework for the therapeutic efficacy of TMS describing the role of executive control circuits, default mode, and salience circuits as putative targets for neuromodulation (via targeting the DLPFC, MPFC, cingulate, and insula bilaterally). A series of the largest studies of TMS in SUDs are listed and discussed in the context of this framework. Our review concludes with an assessment of the current state of knowledge regarding the use of rTMS as a therapeutic tool in reducing drug, alcohol, and nicotine use and identifies gaps in the literature that need to be addressed in future studies. Namely, while the presumed mechanism through which TMS exerts its effects is by modulating the functional connectivity circuits involved in executive control and salience of drug-related cues, it is also possible that TMS has direct effects on subcortical dopamine, a hypothesis that could be explored in greater detail with PET imaging.
Collapse
Affiliation(s)
| | - Colleen A Hanlon
- BrainsWay Ltd., Winston-Salem, NC 27106, USA
- Wake Forest School of Medicine, Winston-Salem, NC 27106, USA
| | - Aron Tendler
- BrainsWay Ltd., Winston-Salem, NC 27106, USA
- Department of Life Sciences, Ben Gurion University of the Negev, Beer-Sheva 84105, Israel
| |
Collapse
|
7
|
Sahlem GL, Kim B, Baker NL, Wong BL, Caruso MA, Campbell LA, Kaloani I, Sherman BJ, Ford TJ, Musleh AH, Kim JP, Williams NR, Manett AJ, Kratter IH, Short EB, Killeen TK, George MS, McRae-Clark AL. A Preliminary Investigation Of Repetitive Transcranial Magnetic Stimulation Applied To The Left Dorsolateral Prefrontal Cortex In Treatment Seeking Participants With Cannabis Use Disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.10.23292461. [PMID: 37503294 PMCID: PMC10370231 DOI: 10.1101/2023.07.10.23292461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background Cannabis use disorder (CUD) is a common and consequential disorder. When applied to the dorsolateral prefrontal cortex (DLPFC), repetitive transcranial magnetic stimulation (rTMS) reduces craving across substance use disorders and may have a therapeutic clinical effect when applied in serial sessions. The present study sought to preliminarily determine whether serial sessions of rTMS applied to the DLPFC had a therapeutic effect in CUD. Methods This study was a two-site, phase-2, double-blind, randomized-controlled-trial. Seventy-two treatment-seeking participants (37.5% Women, mean age 30.2±9.9SD) with ≥moderate-CUD were randomized to active or sham rTMS (Beam-F3, 10Hz, 20-total-sessions, with cannabis cues) while undergoing a three-session motivational enhancement therapy intervention. The primary outcome was the change in craving between pre- and post-treatment (Marijuana Craving Questionnaire Short-Form-MCQ-SF). Secondary outcomes included the number of weeks of abstinence and the number of days-per-week of cannabis use during 4-weeks of follow-up. Results There were no significant differences in craving between conditions. Participants who received active rTMS reported numerically, but not significantly, more weeks of abstinence in the follow-up period than those who received sham rTMS (15.5%-Active; 9.3%-Sham; rate ratio = 1.66 [95% CI: 0.84, 3.28]; p=0.14). Participants who received active rTMS reported fewer days-per-week of cannabis use over the final two-weeks of the follow-up period (Active vs. Sham: -0.72; Z=-2.33, p=0.02). Conclusions This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use, though further study is needed with additional rTMS-sessions and a longer follow-up period.
Collapse
Affiliation(s)
- Gregory L. Sahlem
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Bohye Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Nathaniel L. Baker
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brendan L. Wong
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Margaret A. Caruso
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren A. Campbell
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Irakli Kaloani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Brian J. Sherman
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tiffany J. Ford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Ahmad H. Musleh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Jane P. Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Nolan R. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Andrew J. Manett
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ian H. Kratter
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Edward B. Short
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terese K. Killeen
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mark S. George
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
| | - Aimee L. McRae-Clark
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
| |
Collapse
|
8
|
Dougherty JW, Baron D. Substance Use and Addiction in Athletes: The Case for Neuromodulation and Beyond. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16082. [PMID: 36498156 PMCID: PMC9735488 DOI: 10.3390/ijerph192316082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/29/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Substance use, misuse and use disorders continue to be major problems in society as a whole and athletes are certainly not exempt. Substance use has surrounded sports since ancient times and the pressures associated with competition sometimes can increase the likelihood of use and subsequent misuse. The addiction field as a whole has very few answers to how to prevent and secondarily treat substance use disorders and the treatments overall do not necessarily agree with the role of being an athlete. With concerns for side effects that may affect performance coupled with organizational rules and high rates of recidivism in the general population, newer treatments must be investigated. Prevention strategies must continue to be improved and more systems need to be in place to find and treat any underlying causes leading to these behaviors. This review attempts to highlight some of the data regarding the field of substance misuse and addiction in the athletic population as well as explore possible future directions for treatment including Neuromodulation methods and Ketamine. There is a need for more rigorous, high-quality studies to look at addiction as a whole and in particular how to approach this vulnerable subset of the population.
Collapse
Affiliation(s)
- John W. Dougherty
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - David Baron
- Office of the President, Western University of Health Sciences, Pomona, CA 91766, USA
| |
Collapse
|
9
|
Bidzinski KK, Lowe DJE, Sanches M, Sorkhou M, Boileau I, Kiang M, Blumberger DM, Remington G, Ma C, Castle DJ, Rabin RA, George TP. Investigating repetitive transcranial magnetic stimulation on cannabis use and cognition in people with schizophrenia. SCHIZOPHRENIA 2022; 8:2. [PMID: 35210458 PMCID: PMC8873399 DOI: 10.1038/s41537-022-00210-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/11/2022] [Indexed: 11/09/2022]
Abstract
AbstractCannabis use disorder (CUD) occurs at high rates in schizophrenia, which negatively impacts its clinical prognosis. These patients have greater difficulty quitting cannabis which may reflect putative deficits in the dorsolateral prefrontal cortex (DLPFC), a potential target for treatment development. We examined the effects of active versus sham high-frequency (20-Hz) repetitive transcranial magnetic stimulation (rTMS) on cannabis use in outpatients with schizophrenia and CUD. Secondary outcomes included cannabis craving/withdrawal, psychiatric symptoms, cognition and tobacco use. Twenty-four outpatients with schizophrenia and CUD were enrolled in a preliminary double-blind, sham-controlled randomized trial. Nineteen participants were randomized to receive active (n = 9) or sham (n = 10) rTMS (20-Hz) applied bilaterally to the DLPFC 5x/week for 4 weeks. Cannabis use was monitored twice weekly. A cognitive battery was administered pre- and post-treatment. rTMS was safe and well-tolerated with high treatment retention (~90%). Contrast estimates suggested greater reduction in self-reported cannabis use (measured in grams/day) in the active versus sham group (Estimate = 0.33, p = 0.21; Cohen’s d = 0.72), suggesting a clinically relevant effect of rTMS. A trend toward greater reduction in craving (Estimate = 3.92, p = 0.06), and significant reductions in PANSS positive (Estimate = 2.42, p = 0.02) and total (Estimate = 5.03, p = 0.02) symptom scores were found in the active versus sham group. Active rTMS also improved attention (Estimate = 6.58, p < 0.05), and suppressed increased tobacco use that was associated with cannabis reductions (Treatment x Time: p = 0.01). Our preliminary findings suggest that rTMS to the DLPFC is safe and potentially efficacious for treating CUD in schizophrenia.
Collapse
|
10
|
Johnstone S, Lowe DJE, Kozak-Bidzinski K, Sanches M, Castle DJ, Rabin JS, Rabin RA, George TP. Neurocognitive moderation of repetitive transcranial magnetic stimulation (rTMS) effects on cannabis use in schizophrenia: a preliminary analysis. SCHIZOPHRENIA 2022; 8:99. [PMCID: PMC9668838 DOI: 10.1038/s41537-022-00303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022]
Abstract
AbstractRepetitive transcranial magnetic stimulation (rTMS) is a promising treatment for cannabis use disorder in schizophrenia; however, gaps in the literature remain as to the potential role of neurocognitive functioning in treatment response. We evaluated the moderating role of select cognitive functions including baseline executive functioning, verbal memory, and sustained attention, and we explore the mediating role of changes in task performance on changes in cannabis use in both active and sham rTMS groups. Participants underwent high-frequency (20 Hz) rTMS applied to the bilateral dorsolateral prefrontal cortex 5x/week for 4 weeks. Weekly self-report of cannabis use and semi-quantitative urinary carboxy-tetrahydrocannabinol levels were recorded. A neurocognitive battery assessing verbal memory, visuospatial working memory, verbal working memory, sustained attention, delayed discounting, and complex planning was administered pre- and post-treatment. Better baseline performance on tasks assessing sustained attention, delayed discounting, and complex planning moderated the extent to which participants in the active group reduced cannabis use. There were no significant indirect pathways between treatment, changes in neuropsychological performance, and changes in cannabis use; however, active rTMS improved complex planning and sustained attention. These preliminary findings suggest that there is a moderating role of sustained attention, delayed discounting, and complex planning on the effects of rTMS on cannabis use. Further, mediation models suggest rTMS may exert direct effects on cannabis use independent of its effects on cognitive functioning in people with SCZ. Trial Registration: clinicaltrials.gov: NCT03189810.
Collapse
|
11
|
Nardone R, Sebastianelli L, Versace V, Ferrazzoli D, Brigo F, Schwenker K, Saltuari L, Trinka E. TMS for the functional evaluation of cannabis effects and for treatment of cannabis addiction: A review. Psychiatry Res 2022; 310:114431. [PMID: 35219263 DOI: 10.1016/j.psychres.2022.114431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/15/2022]
Abstract
The knowledge about the effects of cannabis on human cortical brain processes is increasing. In this regard, transcranial magnetic stimulation (TMS) enables the evaluation of central nervous system function, including drug effects. Moreover, repetitive TMS (rTMS) has been used therapeutically in several substance use disorders. In this scoping review, we summarize and discuss studies that have employed TMS and rTMS techniques in users of cannabis for recreational purposes. In subjects with a history of persistent cannabis use, TMS studies showed reduced short-interval cortical inhibition (SICI). This observation points more at neurobiological changes of chronic cannabis use than to a direct effect of cannabis on gamma-aminobutyric acid (GABA) A receptors. Moreover, individuals vulnerable to becoming long-term users of cannabis may also have underlying pre-existing abnormalities in SICI. Of note, the use of cannabis is associated with an increased risk of schizophrenia, and the down-regulation of GABAergic function may play a role. Less frequent cannabis use and spontaneous craving were observed following rTMS applied to the dorsolateral prefrontal cortex (DLPFC). There is emerging evidence that the posterior cingulate cortex and the precuneus are potential targets for rTMS intervention in cannabis use disorder. However, larger and randomized trials should corroborate these encouraging findings.
Collapse
Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria; Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria; UMIT, University for Medical Informatics and Health Technology, Hall in Tirol, Austria
| |
Collapse
|
12
|
Walia P, Ghosh A, Singh S, Dutta A. Portable Neuroimaging-Guided Noninvasive Brain Stimulation of the Cortico-Cerebello-Thalamo-Cortical Loop—Hypothesis and Theory in Cannabis Use Disorder. Brain Sci 2022; 12:brainsci12040445. [PMID: 35447977 PMCID: PMC9027826 DOI: 10.3390/brainsci12040445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/06/2022] [Accepted: 03/22/2022] [Indexed: 12/22/2022] Open
Abstract
Background: Maladaptive neuroplasticity-related learned response in substance use disorder (SUD) can be ameliorated using noninvasive brain stimulation (NIBS); however, inter-individual variability needs to be addressed for clinical translation. Objective: Our first objective was to develop a hypothesis for NIBS for learned response in SUD based on a competing neurobehavioral decision systems model. The next objective was to develop the theory by conducting a computational simulation of NIBS of the cortico-cerebello-thalamo-cortical (CCTC) loop in cannabis use disorder (CUD)-related dysfunctional “cue-reactivity”—a construct closely related to “craving”—that is a core symptom. Our third objective was to test the feasibility of a neuroimaging-guided rational NIBS approach in healthy humans. Methods: “Cue-reactivity” can be measured using behavioral paradigms and portable neuroimaging, including functional near-infrared spectroscopy (fNIRS) and electroencephalogram (EEG) metrics of sensorimotor gating. Therefore, we conducted a computational simulation of NIBS, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) of the cerebellar cortex and deep cerebellar nuclei (DCN) of the CCTC loop for its postulated effects on fNIRS and EEG metrics. We also developed a rational neuroimaging-guided NIBS approach for the cerebellar lobule (VII) and prefrontal cortex based on a healthy human study. Results: Simulation of cerebellar tDCS induced gamma oscillations in the cerebral cortex, while transcranial temporal interference stimulation induced a gamma-to-beta frequency shift. A preliminary healthy human study (N = 10) found that 2 mA cerebellar tDCS evoked similar oxyhemoglobin (HbO) response in the range of 5 × 10−6 M across the cerebellum and PFC brain regions (α = 0.01); however, infra-slow (0.01–0.10 Hz) prefrontal cortex HbO-driven phase–amplitude-coupled (PAC; 4 Hz, ±2 mA (max)) cerebellar tACS evoked HbO levels in the range of 10−7 M that were statistically different (α = 0.01) across these brain regions. Conclusion: Our healthy human study showed the feasibility of fNIRS of cerebellum and PFC and closed-loop fNIRS-driven ctACS at 4 Hz, which may facilitate cerebellar cognitive function via the frontoparietal network. Future work needs to combine fNIRS with EEG for multi-modal imaging for closed-loop NIBS during operant conditioning.
Collapse
Affiliation(s)
- Pushpinder Walia
- Neuroengineering and Informatics for Rehabilitation Laboratory, University at Buffalo, Buffalo, NY 14228, USA;
| | - Abhishek Ghosh
- Postgraduate Institute of Medical Education & Research, Chandigarh 700020, India; (A.G.); (S.S.)
| | - Shubhmohan Singh
- Postgraduate Institute of Medical Education & Research, Chandigarh 700020, India; (A.G.); (S.S.)
| | - Anirban Dutta
- Neuroengineering and Informatics for Rehabilitation Laboratory, University at Buffalo, Buffalo, NY 14228, USA;
- Correspondence:
| |
Collapse
|
13
|
Gay A, Cabe J, De Chazeron I, Lambert C, Defour M, Bhoowabul V, Charpeaud T, Tremey A, Llorca PM, Pereira B, Brousse G. Repetitive Transcranial Magnetic Stimulation (rTMS) as a Promising Treatment for Craving in Stimulant Drugs and Behavioral Addiction: A Meta-Analysis. J Clin Med 2022; 11:624. [PMID: 35160085 PMCID: PMC8836499 DOI: 10.3390/jcm11030624] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 02/05/2023] Open
Abstract
Addiction is a mental disorder with limited available treatment options. The therapeutic potential of repetitive transcranial magnetic stimulation (rTMS) on it, by targeting craving in particular, has been explored with heterogenous results. This meta-analysis uses updated evidence to assess overall rTMS efficacy on craving, differential effects between addiction types clustered into three groups (depressant (alcohol, cannabis, opiate), stimulant (nicotine, cocaine, methamphetamine), and behavioral addiction (gambling, eating disorder)), and stimulation settings. Studies on substance use, gambling, and eating disorders are included, with unrestricted stimulation settings, by searching the PubMed, Embase, PsycINFO, and Cochrane databases up to 30 April 2020. A total of 34 eligible studies (42 units of analysis) were identified. Because of highly significant heterogeneity in primary results, a sensitivity analysis was performed on a remaining sample of 26 studies (30 units of analysis). Analyses performed using random effects model revealed a small effect size favoring active rTMS over shamTMS stimulation in the reduction in craving. We found a significant difference between addiction types, with a persistent small effect only for stimulant and behavioral groups. In these groups we found no difference between the different combinations of target and frequency of stimulation, but a significant correlation between number of sessions and craving reduction. In conclusion, efficacy of rTMS on craving in stimulant and behavioral addiction was highlighted, but recommendations on optimal stimulation settings and its clinical application await further research.
Collapse
Affiliation(s)
- Aurélia Gay
- University Department of Psychiatry and Addiction, CHU St-Etienne, CEDEX 2, 42055 Saint-Étienne, France; (M.D.); (V.B.)
- TAPE Laboratory, EA7423, Jean Monnet University, 42100 Saint-Étienne, France
| | - Julien Cabe
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (J.C.); (I.D.C.); (P.-M.L.); (G.B.)
| | - Ingrid De Chazeron
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (J.C.); (I.D.C.); (P.-M.L.); (G.B.)
| | - Céline Lambert
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (C.L.); (B.P.)
| | - Maxime Defour
- University Department of Psychiatry and Addiction, CHU St-Etienne, CEDEX 2, 42055 Saint-Étienne, France; (M.D.); (V.B.)
| | - Vikesh Bhoowabul
- University Department of Psychiatry and Addiction, CHU St-Etienne, CEDEX 2, 42055 Saint-Étienne, France; (M.D.); (V.B.)
| | - Thomas Charpeaud
- Service d’Addictologie et Pathologies Duelles, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (T.C.); (A.T.)
| | - Aurore Tremey
- Service d’Addictologie et Pathologies Duelles, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (T.C.); (A.T.)
| | - Pierre-Michel Llorca
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (J.C.); (I.D.C.); (P.-M.L.); (G.B.)
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (C.L.); (B.P.)
| | - Georges Brousse
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (J.C.); (I.D.C.); (P.-M.L.); (G.B.)
| |
Collapse
|
14
|
Kearney-Ramos T, Haney M. Repetitive transcranial magnetic stimulation as a potential treatment approach for cannabis use disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110290. [PMID: 33677045 PMCID: PMC9165758 DOI: 10.1016/j.pnpbp.2021.110290] [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: 08/28/2020] [Revised: 01/22/2021] [Accepted: 02/19/2021] [Indexed: 01/22/2023]
Abstract
The expanding legalization of cannabis across the United States is associated with increases in cannabis use, and accordingly, an increase in the number and severity of individuals with cannabis use disorder (CUD). The lack of FDA-approved pharmacotherapies and modest efficacy of psychotherapeutic interventions means that many of those who seek treatment for CUD relapse within the first few months. Consequently, there is a pressing need for innovative, evidence-based treatment development for CUD. Preliminary evidence suggests that repetitive transcranial magnetic stimulation (rTMS) may be a novel, non-invasive therapeutic neuromodulation tool for the treatment of a variety of substance use disorders (SUDs), including recently receiving FDA clearance (August 2020) for use as a smoking cessation aid in tobacco cigarette smokers. However, the potential of rTMS for CUD has not yet been reviewed. This paper provides a primer on therapeutic neuromodulation techniques for SUDs, with a particular focus on reviewing the current status of rTMS research in people who use cannabis. Lastly, future directions are proposed for rTMS treatment development in CUD, with suggestions for study design parameters and clinical endpoints based on current gold-standard practices for therapeutic neuromodulation research.
Collapse
Affiliation(s)
- Tonisha Kearney-Ramos
- New York State Psychiatric Institute, New York, NY, USA; Columbia University Irving Medical Center, New York, NY, USA.
| | - Margaret Haney
- New York State Psychiatric Institute, New York, New York, USA,Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
15
|
Martin‐Rodriguez JF, Ruiz‐Veguilla M, Alvarez de Toledo P, Aizpurua‐Olaizola O, Zarandona I, Canal‐Rivero M, Rodriguez‐Baena A, Mir P. Impaired motor cortical plasticity associated with cannabis use disorder in young adults. Addict Biol 2021; 26:e12912. [PMID: 32323450 DOI: 10.1111/adb.12912] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/02/2020] [Accepted: 04/09/2020] [Indexed: 12/28/2022]
Abstract
Maladaptive cortical plasticity has been described in individuals with heroin and methamphetamine addiction and may mediate other substance abuse disorders. It is unknown whether cannabis dependence in humans alters the capacity for induction of cortical plasticity. The aim of this study was to non-invasively investigate cortical plasticity with transcranial magnetic stimulation in young adults who meet DSM-5 criteria for cannabis use disorder (CUD). Thirty men (ages 20- 30) who used cannabis daily over the previous 6 months (15 diagnosed of CUD) and 15 demographically matched non-users were enrolled in this study. All participants underwent two sessions of theta burst stimulation (TBS) in which either continuous TBS (cTBS; 600 pulses, 80% active motor threshold) or intermittent TBS (iTBS; 2-s train of cTBS repeated every 10 s for a total of 190 s, 600 pulses) was applied over the primary motor cortex. The effects of these protocols were assessed by analysing the contralateral motor evoked potentials (MEPs). The relationships between cortical plasticity and problematic cannabis use, degree of dependence, and nicotine addiction were also investigated. Significant MEP inhibition after cTBS was observed in both cannabis users without CUD and non-users, while this inhibition was not seen in cannabis users with CUD. Strikingly, less motor cortical plasticity was observed in subjects with severe problematic cannabis use. No significant differences between users and non-users were found in the iTBS-induced cortical plasticity measures. Our study provides the first evidence of maladaptive cortical plasticity associated with cannabis use disorder and problematic cannabis use in humans.
Collapse
Affiliation(s)
- Juan Francisco Martin‐Rodriguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Madrid Spain
- Experimental Psychology Department, Faculty of Psychology University of Seville Seville Spain
| | - Miguel Ruiz‐Veguilla
- CIBERSAM Centro de Investigación Biomédica en Red Salud Mental Madrid Spain
- UGC‐SALUD MENTAL, Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla/UGC Salud Mental HVR Seville Spain
| | - Paloma Alvarez de Toledo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain
| | | | - Iratxe Zarandona
- Departamento de Química Analítica Universidad del País Vasco (UPV/EHU) Leioa Spain
| | - Manuel Canal‐Rivero
- CIBERSAM Centro de Investigación Biomédica en Red Salud Mental Madrid Spain
- Departamento de Psiquiatría Hospital Universitario Germans Trías i Pujol Badalona, Barcelona Spain
| | - Antonio Rodriguez‐Baena
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Madrid Spain
| |
Collapse
|
16
|
Madeo G, Terraneo A, Cardullo S, Gómez Pérez LJ, Cellini N, Sarlo M, Bonci A, Gallimberti L. Long-Term Outcome of Repetitive Transcranial Magnetic Stimulation in a Large Cohort of Patients With Cocaine-Use Disorder: An Observational Study. Front Psychiatry 2020; 11:158. [PMID: 32180745 PMCID: PMC7059304 DOI: 10.3389/fpsyt.2020.00158] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/19/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Cocaine is a psychostimulant drug used as performance enhancer throughout history. The prolonged use of cocaine is associated with addiction and a broad range of cognitive deficits. Currently, there are no medications proven to be effective for cocaine-use disorder (CocUD). Previous preliminary clinical work suggests some benefit from repetitive transcranial magnetic stimulation (rTMS) stimulating the prefrontal cortex (PFC), involved in inhibitory cognitive control, decision-making and attention. All published studies to date have been limited by small sample sizes and short follow-up times. Methods: This is a retrospective observational study of 284 outpatients (of whom 268 were men) meeting DSM-5 criteria for CocUD. At treatment entry, most were using cocaine every day or several times per week. All patients underwent 3 months of rTMS and were followed for up to 2 years, 8 months. Self-report, reports by family or significant others and regular urine screens were used to assess drug use. Results: Median time to the first lapse (resumption of cocaine use) since the beginning of treatment was 91 days. For most patients, TMS was re-administered weekly, then monthly, throughout follow-up. The decrease in frequency of rTMS sessions was not accompanied by an increase in lapses to cocaine use. Mean frequency of cocaine use was <1·0 day/month (median 0), while serious rTMS-related adverse events were infrequent, consistent with published reports from smaller studies. Conclusions: This is the first follow-up study to show that rTMS treatment is accompanied by long-lasting reductions in cocaine use in a large cohort.
Collapse
Affiliation(s)
| | | | | | | | - Nicola Cellini
- Department of General Psychology, University of Padua, Padua, Italy.,Padova Neuroscience Center, University of Padua, Padua, Italy
| | - Michela Sarlo
- Department of General Psychology, University of Padua, Padua, Italy.,Padova Neuroscience Center, University of Padua, Padua, Italy
| | | | | |
Collapse
|
17
|
Sahlem GL, Caruso MA, Short EB, Fox JB, Sherman BJ, Manett AJ, Malcolm RJ, George MS, McRae-Clark AL. A case series exploring the effect of twenty sessions of repetitive transcranial magnetic stimulation (rTMS) on cannabis use and craving. Brain Stimul 2020; 13:265-266. [PMID: 31619347 PMCID: PMC7263465 DOI: 10.1016/j.brs.2019.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Gregory L Sahlem
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Margaret A Caruso
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - E Baron Short
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - James B Fox
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brian J Sherman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew J Manett
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Robert J Malcolm
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| |
Collapse
|
18
|
Zhang JJQ, Fong KNK, Ouyang RG, Siu AMH, Kranz GS. Effects of repetitive transcranial magnetic stimulation (rTMS) on craving and substance consumption in patients with substance dependence: a systematic review and meta-analysis. Addiction 2019; 114:2137-2149. [PMID: 31328353 DOI: 10.1111/add.14753] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/10/2019] [Accepted: 07/16/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Repetitive transcranial magnetic stimulation (rTMS) is increasingly used as an intervention for treating substance dependence. We aimed to assess evidence of the anti-craving and consumption-reducing effects of rTMS in patients with alcohol, nicotine and illicit drug dependence. METHODS A systematic review and meta-analysis of 26 randomized controlled trials (RCTs) published from January 2000 to October 2018 that investigated the effects of rTMS on craving and substance consumption in patients with nicotine, alcohol and illicit drug dependence (n = 748). Craving, measured using self-reported questionnaires or visual analog scale, and substance consumption, measured using self-report substance intake or number of addiction relapse cases, were considered as primary and secondary outcomes, respectively. Substance type, study design and rTMS parameters were used as the independent factors in the meta-regression. RESULTS Results showed that excitatory rTMS of the left dorsolateral pre-frontal cortex (DLPFC) significantly reduced craving [Hedges' g = -0.62; 95% confidence interval (CI) = -0.89 to -0.35; P < 0.0001], compared with sham stimulation. Moreover, meta-regression revealed a significant positive association between the total number of stimulation pulses and effect size among studies using excitatory left DLPFC stimulation (P = 0.01). Effects of other rTMS protocols on craving were not significant. However, when examining substance consumption, excitatory rTMS of the left DLPFC and excitatory deep TMS (dTMS) of the bilateral DLPFC and insula revealed significant consumption-reducing effects, compared with sham stimulation. CONCLUSION Excitatory repetitive transcranial magnetic stimulation of the dorsolateral pre-frontal cortex appears to have an acute effect on reducing craving and substance consumption in patients with substance dependence. The anti-craving effect may be associated with stimulation dose.
Collapse
Affiliation(s)
- Jack J Q Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Rang-Ge Ouyang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Andrew M H Siu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR.,Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| |
Collapse
|
19
|
Ekhtiari H, Tavakoli H, Addolorato G, Baeken C, Bonci A, Campanella S, Castelo-Branco L, Challet-Bouju G, Clark VP, Claus E, Dannon PN, Del Felice A, den Uyl T, Diana M, di Giannantonio M, Fedota JR, Fitzgerald P, Gallimberti L, Grall-Bronnec M, Herremans SC, Herrmann MJ, Jamil A, Khedr E, Kouimtsidis C, Kozak K, Krupitsky E, Lamm C, Lechner WV, Madeo G, Malmir N, Martinotti G, McDonald WM, Montemitro C, Nakamura-Palacios EM, Nasehi M, Noël X, Nosratabadi M, Paulus M, Pettorruso M, Pradhan B, Praharaj SK, Rafferty H, Sahlem G, Salmeron BJ, Sauvaget A, Schluter RS, Sergiou C, Shahbabaie A, Sheffer C, Spagnolo PA, Steele VR, Yuan TF, van Dongen JDM, Van Waes V, Venkatasubramanian G, Verdejo-García A, Verveer I, Welsh JW, Wesley MJ, Witkiewitz K, Yavari F, Zarrindast MR, Zawertailo L, Zhang X, Cha YH, George TP, Frohlich F, Goudriaan AE, Fecteau S, Daughters SB, Stein EA, Fregni F, Nitsche MA, Zangen A, Bikson M, Hanlon CA. Transcranial electrical and magnetic stimulation (tES and TMS) for addiction medicine: A consensus paper on the present state of the science and the road ahead. Neurosci Biobehav Rev 2019; 104:118-140. [PMID: 31271802 PMCID: PMC7293143 DOI: 10.1016/j.neubiorev.2019.06.007] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/30/2019] [Accepted: 06/08/2019] [Indexed: 12/21/2022]
Abstract
There is growing interest in non-invasive brain stimulation (NIBS) as a novel treatment option for substance-use disorders (SUDs). Recent momentum stems from a foundation of preclinical neuroscience demonstrating links between neural circuits and drug consuming behavior, as well as recent FDA-approval of NIBS treatments for mental health disorders that share overlapping pathology with SUDs. As with any emerging field, enthusiasm must be tempered by reason; lessons learned from the past should be prudently applied to future therapies. Here, an international ensemble of experts provides an overview of the state of transcranial-electrical (tES) and transcranial-magnetic (TMS) stimulation applied in SUDs. This consensus paper provides a systematic literature review on published data - emphasizing the heterogeneity of methods and outcome measures while suggesting strategies to help bridge knowledge gaps. The goal of this effort is to provide the community with guidelines for best practices in tES/TMS SUD research. We hope this will accelerate the speed at which the community translates basic neuroscience into advanced neuromodulation tools for clinical practice in addiction medicine.
Collapse
Affiliation(s)
| | - Hosna Tavakoli
- Institute for Cognitive Science Studies (ICSS), Iran; Iranian National Center for Addiction Studies (INCAS), Iran
| | - Giovanni Addolorato
- Alcohol Use Disorder Unit, Division of Internal Medicine, Gastroenterology and Hepatology Unit, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy; Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, University Hospital Ghent, Ghent, Belgium
| | - Antonello Bonci
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Vincent P Clark
- University of New Mexico, USA; The Mind Research Network, USA
| | | | | | - Alessandra Del Felice
- University of Padova, Department of Neuroscience, Padova, Italy; Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
| | | | - Marco Diana
- 'G. Minardi' Laboratory of Cognitive Neuroscience, Department of Chemistry and Pharmacy, University of Sassari, Italy
| | | | - John R Fedota
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | | | - Luigi Gallimberti
- Novella Fronda Foundation, Human Science and Brain Research, Padua, Italy
| | | | - Sarah C Herremans
- Department of Psychiatry and Medical Psychology, University Hospital Ghent, Ghent, Belgium
| | - Martin J Herrmann
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Asif Jamil
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | | | | | - Karolina Kozak
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | - Evgeny Krupitsky
- V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St.-Petersburg, Russia; St.-Petersburg First Pavlov State Medical University, Russia
| | - Claus Lamm
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Austria
| | | | - Graziella Madeo
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | | | | | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Chiara Montemitro
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA; University G.d'Annunzio of Chieti-Pescara, Italy
| | | | - Mohammad Nasehi
- Cognitive and Neuroscience Research Center (CNRC), Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Xavier Noël
- Université Libre de Bruxelles (ULB), Belgium
| | | | | | | | | | - Samir K Praharaj
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Haley Rafferty
- Spaulding Rehabilitation Hospital, Harvard Medical School, USA
| | | | - Betty Jo Salmeron
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Anne Sauvaget
- Laboratory «Movement, Interactions, Performance» (E.A. 4334), University of Nantes, 25 Bis Boulevard Guy Mollet, BP 72206, 44322, Nantes Cedex 3, France; CHU de Nantes Addictology and Liaison Psychiatry Department, University Hospital Nantes, Nantes Cedex 3, France
| | - Renée S Schluter
- Laureate Institute for Brain Research, USA; Institute for Cognitive Science Studies (ICSS), Iran
| | | | - Alireza Shahbabaie
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | | | | | - Vaughn R Steele
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Ti-Fei Yuan
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China
| | | | - Vincent Van Waes
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université Bourgogne Franche-Comté, Besançon, France
| | | | | | | | - Justine W Welsh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Fatemeh Yavari
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Mohammad-Reza Zarrindast
- Department of Pharmacology School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Laurie Zawertailo
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | - Xiaochu Zhang
- University of Science and Technology of China, China
| | | | - Tony P George
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | | | - Anna E Goudriaan
- Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin, Department of Research and Quality of Care, Amsterdam, The Netherlands
| | | | | | - Elliot A Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, USA
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; University Medical Hospital Bergmannsheil, Dept. Neurology, Bochum, Germany
| | | | | | | |
Collapse
|
20
|
Madeo G, Bonci A. Rewiring the Addicted Brain: Circuits-Based Treatment for Addiction. COLD SPRING HARBOR SYMPOSIA ON QUANTITATIVE BIOLOGY 2019; 83:173-184. [PMID: 31097615 DOI: 10.1101/sqb.2018.83.038158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The advent of the noninvasive brain stimulation (NIBS) technique has paved the way for neural circuit-based treatments for addiction. Recently, evidence from both preclinical and clinical studies has evaluated the use of transcranial magnetic stimulation (TMS) as a safe and cost-effective therapeutic tool for substance use disorders (SUDs). Indeed, repetitive TMS impacts on neural activity inducing short- and long-term effects involving neuroplasticity mechanisms locally within the target area of stimulation and the network level throughout the brain. Here, we provide an integrated view of evidence highlighting the mechanisms of TMS-induced effects on modulating the maladaptive brain circuitry of addiction. We then review the preclinical and clinical findings suggesting rTMS as an effective interventional tool for the treatment of SUDs.
Collapse
Affiliation(s)
- Graziella Madeo
- Novella Fronda Foundation, Human Science and Brain Research Piazza Castello, 16-35141 Padua, Italy.,Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland 21224, USA
| | - Antonello Bonci
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland 21224, USA.,Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| |
Collapse
|
21
|
Repetitive transcranial magnetic stimulation: Re-wiring the alcoholic human brain. Alcohol 2019; 74:113-124. [PMID: 30420113 DOI: 10.1016/j.alcohol.2018.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/15/2018] [Accepted: 05/28/2018] [Indexed: 12/28/2022]
Abstract
Alcohol use disorders (AUDs) are one of the leading causes of mortality and morbidity worldwide. In spite of significant advances in understanding the neural underpinnings of AUDs, therapeutic options remain limited. Recent studies have highlighted the potential of repetitive transcranial magnetic stimulation (rTMS) as an innovative, safe, and cost-effective treatment for AUDs. Here, we summarize the fundamental principles of rTMS and its putative mechanisms of action via neurocircuitries related to alcohol addiction. We will also discuss advantages and limitations of rTMS, and argue that Hebbian plasticity and connectivity changes, as well as state-dependency, play a role in shaping some of the long-term effects of rTMS. Visual imaging studies will be linked to recent clinical pilot studies describing the effect of rTMS on alcohol craving and intake, pinpointing new advances, and highlighting conceptual gaps to be filled by future controlled studies.
Collapse
|
22
|
Prashad S, Dedrick ES, To WT, Vanneste S, Filbey FM. Testing the role of the posterior cingulate cortex in processing salient stimuli in cannabis users: an rTMS study. Eur J Neurosci 2018; 50:2357-2369. [PMID: 30290037 PMCID: PMC6767056 DOI: 10.1111/ejn.14194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 11/29/2022]
Abstract
The posterior cingulate cortex (PCC) and precuneus are hubs in the default mode network and play a role in processing external salient stimuli. Accordingly, activation in these regions has been associated with response to salient stimuli using drug cue‐reactivity paradigms in substance using populations. These studies suggest that the PCC and precuneus may underlie deficits in processing salient stimuli that contribute toward the development of substance use disorders. The goal of this study was to directly test this hypothesis using repetitive transcranial magnetic stimulation (rTMS). Using a double‐blind, placebo‐controlled design, we used rTMS to target the PCC and precuneus with a double‐cone coil at 10 Hz (high frequency) and 1 Hz (low frequency) in 10 adult cannabis users and 10 age‐ and sex‐matched non‐using controls. Electroencephalography data were collected before and after rTMS during a modified oddball paradigm with neutral, oddball, self‐relevant, and cannabis‐related stimuli. Cannabis users exhibited increased amplitude in P3 and faster latencies in the P3, N2, and P2 components in response to self‐relevant stimuli compared to controls during baseline that normalized after rTMS. These results suggest that cannabis users exhibited heightened salience to external self‐relevant stimuli that were modulated after rTMS. PCC dysfunction in cannabis users may be related to abnormalities in processing salient stimuli, such those during cue‐reactivity, and provides a potential target for cannabis use disorder intervention.
Collapse
Affiliation(s)
- Shikha Prashad
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX, 75235, USA
| | - Elizabeth S Dedrick
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX, 75235, USA
| | - Wing Ting To
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX, 75235, USA
| | - Sven Vanneste
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX, 75235, USA
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX, 75235, USA
| |
Collapse
|
23
|
Sahlem GL, Tomko RL, Sherman BJ, Gray KM, McRae-Clark AL. Impact of cannabis legalization on treatment and research priorities for cannabis use disorder. Int Rev Psychiatry 2018; 30:216-225. [PMID: 29956576 PMCID: PMC6322658 DOI: 10.1080/09540261.2018.1465398] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
An increasing proportion of the world has legalized cannabis for medicinal or recreational use. The legalization trend appears to be continuing. These changes in the legislative landscape may have important health, treatment, and research implications. This review discusses public health outcomes that may be impacted by increases in cannabis availability and use. It additionally considers potential research and treatment priorities in the face of widespread cannabis legalization.
Collapse
Affiliation(s)
- Gregory L. Sahlem
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel L. Tomko
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Brian J. Sherman
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin M. Gray
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Aimee L. McRae-Clark
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| |
Collapse
|
24
|
Coles AS, Kozak K, George TP. A review of brain stimulation methods to treat substance use disorders. Am J Addict 2018; 27:71-91. [PMID: 29457674 DOI: 10.1111/ajad.12674] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/26/2017] [Accepted: 12/16/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) are a leading cause of disability worldwide. While several pharmacological and behavioral treatments for SUDs are available, these may not be effective for all patients. Recent studies using non-invasive neuromodulation techniques including Repetitive Transcranial Magnetic Stimulation (rTMS), Transcranial Direct Current Stimulation (tDCS), and Deep Brain Stimulation (DBS) have shown promise for SUD treatment. OBJECTIVE Multiple studies were evaluated investigating the therapeutic potential of non-invasive brain stimulation techniques in treatment of SUDs. METHOD Through literature searches (eg, PubMed, Google Scholar), 60 studies (2000-2017) were identified examining the effect of rTMS, tDCS, or DBS on cravings and consumption of SUDs, including tobacco, alcohol, cannabis, opioids, and stimulants. RESULTS rTMS and tDCS demonstrated decreases in drug craving and consumption, while early studies with DBS suggest similar results. Results are most encouraging when stimulation is targeted to the Dorsolateral Prefrontal Cortex (DLPFC). CONCLUSIONS Short-term treatment with rTMS and tDCS may have beneficial effects on drug craving and consumption. Future studies should focus on extending therapeutic benefits by increasing stimulation frequency and duration of treatment. SCIENTIFIC SIGNIFICANCE The utility of these methods in SUD treatment and prevention are unclear, and warrants further study using randomized, controlled designs. (Am J Addict 2018;27:71-91).
Collapse
Affiliation(s)
- Alexandria S Coles
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karolina Kozak
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada
| | - Tony P George
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada.,Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|