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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.
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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.
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Mattioli F, Maglianella V, D'Antonio S, Trimarco E, Caligiore D. Non-invasive brain stimulation for patients and healthy subjects: Current challenges and future perspectives. J Neurol Sci 2024; 456:122825. [PMID: 38103417 DOI: 10.1016/j.jns.2023.122825] [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: 07/06/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
Non-invasive brain stimulation (NIBS) techniques have a rich historical background, yet their utilization has witnessed significant growth only recently. These techniques encompass transcranial electrical stimulation and transcranial magnetic stimulation, which were initially employed in neuroscience to explore the intricate relationship between the brain and behaviour. However, they are increasingly finding application in research contexts as a means to address various neurological, psychiatric, and neurodegenerative disorders. This article aims to fulfill two primary objectives. Firstly, it seeks to showcase the current state of the art in the clinical application of NIBS, highlighting how it can improve and complement existing treatments. Secondly, it provides a comprehensive overview of the utilization of NIBS in augmenting the brain function of healthy individuals, thereby enhancing their performance. Furthermore, the article delves into the points of convergence and divergence between these two techniques. It also addresses the existing challenges and future prospects associated with NIBS from ethical and research standpoints.
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Affiliation(s)
- Francesco Mattioli
- AI2Life s.r.l., Innovative Start-Up, ISTC-CNR Spin-Off, Via Sebino 32, 00199 Rome, Italy; School of Computing, Electronics and Mathematics, University of Plymouth, Drake Circus, Plymouth PL4 8AA, United Kingdom
| | - Valerio Maglianella
- Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy
| | - Sara D'Antonio
- Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy
| | - Emiliano Trimarco
- Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy
| | - Daniele Caligiore
- AI2Life s.r.l., Innovative Start-Up, ISTC-CNR Spin-Off, Via Sebino 32, 00199 Rome, Italy; Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy.
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3
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Chan YH, Chang HM, Lu ML, Goh KK. Targeting cravings in substance addiction with transcranial direct current stimulation: insights from a meta-analysis of sham-controlled trials. Psychiatry Res 2024; 331:115621. [PMID: 38043411 DOI: 10.1016/j.psychres.2023.115621] [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: 06/24/2023] [Revised: 10/06/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023]
Abstract
Addiction is a substantial health concern; craving-the core symptom of addiction-is strongly associated with relapse. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that reduces cravings by altering cortical excitability and connectivity in brain regions. This systematic review and meta-analysis was conducted (following the PRISMA guidelines) to evaluate the efficacy of tDCS in reducing cravings for substances. Our analysis included 43 randomized, sham-controlled trials involving 1,095 and 913 participants receiving tDCS and sham stimulation, respectively. We analyzed the changes in craving scores and found that tDCS led to a moderate reduction in cravings compared with the sham effects. This effect was particularly pronounced when bilateral stimulation was used, the anodal electrode was placed on the right dorsolateral prefrontal cortex, current intensities ranged from 1.5 to 2 mA, stimulation sessions lasted 20 minutes, and the electrodes size was ≥35 cm². Notably, tDCS effectively reduced cravings for opioids, methamphetamine, cocaine, and tobacco but not for alcohol or cannabis. Our findings indicate tDCS as a promising, noninvasive, and low-risk intervention for reducing cravings for opioids, methamphetamine, cocaine, and tobacco. Additional studies are warranted to refine stimulation parameters and evaluate the long-term efficacy of tDCS in managing substance cravings.
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Affiliation(s)
- Yi-Hsun Chan
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hu-Ming Chang
- Department of Addiction Sciences, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kah Kheng Goh
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; The Innovative and Translational Research Center for Brain Consciousness, Taipei Medical University, Taipei, Taiwan.
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Chmiel J, Chojdak-Łukasiewicz J, Leszek J. The Effect of Transcranial Direct Current Stimulation (tDCS) on Cocaine Addiction: A Narrative Review. J Clin Med 2023; 12:6511. [PMID: 37892650 PMCID: PMC10607438 DOI: 10.3390/jcm12206511] [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: 07/03/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Cocaine addiction is a significant problem worldwide. The development of addiction involves a reward system, which consists of certain brain regions like the ventral tegmental area, nucleus accumbens, and prefrontal cortex. Currently, there are no approved medications for treating cocaine dependence, so researchers are actively searching for effective treatments that can impact the brain. One potential treatment under investigation is transcranial direct current stimulation (tDCS), a non-invasive method of stimulating the brain to modulate its activity. In this review, we explore the use of tDCS in treating cocaine addiction. We found nine relevant articles via a literature search, and the results indicate that applying tDCS to the right dorsolateral prefrontal cortex (DLPFC) holds promise for reducing drug cravings in individuals with cocaine addiction. The review also discusses the possible mechanisms by which tDCS works and provides recommendations for future research in this field.
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Affiliation(s)
- James Chmiel
- Institute of Neurofeedback and tDCS Poland, 70-393 Szczecin, Poland
| | | | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
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Hirosawa T, Soma D, Miyagishi Y, Furutani N, Yoshimura Y, Kameya M, Yamaguchi Y, Yaoi K, Sano M, Kitamura K, Takahashi T, Kikuchi M. Effect of transcranial direct current stimulation on the functionality of 40 Hz auditory steady state response brain network: graph theory approach. Front Psychiatry 2023; 14:1156617. [PMID: 37363170 PMCID: PMC10288104 DOI: 10.3389/fpsyt.2023.1156617] [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: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Measuring whole-brain networks of the 40 Hz auditory steady state response (ASSR) is a promising approach to describe the after-effects of transcranial direct current stimulation (tDCS). The main objective of this study was to evaluate the effect of tDCS on the brain network of 40 Hz ASSR in healthy adult males using graph theory. The second objective was to identify a population in which tDCS effectively modulates the brain network of 40 Hz ASSR. Methods This study used a randomized, sham-controlled, double-blinded crossover approach. Twenty-five adult males (20-24 years old) completed two sessions at least 1 month apart. The participants underwent cathodal or sham tDCS of the dorsolateral prefrontal cortex, after which 40 Hz ASSR was measured using magnetoencephalography. After the signal sources were mapped onto the Desikan-Killiany brain atlas, the statistical relationships between localized activities were evaluated in terms of the debiased weighted phase lag index (dbWPLI). Weighted and undirected graphs were constructed for the tDCS and sham conditions based on the dbWPLI. Weighted characteristic path lengths and clustering coefficients were then measured and compared between the tDCS and sham conditions using mixed linear models. Results The characteristic path length was significantly lower post-tDCS simulation (p = 0.04) than after sham stimulation. This indicates that after tDCS simulation, the whole-brain networks of 40 Hz ASSR show a significant functional integration. Simple linear regression showed a higher characteristic path length at baseline, which was associated with a larger reduction in characteristic path length after tDCS. Hence, a pronounced effect of tDCS is expected for those who have a less functionally integrated network of 40 Hz ASSR. Discussion Given that the healthy brain is functionally integrated, we conclude that tDCS could effectively normalize less functionally integrated brain networks rather than enhance functional integration.
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Affiliation(s)
- Tetsu Hirosawa
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
| | - Daiki Soma
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yoshiaki Miyagishi
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Naoki Furutani
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yuko Yoshimura
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
- Faculty of Education, Institute of Human and Social Sciences, Kanazawa University, Kanazawa, Japan
| | - Masafumi Kameya
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yohei Yamaguchi
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Ken Yaoi
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Masuhiko Sano
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Koji Kitamura
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Tetsuya Takahashi
- Department of Neuropsychiatry, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Mitsuru Kikuchi
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Del Mauro L, Vergallito A, Gattavara G, Juris L, Gallucci A, Vedani A, Cappelletti L, Farneti PM, Romero Lauro LJ. Betting on Non-Invasive Brain Stimulation to Treat Gambling Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:698. [PMID: 37190663 PMCID: PMC10136786 DOI: 10.3390/brainsci13040698] [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: 03/18/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Gambling disorder (GD) is a behavioral addiction that severely impacts individuals' functioning, leading to high socioeconomic costs. Non-invasive brain stimulation (NiBS) has received attention for treating psychiatric and neurological conditions in recent decades, but there is no recommendation for its use for GD. Therefore, this study aimed to systematically review and analyze the available literature to determine the effectiveness of NiBS in treating GD. Following the PRISMA guidelines, we screened four electronic databases up to July 2022 and selected relevant English-written original articles. We included ten papers in the systematic review and seven in the meta-analysis. As only two studies employed a sham-controlled design, the pre-post standardized mean change (SMCC) was computed as effect size only for real stimulation. The results showed a significant effect of NiBS in reducing craving scores (SMCC = -0.69; 95% CI = [-1.2, -0.2], p = 0.010). Moreover, considering the GD's frequent comorbidity with mood disorders, we ran an exploratory analysis of the effects of NiBS on depressive symptoms, which showed significant decreases in post-treatment scores (SMCC = -0.71; 95% CI = [-1.1, -0.3], p < 0.001). These results provide initial evidence for developing NiBS as a feasible therapy for GD symptoms but further comprehensive research is needed to validate these findings. The limitations of the available literature are critically discussed.
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Affiliation(s)
- Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
- Fondazione Eris Onlus, 20134 Milano, Italy
| | - Alessandra Vergallito
- Department of Psychology & Neuromi, University of Milano-Bicocca, 20126 Milano, Italy
| | - Gaia Gattavara
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
| | | | - Alessia Gallucci
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Anna Vedani
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
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Fang Y, Sun Y, Liu Y, Liu T, Hao W, Liao Y. Neurobiological mechanisms and related clinical treatment of addiction: a review. PSYCHORADIOLOGY 2022; 2:180-189. [PMID: 38665277 PMCID: PMC10917179 DOI: 10.1093/psyrad/kkac021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 04/28/2024]
Abstract
Drug addiction or substance use disorder (SUD), has been conceptualized as a three-stage (i.e. binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation/craving) recurring cycle that involves complex changes in neuroplasticity, reward, motivation, desire, stress, memory, and cognitive control, and other related brain regions and brain circuits. Neuroimaging approaches, including magnetic resonance imaging, have been key to mapping neurobiological changes correlated to complex brain regions of SUD. In this review, we highlight the neurobiological mechanisms of these three stages of addiction. The abnormal activity of the ventral tegmental, nucleus accumbens, and caudate nucleus in the binge/intoxication stage involve the reward circuit of the midbrain limbic system. The changes in the orbitofrontal cortex, dorsolateral prefrontal cortex, amygdala, and hypothalamus emotional system in the withdrawal/negative affect stage involve increases in negative emotional states, dysphoric-like effects, and stress-like responses. The dysregulation of the insula and prefrontal lobes is associated with craving in the anticipation stage. Then, we review the present treatments of SUD based on these neuroimaging findings. Finally, we conclude that SUD is a chronically relapsing disorder with complex neurobiological mechanisms and multimodal stages, of which the craving stage with high relapse rate may be the key element in treatment efficacy of SUD. Precise interventions targeting different stages of SUD and characteristics of individuals might serve as a potential therapeutic strategy for SUD.
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Affiliation(s)
- Yehong Fang
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
| | - Yunkai Sun
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
| | - Yi Liu
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
| | - Tieqiao Liu
- Department of Psychiatry & Mental Health Institute of the Second Xiangya Hospital, Central South University. National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders. Hunan Key Laboratory of Psychiatry and Mental Health, 139 Renmin (M) Rd, Changsha, Hunan 410011, P. R. China
| | - Wei Hao
- Department of Psychiatry & Mental Health Institute of the Second Xiangya Hospital, Central South University. National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders. Hunan Key Laboratory of Psychiatry and Mental Health, 139 Renmin (M) Rd, Changsha, Hunan 410011, P. R. China
| | - Yanhui Liao
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
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8
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Kim E, Kum J, Lee SH, Kim H. Development of a wireless ultrasonic brain stimulation system for concurrent bilateral neuromodulation in freely moving rodents. Front Neurosci 2022; 16:1011699. [PMID: 36213731 PMCID: PMC9539445 DOI: 10.3389/fnins.2022.1011699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Bilateral brain stimulation is an important modality used to investigate brain circuits and treat neurological conditions. Recently, low-intensity pulsed ultrasound (LIPUS) received significant attention as a novel non-invasive neurostimulation technique with high spatial specificity. Despite the growing interest, the typical ultrasound brain stimulation study, especially for small animals, is limited to a single target of sonication. The constraint is associated with the complexity and the cost of the hardware system required to achieve multi-regional sonication. This work presented the development of a low-cost LIPUS system with a pair of single-element ultrasound transducers to address the above problem. The system was built with a multicore processor with an RF amplifier circuit. In addition, LIPUS device was incorporated with a wireless module (bluetooth low energy) and powered by a single 3.7 V battery. As a result, we achieved an ultrasound transmission with a central frequency of 380 kHz and a peak-to-peak pressure of 480 kPa from each ultrasound transducer. The developed system was further applied to anesthetized rats to investigate the difference between uni- and bilateral stimulation. A significant difference in cortical power density extracted from electroencephalogram signals was observed between uni- and bilateral LIPUS stimulation. The developed device provides an affordable solution to investigate the effects of LIPUS on functional interhemispheric connection.
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Affiliation(s)
- Evgenii Kim
- Biomedical Research Division, Bionics Research Center, Korea Institute of Science and Technology, Seoul, South Korea
| | - Jeungeun Kum
- Biomedical Research Division, Bionics Research Center, Korea Institute of Science and Technology, Seoul, South Korea
- Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul, South Korea
| | - Seung Hyun Lee
- Biomedical Research Division, Bionics Research Center, Korea Institute of Science and Technology, Seoul, South Korea
| | - Hyungmin Kim
- Biomedical Research Division, Bionics Research Center, Korea Institute of Science and Technology, Seoul, South Korea
- Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul, South Korea
- *Correspondence: Hyungmin Kim,
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Schwartz EKC, Wolkowicz NR, De Aquino JP, MacLean RR, Sofuoglu M. Cocaine Use Disorder (CUD): Current Clinical Perspectives. Subst Abuse Rehabil 2022; 13:25-46. [PMID: 36093428 PMCID: PMC9451050 DOI: 10.2147/sar.s337338] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
Cocaine use disorder (CUD) is a devastating disorder, impacting both individuals and society. Individuals with CUD face many barriers in accessing treatment for CUD, and most individuals with CUD never receive treatment. In this review, we provide an overview of CUD, including risk factors for CUD, common co-occurring disorders, acute and chronic effects of cocaine use, and currently available pharmacological and behavioral treatments. There are no FDA-approved pharmacological treatments for CUD. Future studies with larger sample sizes and testing treatment combinations are warranted. However, individuals with CUD and co-occurring disorders (eg, a mood or anxiety disorder) may benefit from medication treatments. There are behavioral interventions that have demonstrated efficacy in treating CUD – contingency management (CM) and cognitive-behavioral therapy for substance use disorders (CBT-SUD) in particular – however many barriers remain in delivering these treatments to patients. Following the discussion of current treatments, we highlight some promising emerging treatments, as well as offer a framework that can be used in building a treatment plan for individuals with CUD.
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Affiliation(s)
- Elizabeth K C Schwartz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
- Correspondence: Elizabeth KC Schwartz, Tel +1-203-932-5711, Fax +1-203-937-3472, Email
| | - Noah R Wolkowicz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - R Ross MacLean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
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10
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Ekhtiari H, Soleimani G, Kuplicki R, Yeh H, Cha Y, Paulus M. Transcranial direct current stimulation to modulate fMRI drug cue reactivity in methamphetamine users: A randomized clinical trial. Hum Brain Mapp 2022; 43:5340-5357. [PMID: 35915567 PMCID: PMC9812244 DOI: 10.1002/hbm.26007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 01/15/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) has been studied as a therapeutic option to alter maladaptive brain functions associated with chronic substance use. We present a randomized, triple-blind, sham-controlled, clinical trial to determine the neural substrates of tDCS effects on drug craving. Sixty participants with methamphetamine use disorder were assigned to two groups: active tDCS (5 x 7 cm2 , 2 mA, 20 min, anode/cathode over the F4/Fp1) and sham stimulation. Neuroimaging data of a methamphetamine cue reactivity task were collected immediately before and after stimulation. There was a significant reduction in self-reported craving after stimulation without any significant effect of time-by-group interaction. Our whole-brain analysis demonstrated that there was a global decrease in brain reactivity to cues following sham but not active tDCS. There were significant time-by-group interactions in five main clusters in middle and inferior frontal gyri, anterior insula, inferior parietal lobule, and precuneus with higher activations after active stimulation. There was a significant effect of stimulation type in the relationship between electrical current at the individual level and changes in task-modulated activation. Brain regions with the highest electric current in the prefrontal cortex showed a significant time-by-group interaction in task-modulated connectivity in the frontoparietal network. In this trial, there was no significant effect of the one session of active-F4/Fp1 tDCS on drug craving self-report compared to sham stimulation. However, activation and connectivity differences induced by active compared to sham stimulation suggested some potential mechanisms of tDCS to modulate neural response to drug cues.
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Affiliation(s)
| | - Ghazaleh Soleimani
- Department of Biomedical EngineeringAmirkabir University of TechnologyTehranIran,Iranian National Center for Addiction StudiesTehran University of Medical SciencesTehranIran
| | | | - Hung‐Wen Yeh
- UMKC School of MedicineUniversity of Missouri‐Kansas City School of MedicineKansa CityMissouriUSA
| | - Yoon‐Hee Cha
- Department of Psychiatry, Medical schoolUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Martin Paulus
- Laureate Institute for Brain ResearchTulsaOklahomaUSA
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11
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Li Q, Fu Y, Liu C, Meng Z. Transcranial Direct Current Stimulation of the Dorsolateral Prefrontal Cortex for Treatment of Neuropsychiatric Disorders. Front Behav Neurosci 2022; 16:893955. [PMID: 35711693 PMCID: PMC9195619 DOI: 10.3389/fnbeh.2022.893955] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/04/2022] [Indexed: 12/16/2022] Open
Abstract
Background The dorsolateral prefrontal cortex (DLPFC) is a key node of the frontal cognitive circuit. It is involved in executive control and many cognitive processes. Abnormal activities of DLPFC are likely associated with many psychiatric diseases. Modulation of DLPFC may have potential beneficial effects in many neural and psychiatric diseases. One of the widely used non-invasive neuromodulation technique is called transcranial direct current stimulation (or tDCS), which is a portable and affordable brain stimulation approach that uses direct electrical currents to modulate brain functions. Objective This review aims to discuss the results from the past two decades which have shown that tDCS can relieve clinical symptoms in various neurological and psychiatric diseases. Methods Here, we performed searches on PubMed to collect clinical and preclinical studies that using tDCS as neuromodulation technique, DLPFC as the stimulation target in treating neuropsychiatric disorders. We summarized the stimulation sites, stimulation parameters, and the overall effects in these studies. Results Overall, tDCS stimulation of DLPFC could alleviate the clinical symptoms of schizophrenia, depression, drug addiction, attention deficit hyperactivity disorder and other mental disorders. Conclusion The stimulation parameters used in these studies were different from each other. The lasting effect of stimulation was also not consistent. Nevertheless, DLPFC is a promising target for non-invasive stimulation in many psychiatric disorders. TDCS is a safe and affordable neuromodulation approach that has potential clinical uses. Larger clinical studies will be needed to determine the optimal stimulation parameters in each condition.
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Affiliation(s)
- Qing Li
- Medical School, Kunming University of Science and Technology, Kunming, China
- Shenzhen Key Laboratory of Drug Addiction, Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yu Fu
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Chang Liu
- Shenzhen Key Laboratory of Viral Vectors for Biomedicine, Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Fundamental Research Institutions, Shenzhen, China
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- *Correspondence: Chang Liu,
| | - Zhiqiang Meng
- Shenzhen Key Laboratory of Drug Addiction, Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Fundamental Research Institutions, Shenzhen, China
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Zhiqiang Meng,
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Mostafavi H, Dadashi M, Faridi A, Kazemzadeh F, Eskandari Z. Using Bilateral tDCS to Modulate EEG Amplitude and Coherence of Men With Opioid Use Disorder Under Methadone Therapy: A Sham-controlled Clinical Trial. Clin EEG Neurosci 2022; 53:184-195. [PMID: 34105988 DOI: 10.1177/15500594211022100] [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] [Indexed: 12/24/2022]
Abstract
Objective. This study aimed to investigate the effect of bilateral transcranial direct current stimulation (tDCS) on the electroencephalography (EEG) amplitude and coherence in male patients with opioid use disorder (OUD), who were under methadone therapy. It compares the effects of active versus sham tDCS. Methods. This is a double-blind sham-controlled clinical trial. Participants were 30 male patients with OUD; they were divided into 3 groups of left anode/right cathode tDCS, right anode/left cathode tDCS, and sham tDCS. Their brainwave activity was measured by quantitative EEG before study and then active groups underwent tDCS (2 mA, 20 min) applied over their right/left dorsolateral prefrontal cortex (DLPFC) for 10 consecutive days. After stimulation, they were re-assessed. The collected data were analyzed in SPSS, MATLAB, and NeuroGuide v.2 applications. Results. After active tDCS, a significant decrease in amplitude of slow brain waves (delta, theta, and alpha) in prefrontal, frontal, occipital, and parietal areas, and an increase in the coherence of beta, delta, and theta frequency bands in the parietal, central, and temporal regions of addicts were reported. In the sham group, there was a significant decrease in the amplitude of the alpha wave and in the coherence of delta and theta waves. Conclusion. The active tDCS over the right/left DLPFC, as a noninvasive and complementary treatment, can modulate the amplitude and coherence of brainwaves in patients with OUD.
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Affiliation(s)
- Hossein Mostafavi
- 48539Department of Physiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohsen Dadashi
- Department of Clinical Psychology, Faculty of Medicine, Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Alireza Faridi
- 185134Department of Clinical Psychology and Addiction Studies, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Fatemeh Kazemzadeh
- 185134Department of Electrical Engineering, University of Zanjan, Zanjan, Iran
| | - Zakaria Eskandari
- 185134Department of Clinical Psychology and Addiction Studies, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Fayaz Feyzi Y, Vahed N, Sadeghamal Nikraftar N, Arezoomandan R. Synergistic effect of combined transcranial direct current stimulation and Matrix Model on the reduction of methamphetamine craving and improvement of cognitive functioning: a randomized sham-controlled study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:311-320. [PMID: 35404725 DOI: 10.1080/00952990.2021.2015771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Addiction is associated with decreased activity of the prefrontal networks, especially dorsolateral prefrontal cortex (DLPFC). OBJECTIVE This study examined the effectiveness of transcranial direct current stimulation (tDCS) over DLPFC in combination with Matrix Model psychotherapy in the alleviation of craving and cognitive improvement of participants with methamphetamine use disorder. METHODS In a randomized and sham-controlled trial, 60 male participants were assigned to Matrix psychotherapy only, sham tDCS plus Matrix, or active tDCS plus Matrix. Sixteen sessions of 20-min anodal (2 mA over F3 for targeting the left DLPFC) or sham tDCS along were administered in the outpatient setting. Pre- and post-intervention craving, executive functioning, and working memory were assessed using the Obsessive-Compulsive Drug Use Scale, Wisconsin Card Sorting Test, and Wechsler Memory Scale, respectively. One month following the interventions relapse was investigated by urine drug screen or interview. RESULTS In comparison with sham tDCS (n = 12) and Matrix psychotherapy only group (n = 13), the active tDCS group (n = 15) showed more reduction in craving (p<.05, η2 = .21). Auditory and visual memory (Wechsler) and true answers and false answers (WCST) significantly improved in the active tDCS group (η2 = .18, η2 = 12, η2 = 03, η2 = .02, respectively) but not in the other groups. Relapse rates did not significantly differ between groups (p = .17). A significant correlation was found between craving reduction and cognitive functioning in the active tDCS group. CONCLUSION The combination of Matrix Model psychotherapy and tDCS may an effective therapy for cognitive improvement and craving in participants with methamphetamine use disorder. CLINICAL TRIALS REGISTRY This study was registered at the Iranian Registry of Clinical Trials (IRCT20161026030510N3).
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Affiliation(s)
- Yasha Fayaz Feyzi
- Department of Addiction, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Neda Vahed
- Department of Addiction, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | | | - Reza Arezoomandan
- Department of Addiction, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
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Perrotta D, Perri RL. Mini-review: When neurostimulation joins cognitive-behavioral therapy. On the need of combining evidence-based treatments for addiction disorders. Neurosci Lett 2022; 777:136588. [PMID: 35341891 DOI: 10.1016/j.neulet.2022.136588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/29/2021] [Accepted: 03/22/2022] [Indexed: 11/18/2022]
Abstract
Substance and behavioral addiction is a global health problem related to cognitive functioning and emotional responses like top-down control and craving. The present review discusses the role of non-invasive brain stimulation (NIBS) and cognitive-behavioral therapy (CBT) as evidence-based treatments for addiction disorders. The discussion spans between several evidence for both therapies, also considering the difference and heterogeneity among clinical protocols. Nowadays, literature is consistent in indicating the neurostimulation of the prefrontal cortex as effective for different kinds of addiction, corroborating the evidence that they rely on a common network in the brain. Likewise, within the CBT studies it is possible to observe a wide range of interventions that are overall effective in regulating the executive functions associated with addiction disorders. Nevertheless, the integration of NIBS and CBT in addictions has been scarcely considered in literature so far. For this reason, the present article is meant to foster empirical research in this field by highlighting the findings supporting these evidence-based interventions, both as stand-alone and integrated treatments. To this aim, psychological and neurophysiological mechanisms of NIBS and CBT in addictions are reviewed, and the rationale of their integration discussed. In particular, as evidence suggest these treatments affect top-down and bottom-up processes in different ways, with NIBS reducing craving and CBT boosting motivation and coping, we suggest their combination might better target the different components of addiction to promote abstinence.
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Soleimani G, Kupliki R, Bodurka J, Paulus M, Ekhtiari H. How structural and functional MRI can inform dual-site tACS parameters: A case study in a clinical population and its pragmatic implications. Brain Stimul 2022; 15:337-351. [PMID: 35042056 DOI: 10.1016/j.brs.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Abnormalities in frontoparietal network (FPN) were observed in many neuropsychiatric diseases including substance use disorders. A growing number of studies are using dual-site-tACS with frontoparietal synchronization to engage this network. However, a computational pathway to inform and optimize parameter space for frontoparietal synchronization is still lacking. In this case study, in a group of participants with methamphetamine use disorders, we proposed a computational pathway to extract optimal electrode montage while accounting for stimulation intensity using structural and functional MRI. METHODS Sixty methamphetamine users completed an fMRI drug cue-reactivity task. Four main steps were taken to define electrode montage and adjust stimulation intensity using 4x1 high-definition (HD) electrodes for a dual-site-tACS; (1) Frontal seed was defined based on the maximum electric fields (EF) predicted by simulation of HD montage over DLPFC (F3/F4 in EEG 10-20), (2) frontal seed-to-whole brain context-dependent correlation was calculated to determine connected regions to frontal seeds, (3) center of connected cluster in parietal cortex was selected as a location for placing the second set of HD electrodes to shape the informed montage, (4) individualized head models were used to determine optimal stimulation intensity considering underlying brain structure. The informed montage was compared to montages with large electrodes and classic frontoparietal HD montages (F3-P3/F4-P4) in terms of tACS-induced EF and ROI-to-ROI task-based/resting-state connectivity. RESULTS Compared to the large electrodes, HD frontoparietal montages allow for a finer control of the spatial peak fields in the main nodes of the FPN at the cost of lower maximum EF (large-pad/HD: max EF[V/m] = 0.37/0.11, number of cortical sub-regions that EF exceeds 50% of the max = 77/13). For defining stimulation targets based on EF patterns, using group-level head models compared to a single standard head model results in comparable but significantly different seed locations (6.43mm Euclidean distance between the locations of the frontal maximum EF in standard-space). As expected, significant task-based/resting-state connections were only found between frontal-parietal locations in the informed montage. Cue-induced craving score was correlated with frontoparietal connectivity only in the informed montage (r = -0.24). Stimulation intensity in the informed montage, and not in the classic HD montage, needs 40% reduction in the parietal site to reduce the disparity in EF between sites. CONCLUSION This study provides some empirical insights to montage and dose selection in dual-site-tACS using individual brain structures and functions and proposes a computational pathway to use head models and functional MRI to define (1) optimum electrode montage for targeting FPN in a context of interest (drug-cue-reactivity) and (2) proper transcranial stimulation intensity.
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Affiliation(s)
- Ghazaleh Soleimani
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran; Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Rayus Kupliki
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, OK, United States.
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The neurobiology of drug addiction: cross-species insights into the dysfunction and recovery of the prefrontal cortex. Neuropsychopharmacology 2022; 47:276-291. [PMID: 34408275 PMCID: PMC8617203 DOI: 10.1038/s41386-021-01153-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 01/03/2023]
Abstract
A growing preclinical and clinical body of work on the effects of chronic drug use and drug addiction has extended the scope of inquiry from the putative reward-related subcortical mechanisms to higher-order executive functions as regulated by the prefrontal cortex. Here we review the neuroimaging evidence in humans and non-human primates to demonstrate the involvement of the prefrontal cortex in emotional, cognitive, and behavioral alterations in drug addiction, with particular attention to the impaired response inhibition and salience attribution (iRISA) framework. In support of iRISA, functional and structural neuroimaging studies document a role for the prefrontal cortex in assigning excessive salience to drug over non-drug-related processes with concomitant lapses in self-control, and deficits in reward-related decision-making and insight into illness. Importantly, converging insights from human and non-human primate studies suggest a causal relationship between drug addiction and prefrontal insult, indicating that chronic drug use causes the prefrontal cortex damage that underlies iRISA while changes with abstinence and recovery with treatment suggest plasticity of these same brain regions and functions. We further dissect the overlapping and distinct characteristics of drug classes, potential biomarkers that inform vulnerability and resilience, and advancements in cutting-edge psychological and neuromodulatory treatment strategies, providing a comprehensive landscape of the human and non-human primate drug addiction literature as it relates to the prefrontal cortex.
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Jiang X, Tian Y, Zhang Z, Zhou C, Yuan J. The Counterproductive Effect of Right Anodal/Left Cathodal Transcranial Direct Current Stimulation Over the Dorsolateral Prefrontal Cortex on Impulsivity in Methamphetamine Addicts. Front Psychiatry 2022; 13:915440. [PMID: 35815052 PMCID: PMC9257135 DOI: 10.3389/fpsyt.2022.915440] [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: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
The current study aimed to evaluate the effect of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) on behavioral impulsivity in methamphetamine addicts. Forty-five methamphetamine addicts were recruited and randomly divided into active tDCS and sham tDCS groups to receive a daily tDCS intervention for 5 days, with the intensity set to 2 mA for the active group and 0 mA for the sham group. Anodal and cathodal electrodes were, respectively, placed over the right and left DLPFC. Behavioral impulsivity in methamphetamine addicts was examined by the 2-choice oddball task at 3-time points: before tDCS intervention (baseline), after the first intervention (day 1), and after 5 repeated interventions (day 5). Besides, twenty-four healthy male participants were recruited as the healthy controls who completed a 2-choice oddball task. Analysis of accuracy for the 2-choice oddball task showed that behavioral impulsivity was counterproductively increased in the active group, which was shown by the decreased accuracy for the deviant stimulus. The results suggested that the present protocol may not be optimal and other protocols should be considered for the intervention of methamphetamine addicts in the future.
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Affiliation(s)
- Xiaoyu Jiang
- The Affect Cognition and Regulation Laboratory (ACRLab), Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Yu Tian
- The Affect Cognition and Regulation Laboratory (ACRLab), Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Zhiling Zhang
- The Affect Cognition and Regulation Laboratory (ACRLab), Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Changwei Zhou
- Psychological Correction Center, Sichuan Ziyang Drug Rehabilitation Center, Ziyang, China
| | - Jiajin Yuan
- The Affect Cognition and Regulation Laboratory (ACRLab), Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
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Panitz M, Deserno L, Kaminski E, Villringer A, Sehm B, Schlagenhauf F. OUP accepted manuscript. Cereb Cortex Commun 2022; 3:tgac006. [PMID: 35233532 PMCID: PMC8874878 DOI: 10.1093/texcom/tgac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/25/2021] [Accepted: 01/12/2022] [Indexed: 11/19/2022] Open
Abstract
The medial prefrontal cortex (mPFC) is thought to be central for flexible behavioral adaptation. However, the causal relationship between mPFC activity and this behavior is incompletely understood. We investigated whether transcranial direct current stimulation (tDCS) over the mPFC alters flexible behavioral adaptation during reward-based decision-making, targeting Montreal Neurological Institute (MNI) coordinates X = −8, Y = 62, Z = 12, which has previously been associated with impaired behavioral adaptation in alcohol-dependent patients. Healthy human participants (n = 61) received either anodal (n = 30) or cathodal (n = 31) tDCS versus sham tDCS while performing a reversal learning task. To assess the mechanisms of reinforcement learning (RL) underlying our behavioral observations, we applied computational models that varied with respect to the updating of the unchosen choice option. We observed that anodal stimulation over the mPFC induced increased choice switching after punishments compared with sham stimulation, whereas cathodal stimulation showed no effect on participants’ behavior compared with sham stimulation. RL revealed increased updating of the unchosen choice option under anodal as compared with sham stimulation, which accounted well for the increased tendency to switch after punishments. Our findings provide a potential model for tDCS interventions in conditions related to flexible behavioral adaptation, such as addiction.
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Affiliation(s)
- Martin Panitz
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
- Corresponding author: Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1A, 04103 Leipzig, Germany.
| | - Lorenz Deserno
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, 97080 Würzburg, Germany
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, 01187 Dresden, Germany
| | - Elisabeth Kaminski
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
- Department of Human Movement Neurosciences, Faculty of Sports Science, University of Leipzig, Leipzig 04109, Germany
| | - Arno Villringer
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
- Clinic for Cognitive Neurology, University Hospital Leipzig, 04103 Leipzig, Germany
- MindBrainBody Institute, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Bernhard Sehm
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Florian Schlagenhauf
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
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Transcranial direct current stimulation combined with alcohol cue inhibitory control training reduces the risk of early alcohol relapse: A randomized placebo-controlled clinical trial. Brain Stimul 2021; 14:1531-1543. [PMID: 34687964 DOI: 10.1016/j.brs.2021.10.386] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Approximately half of all people with alcohol use disorder (AUD) relapse into alcohol reuse in the next few weeks after a withdrawal treatment. Brain stimulation and cognitive training represent recent forms of complementary interventions in the context of AUD. OBJECTIVE To evaluate the clinical efficacy of five sessions of 2 mA bilateral transcranial direct current stimulation (tDCS) for 20 min over the dorsolateral prefrontal cortex (DLPFC) (left cathodal/right anodal) combined with alcohol cue inhibitory control training (ICT) as part of rehabilitation. The secondary outcomes were executive functioning (e.g. response inhibition) and craving intensity, two mechanisms strongly related to abstinence. METHODS A randomized clinical trial with patients (n = 125) with severe AUD at a withdrawal treatment unit. Each patient was randomly assigned to one of four conditions, in a 2 [verum vs. sham tDCS] x 2 [alcohol cue vs. neutral ICT] factorial design. The main outcome of treatment was the abstinence rate after two weeks or more (up to one year). RESULTS Verum tDCS improved the abstinence rate at the 2-week follow-up compared to the sham condition, independently of the training condition (79.7% [95% CI = 69.8-89.6] vs. 60.7% [95% CI = 48.3-73.1]; p = .02). A priori contrasts analyses revealed higher abstinence rates for the verum tDCS associated with alcohol cue ICT (86.1% [31/36; 95% CI = 74.6-97.6]) than for the other three conditions (64% [57/89; 95% CI = 54-74]). These positive clinical effects on abstinence did not persist beyond two weeks after the intervention. Neither the reduction of craving nor the improvement in executive control resulted specifically from prefrontal-tDCS and ICT. CONCLUSIONS AUD patients who received tDCS applied to DLPFC showed a significantly higher abstinence rate during the weeks following rehabilitation. When combined with alcohol specific ICT, brain stimulation may provide better clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov number NCT03447054 https://clinicaltrials.gov/ct2/show/NCT03447054.
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Herrera-Melendez AL, Bajbouj M, Aust S. Application of Transcranial Direct Current Stimulation in Psychiatry. Neuropsychobiology 2021; 79:372-383. [PMID: 31340213 DOI: 10.1159/000501227] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a neuromodulation technique, which noninvasively alters cortical excitability via weak polarizing currents between two electrodes placed on the scalp. Since it is comparably easy to handle, cheap to use and relatively well tolerated, tDCS has gained increasing interest in recent years. Based on well-known behavioral effects, a number of clinical studies have been performed in populations including patients with major depressive disorder followed by schizophrenia and substance use disorders, in sum with heterogeneous results with respect to efficacy. Nevertheless, the potential of tDCS must not be underestimated since it could be further improved by systematically investigating the various stimulation parameters to eventually increase clinical efficacy. The present article briefly explains the underlying physiology of tDCS, summarizes typical stimulation protocols and then reviews clinical efficacy for various psychiatric disorders as well as prevalent adverse effects. Future developments include combined and more complex interactions of tDCS with pharmacological or psychotherapeutic interventions. In particular, using computational models to individualize stimulation protocols, considering state dependency and applying closed-loop technologies will pave the way for tDCS-based personalized interventions as well as the development of home treatment settings promoting the role of tDCS as an effective treatment option for patients with mental health problems.
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Affiliation(s)
- Ana-Lucia Herrera-Melendez
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany,
| | - Malek Bajbouj
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sabine Aust
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Perri RL, Perrotta D. Transcranial direct current stimulation of the prefrontal cortex reduces cigarette craving in not motivated to quit smokers: A randomized, sham-controlled study. Addict Behav 2021; 120:106956. [PMID: 33940337 DOI: 10.1016/j.addbeh.2021.106956] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
Transcranial direct current stimulation (tDCS) over the dorsolaterateral prefrontal cortex (DLPFC) has been indicated as a promising treatment for several addictions, while its contribution for smoking cessation was less investigated. In particular, the role of motivation to quit and the nicotine dependence level as possible mediators of tDCS effect needs to be deepened. In the present study, we recruited twenty smokers who did not look for a treatment to quit: most of them presented a mild level of nicotine addiction, and they were randomly assigned to active or sham group for receiving bilateral tDCS over the DLPFC. tDCS was provided for five consecutive days with anode over the right hemisphere: in the first and the last day the craving level was evaluated through a specific evoking procedure, and the daily cigarette consumption was recorded. Results showed that the active tDCS decreased by about 50% the cigarette craving, while the number of cigarettes smoked remained unchanged and no differences emerged in the sham group. The present study indicates the tDCS of the DLPFC as a possible treatment for smoking addiction because of its effectiveness in reducing craving. Further, as we recruited smokers with no motivation to quit, and the nicotine dependence level was a moderator of the tDCS effect, we suggest that its efficacy might be even greater in the severe smokers looking for a treatment.
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tDCS randomized controlled trials in no-structural diseases: a quantitative review. Sci Rep 2021; 11:16311. [PMID: 34381076 PMCID: PMC8357949 DOI: 10.1038/s41598-021-95084-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
The increasing number and quality of randomized controlled trials (RCTs) employing transcranial direct current stimulation (tDCS) denote the rising awareness of neuroscientific community about its electroceutical potential and opening to include these treatments in the framework of medical therapies under the indications of the international authorities. The purpose of this quantitative review is to estimate the recommendation strength applying the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria and PICO (population, intervention, comparison, outcome) model values for effective tDCS treatments on no-structural diseases, and to provide an estimate of Sham effect for future RCTs. Applying GRADE evaluation pathway, we searched in literature the tDCS-based RCTs in psychophysical diseases displaying a major involvement of brain electrical activity imbalances. Three independent authors agreed on Class 1 RCTs (18 studies) and meta-analyses were carried out using a random-effects model for pathologies sub-selected based on PICO and systemic involvement criteria. The meta-analysis integrated with extensive evidence of negligible side effects and low-cost, easy-to-use procedures, indicated that tDCS treatments for depression and fatigue in Multiple Sclerosis ranked between moderately and highly recommendable. For these interventions we reported the PICO variables, with left vs. right dorsolateral prefrontal target for 30 min/10 days against depression and bilateral somatosensory vs occipital target for 15 min/5 days against MS fatigue. An across-diseases meta-analysis devoted to the Sham effect provided references for power analysis in future tDCS RCTs on these clinical conditions. High-quality indications support tDCS as a promising tool to build electroceutical treatments against diseases involving neurodynamics alterations.
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Fregni F, El-Hagrassy MM, Pacheco-Barrios K, Carvalho S, Leite J, Simis M, Brunelin J, Nakamura-Palacios EM, Marangolo P, Venkatasubramanian G, San-Juan D, Caumo W, Bikson M, Brunoni AR. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol 2021; 24:256-313. [PMID: 32710772 PMCID: PMC8059493 DOI: 10.1093/ijnp/pyaa051] [Citation(s) in RCA: 238] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. OBJECTIVE We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson's disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction. METHODS Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. RESULTS Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson's disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). CONCLUSION All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
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Affiliation(s)
- Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Mirret M El-Hagrassy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Sandra Carvalho
- Neurotherapeutics and experimental Psychopathology Group (NEP), Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Jorge Leite
- I2P-Portucalense Institute for Psychology, Universidade Portucalense, Porto, Portugal
| | - Marcel Simis
- Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sao Paulo, Brazil
| | - Jerome Brunelin
- CH Le Vinatier, PSYR2 team, Lyon Neuroscience Research Center, UCB Lyon 1, Bron, France
| | - Ester Miyuki Nakamura-Palacios
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Federal University of Espírito Santo, Espírito Santo, Brasil (Dr Nakamura-Palacios)
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, Università Federico II, Naples, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS) Surgery Department, School of Medicine, UFRGS; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA) Laboratory of Pain and Neuromodulation at HCPA, Porto Alegre, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, New York
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry & Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Eskandari Z, Mostafavi H, Hosseini M, Mousavi SE, Ramazani S, Dadashi M. A sham-controlled clinical trial to examine the effect of bilateral tDCS on craving, TNF-α and IL-6 expression levels, and impulsivity of males with opioid use disorder. J Addict Dis 2021; 39:347-356. [PMID: 33719920 DOI: 10.1080/10550887.2021.1883208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) is one of the problems and concerns of all countries in the world. On the other hand, transcranial direct current stimulation (tDCS) has been used as a new therapeutic intervention in various psychiatric disorders. OBJECTIVE This study aimed to investigate the effect of bilateral tDCS on the expression levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), craving and impulsive behaviors of male patients with OUD. METHODS This is a double-blind sham-controlled clinical trial. Participants were 31 male patients with OUD divided into three groups of left anode/right cathode tDCS, right anode/left cathode tDCS, and sham tDCS. They received active tDCS (2 mA, 20 min), applied over their dorsolateral prefrontal cortex (DLPFC) for 10 consecutive days. Expression levels of IL-6 and TNF-α cytokines were measured using ELISA method, and the Desires for Drug Questionnaire and the Barratt Impulsiveness Scale version 11 were used to assess the craving and impulsivity of subjects, respectively. RESULTS Both active and sham tDCS could significantly reduce drug craving in subjects (p < 0.05). Active tDCS over the right/left DLPFC significantly reduced impulsivity and its dimensions (overall, attentional, motor, and nonplanning) compared to the sham tDCS (p < 0.05). It could also reduce the expression levels of IL-6 and TNF-α, but the difference was not statistically significant. CONCLUSIONS The active tDCS over the right/left DLPFC, as a noninvasive and complementary treatment, can be used along with other common methods for the treatment of patients with OUD. It can improve their cognitive functions by reducing impulsivity.
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Affiliation(s)
- Zakaria Eskandari
- Faculty of Medicine, Department of Clinical Psychology and Addiction Studies, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossein Mostafavi
- Faculty of Medicine, Department of Physiology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Masoumeh Hosseini
- Faculty of Medicine, Department of Physiology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Seyedeh Elnaz Mousavi
- Faculty of Medicine, Department of Clinical Psychology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Shokoufe Ramazani
- Faculty of Educational Sciences and Psychology, Department of Educational Sciences, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Mohsen Dadashi
- Faculty of Medicine, Department of Clinical Psychology, Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
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Gaudreault PO, Sharma A, Datta A, Nakamura-Palacios EM, King S, Malaker P, Wagner A, Vasa D, Parvaz MA, Parra LC, Alia-Klein N, Goldstein RZ. A double-blind sham-controlled phase 1 clinical trial of tDCS of the dorsolateral prefrontal cortex in cocaine inpatients: Craving, sleepiness, and contemplation to change. Eur J Neurosci 2021; 53:3212-3230. [PMID: 33662163 DOI: 10.1111/ejn.15172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 02/06/2023]
Abstract
Impaired inhibitory control accompanied by enhanced salience attributed to drug-related cues, both associated with function of the dorsolateral prefrontal cortex (dlPFC), are hallmarks of drug addiction, contributing to worse symptomatology including craving. dlPFC modulation with transcranial direct current stimulation (tDCS) previously showed craving reduction in inpatients with cocaine use disorder (CUD). Our study aimed at assessing feasibility of a longer tDCS protocol in CUD (15 versus the common five/10 sessions) and replicability of previous results. In a randomized double-blind sham-controlled protocol, 17 inpatients with CUD were assigned to either a real-tDCS (right anodal/left cathodal) or a sham-tDCS condition for 15 sessions. Following the previous report, primary outcome measures were self-reported craving, anxiety, depression, and quality of life. Secondary measures included sleepiness, readiness to change drug use, and affect. We also assessed cognitive function including impulsivity. An 88% retention rate demonstrated feasibility. Partially supporting the previous results, there was a trend for self-reported craving to decrease in the real-tDCS group more than the sham-group, an effect that would reach significance with 15 subjects per group. Quality of life and impulsivity improved over time in treatment in both groups. Daytime sleepiness and readiness to change drug use showed significant Group × Time interactions whereby improvements were noted only in the real-tDCS group. One-month follow-up suggested transient effects of tDCS on sleepiness and craving. These preliminary results suggest the need for including more subjects to show a unique effect of real-tDCS on craving and examine the duration of this effect. After replication in larger sample sizes, increased vigilance and motivation to change drug use in the real-tDCS group may suggest fortification of dlPFC-supported executive functions.
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Affiliation(s)
- Pierre-Olivier Gaudreault
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Akarsh Sharma
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - Ester M Nakamura-Palacios
- Program of Post-Graduation in Physiological Sciences, Federal University of Espirito Santo, Vitoria-ES, Brazil
| | - Sarah King
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Pias Malaker
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ariella Wagner
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Devarshi Vasa
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Muhammad A Parvaz
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Lucas C Parra
- Biomedical Engineering Department, City College of New York, New York City, NY, USA
| | - Nelly Alia-Klein
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Rita Z Goldstein
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Cardiorespiratory Fitness Predicts Higher Inhibitory Control in Patients With Substance Use Disorder. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2021. [DOI: 10.1123/jcsp.2019-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Impaired inhibitory control has been shown in individuals with substance use disorder (SUD). Cardiorespiratory fitness has been described as a potential factor to improve inhibitory control; however, the benefits in individuals with SUD are unclear. The aim of this study was to investigate the relationship between cardiorespiratory fitness with general and drug-specific inhibitory control in individuals with SUD. Sixty-two male participants under treatment for SUD performed a general and drug-specific inhibitory control test (go/no-go) and a cardiorespiratory fitness test. Cardiorespiratory fitness, age, and years of drug use were inversely associated with reaction time for both general and drug-specific inhibitory control. In addition, the regression models showed that cardiorespiratory fitness predicts general and drug-specific inhibitory control adjusted for age and time of drug use. However, cardiorespiratory fitness predicts equally both general and drug-specific inhibitory control. These findings suggest that increasing cardiorespiratory fitness could provide benefits in the inhibitory function of individuals with SUD.
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The transcranial direct current stimulation over prefrontal cortex combined with the cognitive training reduced the cue-induced craving in female individuals with methamphetamine use disorder: A randomized controlled trial. J Psychiatr Res 2021; 134:102-110. [PMID: 33383492 DOI: 10.1016/j.jpsychires.2020.12.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/13/2020] [Accepted: 12/19/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Craving and cognitive deficits are potential treatment targets for methamphetamine use disorder (MUD). Previous studies implied that transcranial direct current stimulation (tDCS) and cognitive training respectively improve these symptoms, but the combined effect is unknown. In this study, we investigated the combined effects of tDCS over dorsolateral prefrontal cortex (DLPFC) and computerized cognitive addiction therapy (CCAT) on cue-induced craving and cognitive functions among female individuals with MUD. METHODS Seventy-five patients with MUD were randomly assigned to three groups: CCAT + tDCS group, CCAT + sham tDCS group and the control group. The former two groups received 20 sessions of cognitive training combined 1.5 mA active/sham tDCS over DLPFC (20min/session, 5times/week), while the control group received usual care which includes routine medical care, health education, physical exercises and psychological support related to relapse prevention. The cue-induced craving and cognitive functions were tested at the baseline, the end of 2nd week and 4th week. RESULTS The CCAT + tDCS group showed a significant reduction in cue-induced craving after 4-week intervention. Moreover, the craving score of the real CCAT + tDCS group was significantly lower than that of the CCAT + sham tDCS group and that of the control group at the end of 4th week. A significant improvement in accuracy of TWOB task was only observed in the CCAT + tDCS group at the end of 4th week when compared to baseline. Unexpectedly, participants who received CCAT plus active or sham tDCS did not change their discounting, whereas those in the control group performed more impulsively over time. CONCLUSIONS The study found that the intervention of tDCS over DLPFC combined with CCAT may have potential benefit in improving treatment outcome in patients with MUD. More research is needed to explore the underlying mechanism.
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Pavlova EL, Menshikova AA, Akzhigitov RG, B Guekht A. [Transcranial direct current stimulation in neurology and psychiatry]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 120:123-130. [PMID: 33459552 DOI: 10.17116/jnevro2020120121123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive method of modulating brain excitability by low intensity direct current. At present, there are numerous studies of tDCS application in various mental and neurological diseases. In this review, the data of tDCS efficiency in the treatment of different disorders are presented and the recommendations on using this method in clinical practice are given.
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Affiliation(s)
| | - A A Menshikova
- Soloviev Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - R G Akzhigitov
- Soloviev Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - A B Guekht
- Soloviev Scientific and Practical Psychoneurological Center, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
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Wu LL, Potenza MN, Zhou N, Kober H, Shi XH, Yip SW, Xu JH, Zhu L, Wang R, Liu GQ, Zhang JT. Efficacy of single-session transcranial direct current stimulation on addiction-related inhibitory control and craving: a randomized trial in males with Internet gaming disorder. J Psychiatry Neurosci 2021; 46:E111-E118. [PMID: 33119491 PMCID: PMC7955853 DOI: 10.1503/jpn.190137] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (dlPFC) may reduce substance use and other addictive behaviours. However, the cognitive mechanisms that underpin such effects remain unclear. Impaired inhibitory control linked to hypoactivation of the prefrontal cortex may allow craving-related motivations to lead to compulsive addictive behaviours. However, very few studies have examined whether increasing the activation of the dlPFC via anodal tDCS could enhance inhibitory control over addiction-related distractors. The current study aimed to enrich empirical evidence related to this issue. METHODS Thirty-three males with Internet gaming disorder underwent active (1.5 mA for 20 minutes) and sham tDCS 1 week apart, in randomized order. We assessed inhibitory control over gaming-related distractors and craving pre- and post-stimulation. RESULTS Relative to sham treatment, active tDCS reduced interference from gaming-related (versus non-gaming) distractors and attenuated background craving, but did not affect cue-induced craving. LIMITATIONS This study was limited by its relatively small sample size and the fact that it lacked assessments of tDCS effects on addictive behaviour. Future tDCS studies with multiple sessions in larger samples are warranted to examine the effects on addictive behaviours of alterations in addiction-related inhibitory control. CONCLUSION These findings demonstrate that stimulation of the dlPFC influences inhibitory control over addiction-related cues and addiction-related motivation. This is the first empirical study to suggest that enhanced inhibitory control may be a cognitive mechanism underlying the effects of tDCS on addictions like Internet gaming disorder. Our finding of attenuated background craving replicated previous tDCS studies. Intriguingly, our finding of distinct tDCS effects on 2 forms of craving suggests that they may have disparate underlying mechanisms or differential sensitivity to tDCS. CLINICAL TRIALS # NCT03352973.
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Affiliation(s)
- Lu-Lu Wu
- From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober)
| | - Marc N Potenza
- From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober)
| | - Nan Zhou
- From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober)
| | - Hedy Kober
- From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober)
| | - Xin-Hui Shi
- From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober)
| | - Sarah W Yip
- From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober)
| | - Jia-Hua Xu
- From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober)
| | - Lei Zhu
- From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober)
| | - Rui Wang
- From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober)
| | - Guan-Qun Liu
- From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober)
| | - Jin-Tao Zhang
- From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober)
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Verveer I, van der Veen FM, Shahbabaie A, Remmerswaal D, Franken IHA. Multi-session electrical neuromodulation effects on craving, relapse and cognitive functions in cocaine use disorder: A randomized, sham-controlled tDCS study. Drug Alcohol Depend 2020; 217:108429. [PMID: 33250383 DOI: 10.1016/j.drugalcdep.2020.108429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of transcranial Direct Current Stimulation (tDCS) has previously shown promising results for reducing craving in cocaine use disorder. In this study we further explored the potential of tDCS as add-on intervention in the treatment of cocaine use disorder. METHODS In a randomized, placebo-controlled, between subject study, we applied tDCS bilaterally with the anodal electrode targeting the right dorsolateral prefrontal cortex (DLPFC; https://clinicaltrials.gov/ct2/show/NCT03025321). Patients with cocaine use disorder were allocated to ten sessions of either active tDCS (n = 29) or sham (n = 30) on five consecutive days. Inhibitory control and risky decision-making were measured via a Go-NoGo task and a two-choice gambling task, respectively, each at baseline, one day after all tDCS sessions and after three months. Relapse at follow-up and craving were also assessed. RESULTS There was no significant effect of active tDCS on the number of cocaine use days and craving. Relapse was frequent among patients who had received either active or sham tDCS (48.0 % and 69.2 %, respectively), despite an overall decrease in craving during the first two weeks of treatment. No effects were found on cognitive functions. An exploratory analysis for crack cocaine use only revealed that relapse rates were significantly reduced after active tDCS (n = 17) as compared to sham (n = 19). CONCLUSIONS No beneficial effects of tDCS on number of cocaine use days, craving and cognitive functions were found in the present study, but somewhat promising results were obtained regarding relapse rates among crack-cocaine users specifically. Further research is required to determine the efficacy of tDCS as a complementary treatment in cocaine use disorder.
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Affiliation(s)
- Ilse Verveer
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, the Netherlands.
| | - Frederik M van der Veen
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, the Netherlands
| | - Alireza Shahbabaie
- Cognitive Psychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Danielle Remmerswaal
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, the Netherlands
| | - Ingmar H A Franken
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, the Netherlands
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Mahoney JJ, Hanlon CA, Marshalek PJ, Rezai AR, Krinke L. Transcranial magnetic stimulation, deep brain stimulation, and other forms of neuromodulation for substance use disorders: Review of modalities and implications for treatment. J Neurol Sci 2020; 418:117149. [PMID: 33002757 PMCID: PMC7702181 DOI: 10.1016/j.jns.2020.117149] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022]
Abstract
Given the high prevalence of individuals diagnosed with substance use disorder, along with the elevated rate of relapse following treatment initiation, investigating novel approaches and new modalities for substance use disorder treatment is of vital importance. One such approach involves neuromodulation which has been used therapeutically for neurological and psychiatric disorders and has demonstrated positive preliminary findings for the treatment of substance use disorder. The following article provides a review of several forms of neuromodulation which warrant consideration as potential treatments for substance use disorder. PubMed, PsycINFO, Ovid MEDLINE, and Web of Science were used to identify published articles and clinicaltrials.gov was used to identify currently ongoing or planned studies. Search criteria for Brain Stimulation included the following terminology: transcranial direct current stimulation, transcranial magnetic stimulation, theta burst stimulation, deep brain stimulation, vagus nerve stimulation, trigeminal nerve stimulation, percutaneous nerve field stimulation, auricular nerve stimulation, and low intensity focused ultrasound. Search criteria for Addiction included the following terminology: addiction, substance use disorder, substance-related disorder, cocaine, methamphetamine, amphetamine, alcohol, nicotine, tobacco, smoking, marijuana, cannabis, heroin, opiates, opioids, and hallucinogens. Results revealed that there are currently several forms of neuromodulation, both invasive and non-invasive, which are being investigated for the treatment of substance use disorder. Preliminary findings have demonstrated the potential of these various neuromodulation techniques in improving substance treatment outcomes by reducing those risk factors (e.g. substance craving) associated with relapse. Specifically, transcranial magnetic stimulation has shown the most promise with several well-designed studies supporting the potential for reducing substance craving. Deep brain stimulation has also shown promise, though lacks well-controlled clinical trials to support its efficacy. Transcranial direct current stimulation has also demonstrated promising results though consistently designed, randomized trials are also needed. There are several other forms of neuromodulation which have not yet been investigated clinically but warrant further investigation given their mechanisms and potential efficacy based on findings from other studied indications. In summary, given promising findings in reducing substance use and craving, neuromodulation may provide a non-pharmacological option as a potential treatment and/or treatment augmentation for substance use disorder. Further research investigating neuromodulation, both alone and in combination with already established substance use disorder treatment (e.g. medication treatment), warrants consideration.
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Affiliation(s)
- James J Mahoney
- West Virginia University School of Medicine, Rockefeller Neuroscience Institute, 33 Medical Center Drive, Morgantown, WV 26505, United States of America; WVU Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV 26505, United States of America; WVU Department of Neuroscience, 64 Medical Center Drive, Morgantown, WV 26505, United States of America.
| | - Colleen A Hanlon
- Wake Forest School of Medicine, Cancer Biology and Center for Substance Use and Addiction, 475 Vine Street, Winston-Salem, NC 27101, United States of America
| | - Patrick J Marshalek
- West Virginia University School of Medicine, Rockefeller Neuroscience Institute, 33 Medical Center Drive, Morgantown, WV 26505, United States of America; WVU Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV 26505, United States of America; WVU Department of Neuroscience, 64 Medical Center Drive, Morgantown, WV 26505, United States of America
| | - Ali R Rezai
- West Virginia University School of Medicine, Rockefeller Neuroscience Institute, 33 Medical Center Drive, Morgantown, WV 26505, United States of America; WVU Department of Neuroscience, 64 Medical Center Drive, Morgantown, WV 26505, United States of America; WVU Department of Neurosurgery, 64 Medical Center Drive, Morgantown, WV 26505, United States of America
| | - Lothar Krinke
- West Virginia University School of Medicine, Rockefeller Neuroscience Institute, 33 Medical Center Drive, Morgantown, WV 26505, United States of America; WVU Department of Neuroscience, 64 Medical Center Drive, Morgantown, WV 26505, United States of America; Magstim Inc., 9855 West 78 Street, Suite 12, Eden Prairie, MN 55344, United States of America
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A systematic review of transcranial direct current stimulation effects in attention-deficit/hyperactivity disorder. J Affect Disord 2020; 276:1-13. [PMID: 32697687 PMCID: PMC8128973 DOI: 10.1016/j.jad.2020.06.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/15/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) stands out as the most prevalent neurodevelopmental disorder of childhood, with global prevalence ranging from 3.4% to 7•2%. Its cognitive symptoms result from the combination of complex etiological processes encompassing genetic and environmental components. Available therapeutic approaches are associated with significant challenges such as modest efficacy or side effects. Transcranial direct current stimulation (tDCS) is a promising tool for enhancing cognitive performance in neuropsychiatric disorders. Trials investigating its applicability in ADHD have showed propitious, however, still preliminary findings. METHODS We performed a systemic review by searching on Medline, Cochrane Library, Web of Science, ScienceDirect and Embase using the descriptors: "attention-deficit/hyperactivity disorder" or "ADHD"; and "transcranial direct current stimulation" or "tDCS"; following PRISMA guidelines. RESULTS A total of 383 articles were identified. After removing duplicates, 45 studies were assessed for eligibility, and after careful review, 11 manuscripts applying tDCS in ADHD were included. Significant improvements in attention, inhibitory control and working memory were reported, in addition to increased brain connectivity following use of active tDCS. LIMITATIONS The main limitation was the small number of trials investigating use of tDCS in ADHD. Study methods and outcome measures were quite variable, and generally did not include long-term follow-up. CONCLUSIONS Although the extent literature indicates promising findings, the available data remains highly preliminary. Further trials evaluating the efficacy of tDCS for ADHD, with longer follow-up, are necessary. These studies will be needed to determine the optimal protocol for clinical efficacy.
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Verveer I, Remmerswaal D, van der Veen FM, Franken IH. Long-term tDCS effects on neurophysiological measures of cognitive control in tobacco smokers. Biol Psychol 2020; 156:107962. [DOI: 10.1016/j.biopsycho.2020.107962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 07/17/2020] [Accepted: 09/16/2020] [Indexed: 11/26/2022]
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Zucchella C, Mantovani E, Federico A, Lugoboni F, Tamburin S. Non-invasive Brain Stimulation for Gambling Disorder: A Systematic Review. Front Neurosci 2020; 14:729. [PMID: 33013280 PMCID: PMC7461832 DOI: 10.3389/fnins.2020.00729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Gambling disorder (GD) is the most common behavioral addiction and shares pathophysiological and clinical features with substance use disorders (SUDs). Effective therapeutic interventions for GD are lacking. Non-invasive brain stimulation (NIBS) may represent a promising treatment option for GD. Objective: This systematic review aimed to provide a comprehensive and structured overview of studies applying NIBS techniques to GD and problem gambling. Methods: A literature search using Pubmed, Web of Science, and Science Direct was conducted from databases inception to December 19, 2019, for studies assessing the effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (t-DCS) on subjects with GD or problem gambling. Studies using NIBS techniques on healthy subjects and those without therapeutic goals but only aiming to assess basic neurophysiology measures were excluded. Results: A total of 269 articles were title and abstract screened, 13 full texts were assessed, and 11 were included, of which six were controlled and five were uncontrolled. Most studies showed a reduction of gambling behavior, craving for gambling, and gambling-related symptoms. NIBS effects on psychiatric symptoms were less consistent. A decrease of the behavioral activation related to gambling was also reported. Some studies reported modulation of behavioral measures (i.e., impulsivity, cognitive and attentional control, decision making, cognitive flexibility). Studies were not consistent in terms of NIBS protocol, site of stimulation, clinical and surrogate outcome measures, and duration of treatment and follow-up. Sample size was small in most studies. Conclusions: The clinical and methodological heterogeneity of the included studies prevented us from drawing any firm conclusion on the efficacy of NIBS interventions for GD. Further methodologically sound, robust, and well-powered studies are needed.
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Affiliation(s)
- Chiara Zucchella
- Neurology Unit, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Fabio Lugoboni
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Stefano Tamburin
- Neurology Unit, Department of Neurosciences, Verona University Hospital, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Rosário BDA, de Nazaré MDFS, Estadella D, Ribeiro DA, Viana MDB. Behavioral and neurobiological alterations induced by chronic use of crack cocaine. Rev Neurosci 2020; 31:59-75. [PMID: 31129656 DOI: 10.1515/revneuro-2018-0118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/25/2019] [Indexed: 01/01/2023]
Abstract
Crack cocaine is the crystal form of cocaine and can be smoked, and rapidly absorbed, and, in part for this reason, is potently addictive. It is hypothesized that crack cocaine is able to induce important changes in different tissues and organs, and thus dramatically alter behavior. Nevertheless, which alterations in the central nervous system are related to its frequent use is still a matter of discussion. The present study is a literature review of articles published between the years 2008 and 2018 on the theme 'crack cocaine and brain' available in PUBMED, MEDLINE, EMBASE, and Google scholar databases. The results show that the use of crack cocaine induces important behavioral, neuroanatomical, and biochemical alterations. The main behavioral sequelae include cognitive and emotional changes, such as increased anxiety and depressive symptoms, attention and memory deficits, and hyperactivity. Among the neurobiological alterations are reductions in the activity of the prefrontal, anterior cingulate cortex, and nucleus accumbens. Molecular changes include decreases in neurotrophic factors and increases in oxidative stress and inflammatory cytokines, which may be responsible for the morphological alterations observed. It is also hypothesized that these neurobiological changes might explain the emotional and cognitive dysfunctions experienced by crack cocaine addicts.
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Affiliation(s)
- Bárbara Dos Anjos Rosário
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil
| | | | - Débora Estadella
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil
| | - Daniel Araki Ribeiro
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil
| | - Milena de Barros Viana
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil, e-mail:
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Chen J, Qin J, He Q, Zou Z. A Meta-Analysis of Transcranial Direct Current Stimulation on Substance and Food Craving: What Effect Do Modulators Have? Front Psychiatry 2020; 11:598. [PMID: 32670118 PMCID: PMC7332543 DOI: 10.3389/fpsyt.2020.00598] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022] Open
Abstract
Substance addiction and food addiction are significant social problems worldwide. In previous studies of substance addiction, transcranial direct current stimulation (tDCS) has been used to influence craving of substance or food. However, the reported effects are not always consistent due to inconsistent experimental settings. The way modulators influence the effect of tDCS on substance addiction is worth exploring. This meta-analysis was conducted to estimate the effect size of tDCS on substance and food craving and to investigate the influence of potential modulators. We systemically identified and reviewed studies on substance/food craving using tDCS that were published between January 2008 to January 2020. A total of 32 eligible studies were identified. Hedges' g was computed as an indicator of the effect of tDCS and some potential moderators (substance type, stimulation sites, current intensities, number of sessions, duration of stimulation, and study design) were examined using subgroup analysis. Random effects analysis revealed a total medium effect size [Hedges' g = 0.536, 95% confidence interval (CI): 0.389-0.683, after adjusting Hedges' g = 0.416, 95% CI: 0.262-0.570] preferring active over sham stimulation to reduce craving. A significant difference was observed between the number of sessions (repeated stimulation was better than single stimulation). The duration of stimulation may have a positive influence on the effects of tDCS. No other significant differences were found in other subgroups analysis. In conclusion, our results provided evidence that tDCS can be an effective way to reduce craving of substance or food, and longer multiple stimulus durations in all can more effectively reduce craving; however, the influences of modulators still need be to be examined in depth in future.
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Affiliation(s)
| | | | | | - Zhiling Zou
- Faculty of Psychology, Southwest University, Chongqing, China
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37
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No effect of repetitive tDCS on daily smoking behaviour in light smokers: A placebo controlled EMA study. PLoS One 2020; 15:e0233414. [PMID: 32442205 PMCID: PMC7244103 DOI: 10.1371/journal.pone.0233414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 05/03/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction The effectiveness of repetitive transcranial Direct Current Stimulation (tDCS) on reducing smoking behaviour has been studied with mixed results. Smoking behaviour is influenced by affect and context, therefore we choose to use mobile ecological momentary assessments (EMA) to measure changes in smoking behaviour after tDCS. Methods In a randomized, placebo-controlled, between subject study, we applied tDCS bilaterally with the anodal electrode targeting the right DLPFC (https://clinicaltrials.gov/ct2/show/NCT03027687). Smokers were allocated to six sessions of either active tDCS (n = 35) or sham tDCS (n = 36) and received two sessions on three different days in one week. They were asked to keep track of their daily cigarette consumption, craving and affect in an application on their mobile phones for three months starting one week before the first tDCS session. Results Number of smoked cigarettes a day progressively decreased up to one week after the last tDCS session in both conditions. Active treatment had no additional effect on cigarette consumption, craving and affect. Conclusions In this exploratory study, repetitive bilateral tDCS over the DLPFC had no effect on daily smoking behaviour. Future research needs to investigate how motivation to quit smoking and the number of tDCS sessions affect the efficacy of repetitive tDCS.
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Sadeghi Bimorgh M, Omidi A, Ghoreishi FS, Rezaei Ardani A, Ghaderi A, Banafshe HR. The Effect of Transcranial Direct Current Stimulation on Relapse, Anxiety, and Depression in Patients With Opioid Dependence Under Methadone Maintenance Treatment: A Pilot Study. Front Pharmacol 2020; 11:401. [PMID: 32308624 PMCID: PMC7145941 DOI: 10.3389/fphar.2020.00401] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objective Patients under methadone maintenance therapy (MMT) are susceptible to several complications including mental disturbances and risk of relapse. The present study was designed to evaluate the effects of tDCS on relapse, depression, and anxiety of opioid-dependent patients under methadone maintenance treatment (MMT). Methods It was a randomized-clinical trial that conducted among 27 male patients referred to the outpatient addiction clinic of Ibn-e-Sina psychiatric hospital in Mashhad from July 2018 to May 2019. Participants were allocated to two treatment groups including intervention and sham groups. The intervention group received seven sessions of tDCS, in the F3 (cathode) and F4 (anode) areas of the brain, each one lasts 20 min, in two consecutive weeks. Depression, anxiety, and stress scale-21 (DASS-21) were measured before, during, and after the intervention in patients under MMT. Relapse on the morphine, cannabis, and methamphetamine was screened by urine dipstick tests of morphine, cannabis, and methamphetamine. Results Depression, anxiety, and stress of participants were significantly reduced in the intervention group compared with the control after the seventh session of tDCS (P < 0.001, P=0.01, and P=0.01, respectively). In addition, the relapse rate showed no significant changes between the two groups (P=0.33). Conclusion Overall, our study demonstrated that depression, anxiety, and stress of participants were significantly reduced after the seventh session of tDCS, but did not affect on the relapse rate. Therefore, it can be applied as a safe and effective technique to relieve mental disorder among receiving MMT. Clinical Trial Registration http://www.irct.ir, identifier IRCT20180604039979N1.
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Affiliation(s)
- Mohammad Sadeghi Bimorgh
- Department of Addiction Studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran
| | - Abdollah Omidi
- Department of Clinical Psychology, School of Medicine, Kashan University of Medical Science, Kashan, Iran
| | - Fatemeh Sadat Ghoreishi
- Clinical Research Development Unit, Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Rezaei Ardani
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Ghaderi
- Department of Addiction Studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran.,Clinical Research Development Unit, Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Reza Banafshe
- Physiology Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pharmacology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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Sergiou CS, Woods AJ, Franken IHA, van Dongen JDM. Transcranial direct current stimulation (tDCS) as an intervention to improve empathic abilities and reduce violent behavior in forensic offenders: study protocol for a randomized controlled trial. Trials 2020; 21:263. [PMID: 32169111 PMCID: PMC7069186 DOI: 10.1186/s13063-020-4074-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/13/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Recent studies show that changes in one of the brain areas related to empathic abilities (i.e. the ventromedial prefrontal cortex (vmPFC)) plays an important role in violent behavior in abusers of alcohol and cocaine. According to the models of James Blair, empathy is a potential inhibitor of violent behavior. Individuals with less empathic abilities may be less susceptible and motivated to inhibit violent behavior, which causes a higher risk of violence. Recent neuroscientific research shows that modulating (stimulation or inhibition) certain brain areas could be a promising new intervention for substance abuse and to reduce violent behavior, such as the neurostimulation technique transcranial direct current stimulation (tDCS). This study aims to investigate tDCS as an intervention to increase empathic abilities and reduce violent behavior in forensic substance use offenders. METHODS/DESIGN A total sample of 50 male forensic substance abuse patients (25 active and 25 sham stimulation) will be tested in a double-blind placebo-controlled study, from which half of the patients will receive an active stimulation plus treatment as usual (TAU) and the other half will receive sham stimulation (placebo) plus TAU. The patients in the active condition will receive multichannel tDCS targeting the bilateral vmPFC two times a day for 20 min for five consecutive days. Before and after the stimulation period, the patients will complete self-report measurements, perform the Point Subtraction Aggression Paradigm (PSAP) and a passive viewing empathy task. Resting state electroencephalography (rsEEG) will be performed before and after the treatment period. A follow up will be conducted after 6 months. The primary outcome is to investigate multichannel tDCS as a new intervention to increase empathic abilities and reduce violent behavior in offenders with substance abuse problems. In addition, we will determine whether electrophysiological responses in the brain are affected by the tDCS intervention. Finally, the effects of tDCS on reducing craving will be investigated. DISCUSSION This study is one of the first studies using multichannel tDCS targeting the vmPFC in a forensic sample. This study will explore the opportunities to introduce a new intervention to improve empathic abilities and reduce violence in forensic substance use offenders. Specifically, this study may give insight into how to implement the tDCS intervention in the setting of daily clinical practice in this complex, multiple-problem target group and with that contribute to reduction of recidivism. TRIAL REGISTRATION Dutch Trial Register, NTR7701. Registered on 12 January 2019. Prospectively registered before the recruitment phase. https://www.trialregister.nl/trial/7459. Recruitment started on the 1st of February 2019 and will be finished approximately in the winter of 2019. Protocol version 1. 22 May 2019.
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Affiliation(s)
- Carmen S Sergiou
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Ingmar H A Franken
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - Josanne D M van Dongen
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands.
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Teti Mayer J, Chopard G, Nicolier M, Gabriel D, Masse C, Giustiniani J, Vandel P, Haffen E, Bennabi D. Can transcranial direct current stimulation (tDCS) improve impulsivity in healthy and psychiatric adult populations? A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109814. [PMID: 31715284 DOI: 10.1016/j.pnpbp.2019.109814] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/25/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022]
Abstract
Impulsivity is a multidimensional phenomenon that remains hard to define. It compounds the core pathological construct of many neuropsychiatric illnesses, and despite its close relation to suicide risk, it currently has no specific treatment. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique whose application results in cognitive function improvement, both in healthy and psychiatric populations. Following PRISMA recommendations, a systematic review of the literature concerning tDCS's effects on impulsive behaviour was performed using the PubMed database. The research was based on the combination of the keyword 'tDCS' with 'impulsivity', 'response inhibition', 'risk-taking', 'planning', 'delay discounting' or 'craving'. The initial search yielded 309 articles, 92 of which were included. Seventy-four papers demonstrated improvement in task performance related to impulsivity in both healthy and clinical adult populations. However, results were often inconsistent. The conditions associated with improvement, such as tDCS parameters and other aspects that may influence tDCS's outcomes, are discussed. The overall effects of tDCS on impulsivity are promising. Yet further research is required to develop a more comprehensive understanding of impulsivity, allowing for a more accurate assessment of its behavioural outcomes as well as a definition of tDCS therapeutic protocols for impulsive disorders.
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Affiliation(s)
- Juliana Teti Mayer
- Service de Psychiatrie de l'Adulte, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Bourgogne Franche-Comté, 19 rue Ambroise Paré, 25000 Besançon, France.
| | - Gilles Chopard
- Service de Psychiatrie de l'Adulte, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Bourgogne Franche-Comté, 19 rue Ambroise Paré, 25000 Besançon, France; Centre Mémoire Ressources et Recherche, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France
| | - Magali Nicolier
- Service de Psychiatrie de l'Adulte, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Centre d'Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Bourgogne Franche-Comté, 19 rue Ambroise Paré, 25000 Besançon, France
| | - Damien Gabriel
- Centre d'Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Bourgogne Franche-Comté, 19 rue Ambroise Paré, 25000 Besançon, France
| | - Caroline Masse
- Service de Psychiatrie de l'Adulte, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Bourgogne Franche-Comté, 19 rue Ambroise Paré, 25000 Besançon, France
| | - Julie Giustiniani
- Service de Psychiatrie de l'Adulte, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Centre d'Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Bourgogne Franche-Comté, 19 rue Ambroise Paré, 25000 Besançon, France
| | - Pierre Vandel
- Service de Psychiatrie de l'Adulte, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Bourgogne Franche-Comté, 19 rue Ambroise Paré, 25000 Besançon, France; Centre Mémoire Ressources et Recherche, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France
| | - Emmanuel Haffen
- Service de Psychiatrie de l'Adulte, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Centre d'Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Bourgogne Franche-Comté, 19 rue Ambroise Paré, 25000 Besançon, France; Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France
| | - Djamila Bennabi
- Service de Psychiatrie de l'Adulte, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Centre d'Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Bourgogne Franche-Comté, 19 rue Ambroise Paré, 25000 Besançon, France; Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Universitaire de Besançon, 25030 Besançon Cedex, France
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Habelt B, Arvaneh M, Bernhardt N, Minev I. Biomarkers and neuromodulation techniques in substance use disorders. Bioelectron Med 2020; 6:4. [PMID: 32232112 PMCID: PMC7098236 DOI: 10.1186/s42234-020-0040-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/29/2020] [Indexed: 01/10/2023] Open
Abstract
Addictive disorders are a severe health concern. Conventional therapies have just moderate success and the probability of relapse after treatment remains high. Brain stimulation techniques, such as transcranial Direct Current Stimulation (tDCS) and Deep Brain Stimulation (DBS), have been shown to be effective in reducing subjectively rated substance craving. However, there are few objective and measurable parameters that reflect neural mechanisms of addictive disorders and relapse. Key electrophysiological features that characterize substance related changes in neural processing are Event-Related Potentials (ERP). These high temporal resolution measurements of brain activity are able to identify neurocognitive correlates of addictive behaviours. Moreover, ERP have shown utility as biomarkers to predict treatment outcome and relapse probability. A future direction for the treatment of addiction might include neural interfaces able to detect addiction-related neurophysiological parameters and deploy neuromodulation adapted to the identified pathological features in a closed-loop fashion. Such systems may go beyond electrical recording and stimulation to employ sensing and neuromodulation in the pharmacological domain as well as advanced signal analysis and machine learning algorithms. In this review, we describe the state-of-the-art in the treatment of addictive disorders with electrical brain stimulation and its effect on addiction-related neurophysiological markers. We discuss advanced signal processing approaches and multi-modal neural interfaces as building blocks in future bioelectronics systems for treatment of addictive disorders.
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Affiliation(s)
- Bettina Habelt
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mahnaz Arvaneh
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - Nadine Bernhardt
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ivan Minev
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
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Supervised transcranial direct current stimulation (tDCS) at home: A guide for clinical research and practice. Brain Stimul 2020; 13:686-693. [PMID: 32289698 DOI: 10.1016/j.brs.2020.02.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 01/23/2020] [Accepted: 02/06/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a method of noninvasive neuromodulation and potential therapeutic tool to improve functioning and relieve symptoms across a range of central and peripheral nervous system conditions. Evidence suggests that the effects of tDCS are cumulative with consecutive daily applications needed to achieve clinically meaningful effects. Therefore, there is growing interest in delivering tDCS away from the clinic or research facility, usually at home. OBJECTIVE To provide a comprehensive guide to operationalize safe and responsible use of tDCS in home settings for both investigative and clinical use. METHODS Providing treatment at home can improve access and compliance by decreasing the burden of time and travel for patients and their caregivers, as well as to reach those in remote locations and/or living with more advanced disabilities. RESULTS To date, methodological approaches for at-home tDCS delivery have varied. After implementing the first basic guidelines for at-home tDCS in clinical trials, this work describes a comprehensive guide for facilitating safe and responsible use of tDCS in home settings enabling access for repeated administration over time. CONCLUSION These guidelines provide a reference and standard for practice when employing the use of tDCS outside of the clinic setting.
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Transcranial direct current stimulation: a roadmap for research, from mechanism of action to clinical implementation. Mol Psychiatry 2020; 25:397-407. [PMID: 31455860 PMCID: PMC6981019 DOI: 10.1038/s41380-019-0499-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/27/2019] [Accepted: 07/09/2019] [Indexed: 01/24/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a promising method for altering the function of neural systems, cognition, and behavior. Evidence is emerging that it can also influence psychiatric symptomatology, including major depression and schizophrenia. However, there are many open questions regarding how the method might have such an effect, and uncertainties surrounding its influence on neural activity, and human cognition and functioning. In the present critical review, we identify key priorities for future research into major depression and schizophrenia, including studies of the mechanism(s) of action of tDCS at the neuronal and systems levels, the establishment of the cognitive impact of tDCS, as well as investigations of the potential clinical efficacy of tDCS. We highlight areas of progress in each of these domains, including data that appear to favor an effect of tDCS on neural oscillations rather than spiking, and findings that tDCS administration to the prefrontal cortex during task training may be an effective way to enhance behavioral performance. Finally, we provide suggestions for further empirical study that will elucidate the impact of tDCS on brain and behavior, and may pave the way for efficacious clinical treatments for psychiatric disorders.
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Aronson Fischell S, Ross TJ, Deng ZD, Salmeron BJ, Stein EA. Transcranial Direct Current Stimulation Applied to the Dorsolateral and Ventromedial Prefrontal Cortices in Smokers Modifies Cognitive Circuits Implicated in the Nicotine Withdrawal Syndrome. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:448-460. [PMID: 32151567 DOI: 10.1016/j.bpsc.2019.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The nicotine withdrawal syndrome remains a major impediment to smoking cessation. Cognitive and affective disturbances are associated with altered connectivity within and between the executive control network, default mode network (DMN), and salience network. We hypothesized that functional activity in cognitive control networks, and downstream amygdala circuits, would be modified by application of transcranial direct current stimulation (tDCS) to the left (L) dorsolateral prefrontal cortex (dlPFC, executive control network) and right (R) ventromedial prefrontal cortex (vmPFC, DMN). METHODS A total of 15 smokers (7 women) and 28 matched nonsmokers (14 women) participated in a randomized, sham-controlled, double-blind, exploratory crossover study of 3 tDCS conditions: anodal-(L)dlPFC/cathodal-(R)vmPFC, reversed polarity, and sham. Cognitive tasks probed withdrawal-related constructs (error monitoring, working memory, amygdalar reactivity), while simultaneous functional magnetic resonance imaging measured brain activity. We assessed tDCS impact on trait (nonsmokers vs. sated smokers) and state (sated vs. abstinent) smoking aspects. RESULTS Single-session, anodal-(L)dlPFC/cathodal-(R)vmPFC tDCS enhanced deactivation of DMN nodes during the working memory task and strengthened anterior cingulate cortex activity during the error-monitoring task. Smokers were more responsive to tDCS-induced DMN deactivation when sated (vs. withdrawn) and displayed greater cingulate activity during error monitoring than nonsmokers. Nicotine withdrawal reduced task engagement and attention and reduced suppression of DMN nodes. CONCLUSIONS Cognitive circuit dysregulation associated with nicotine withdrawal may be modifiable by anodal tDCS applied to L-dlPFC and cathodal tDCS applied to R-vmPFC. tDCS may have stronger effects as a complement to existing therapies, such as nicotine replacement, owing to possible enhanced plasticity in the sated state.
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Affiliation(s)
- Sarah Aronson Fischell
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, Maryland; School of Medicine, University of Maryland, Baltimore, Maryland
| | - Thomas J Ross
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, Maryland
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Betty Jo Salmeron
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, Maryland
| | - Elliot A Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, Maryland.
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Eskandari Z, Dadashi M, Mostafavi H, Armani Kia A, Pirzeh R. Comparing the Efficacy of Anodal, Cathodal, and Sham Transcranial Direct Current Stimulation on Brain-Derived Neurotrophic Factor and Psychological Symptoms in Opioid-Addicted Patients. Basic Clin Neurosci 2019; 10:641-650. [PMID: 32477481 PMCID: PMC7253809 DOI: 10.32598/bcn.10.6.1710.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/10/2019] [Accepted: 08/31/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction: Today, addiction to opioids is a serious problem all over the world. Unfortunately, the consumption of these drugs and the number of addicted people have drastically increased. This research aimed at comparing the efficacy of anodal, cathodal, and sham transcranial Direct Current Stimulation (tDCS) on the Brain-Derived Neurotrophic Factor (BDNF) and psychological symptoms in opioid-addicted patients. Methods: Thirty opioid-addicted patients were selected based on the Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition, through the convenience sampling method. They were then randomly assigned to 3 groups (10 in each group). The subjects were evaluated before and after tDCS by their serum level of BDNF, desires for drug questionnaire, and depression anxiety stress scale. The data were analyzed by the Kolmogorov-Smirnov test, one-way analysis of variance, as well as the Bonferroni test. Results: Stimulating the Dorsolateral Prefrontal Cortex (DLPFC) led to a significant change in increasing the level of BDNF (P=0.031) and reducing the degree of depression (P=0.018), anxiety (P=0.001), stress (P=0.012), and decreased the level of craving (P=0.001) in opioid-addicted patients. There was no significant difference between active stimulation groups (anodal left/cathodal right and anodal right/cathodal left). The stimulation of the right DLPFC (group B) significantly increased BDNF in comparison with the sham group (sham tDCS) and decreased anxiety and craving. Nonetheless, no change was observed in depression and stress. The stimulation of the left DLPFC (group A) significantly reduced depression, anxiety, stress, and craving compared with the sham group, while there was no change in BDNF. Conclusion: In addition to the conventional treatments of opioid-addicted patients, tDCS is an effective complementary treatment.
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Affiliation(s)
- Zakaria Eskandari
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohsen Dadashi
- Department of Clinical Psychology, Faculty of Medicine, Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossin Mostafavi
- Department of Clinical Psychology, Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Alireza Armani Kia
- Department of Physiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Reza Pirzeh
- Department of Physiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Abstract
Drug consumption is driven by a drug's pharmacological effects, which are experienced as rewarding, and is influenced by genetic, developmental, and psychosocial factors that mediate drug accessibility, norms, and social support systems or lack thereof. The reinforcing effects of drugs mostly depend on dopamine signaling in the nucleus accumbens, and chronic drug exposure triggers glutamatergic-mediated neuroadaptations in dopamine striato-thalamo-cortical (predominantly in prefrontal cortical regions including orbitofrontal cortex and anterior cingulate cortex) and limbic pathways (amygdala and hippocampus) that, in vulnerable individuals, can result in addiction. In parallel, changes in the extended amygdala result in negative emotional states that perpetuate drug taking as an attempt to temporarily alleviate them. Counterintuitively, in the addicted person, the actual drug consumption is associated with an attenuated dopamine increase in brain reward regions, which might contribute to drug-taking behavior to compensate for the difference between the magnitude of the expected reward triggered by the conditioning to drug cues and the actual experience of it. Combined, these effects result in an enhanced motivation to "seek the drug" (energized by dopamine increases triggered by drug cues) and an impaired prefrontal top-down self-regulation that favors compulsive drug-taking against the backdrop of negative emotionality and an enhanced interoceptive awareness of "drug hunger." Treatment interventions intended to reverse these neuroadaptations show promise as therapeutic approaches for addiction.
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Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Michael Michaelides
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Ruben Baler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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Ma T, Sun Y, Ku Y. Effects of Non-invasive Brain Stimulation on Stimulant Craving in Users of Cocaine, Amphetamine, or Methamphetamine: A Systematic Review and Meta-Analysis. Front Neurosci 2019; 13:1095. [PMID: 31680830 PMCID: PMC6813242 DOI: 10.3389/fnins.2019.01095] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022] Open
Abstract
Dopamine system plays a pivotal role in specific kinds of substance use disorders (SUD, i. e., cocaine and methamphetamine use disorders). Many studies addressed whether dopamine-involved craving could be alleviated by non-invasive brain stimulation (NIBS) techniques. Nevertheless, the outcomes were highly inconsistent and the stimulating parameters were highly variable. In the current study, we ran a meta-analysis to identify an overall effect size of NIBS and try to find stimulating parameters of special note. We primarily find 2,530 unduplicated studies in PubMed, Psychology and Behavioral Sciences Collection, PsycARTICLES, PsycINFO, and Google Scholar database involving “Cocaine”/“Amphetamine”/“Methamphetamine” binded with “TMS”/“tDCS”/“non-invasive stimulation” in either field. After visual screening, 26 studies remained. While 16 studies were further excluded due to the lack of data, invalid craving scoring or the absence of sham condition. At last, 16 units of analysis in 12 eligible studies were coded and forwarded to a random-effect analysis. The results showed a large positive main effect of stimulation (Hedge's g = 1.116, CI = [0.597, 1.634]). Further subgroup analysis found that only high-frequency repetitive transcranial magnetic stimulation (rTMS) could elicit a significant decrease in craving, while the outcome of low-frequency stimulation was relatively controversial. Moreover, univariate meta regression revealed that the number of pulses per session could impose negative moderation toward the intervention. No significant moderation effect was found in types of abuse, overall days of stimulation and other variables of stimulating protocol. In conclusion, this meta-analysis offered a persuasive evidence for the feasibility of using NIBS to remit substance addictive behavior directly based on dopamine system. We also give clear methodological guidance that researchers are expected to use high-frequency, sufficiently segmented rTMS to improve the efficacy in future treatments.
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Affiliation(s)
- Tianye Ma
- The Shanghai Key Lab of Brain Functional Genomics, Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yurong Sun
- The Shanghai Key Lab of Brain Functional Genomics, Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yixuan Ku
- School of Medicine, Tongji Hospital, Tongji University, Shanghai, China.,College of Psychology and Sociology, Shenzhen University, Shenzhen, China.,NYU Shanghai and Collaborative Innovation Center for Brain Science, NYU-ECNU Institute of Brain and Cognitive Science, Shanghai, China
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Food Addiction: Implications for the Diagnosis and Treatment of Overeating. Nutrients 2019; 11:nu11092086. [PMID: 31487791 PMCID: PMC6770567 DOI: 10.3390/nu11092086] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022] Open
Abstract
With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term ‘food addiction’ is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.
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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: 169] [Impact Index Per Article: 33.8] [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.
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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
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Witkiewitz K, Stein ER, Votaw VR, Wilson AD, Roos CR, Gallegos SJ, Clark VP, Claus ED. Mindfulness-Based Relapse Prevention and Transcranial Direct Current Stimulation to Reduce Heavy Drinking: A Double-Blind Sham-Controlled Randomized Trial. Alcohol Clin Exp Res 2019; 43:1296-1307. [PMID: 30977904 DOI: 10.1111/acer.14053] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/01/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mindfulness-based relapse prevention (MBRP) and transcranial direct current stimulation (tDCS) have independently shown benefits for treating alcohol use disorder (AUD). Recent work suggests tDCS may enhance mindfulness. The combination of MBRP and tDCS may provide synergistic benefits and may target both behavioral and neurobiological dysfunctions in AUD. The goal of this double-blind sham-controlled randomized trial was to examine the efficacy of a rolling group MBRP treatment combined with tDCS among individuals interested in reducing their drinking. METHODS Individuals who were interested in reducing their alcohol use (n = 84; 40.5% female; mean age = 52.3; 98.9% with current AUD) were randomized to receive active (2.0 milliamps) or sham (0.0 milliamps) anodal tDCS (5 cm × 3 cm electrode) of the right inferior frontal gyrus with the 5 cm × 3 cm cathodal electrode applied to the left upper arm, combined with 8 weeks of outpatient MBRP rolling group treatment. Assessments were conducted at baseline, posttreatment, and 2 months following treatment. The primary outcome was drinks per drinking day, and secondary outcomes were percent heavy drinking days, self-reported craving, alcohol cue reactivity in an alcohol cue task, and response inhibition in a stop signal reaction time task. RESULTS Results indicated significant reductions in drinks per drinking day over time, B(SE) = -0.535 (0.16), p = 0.001, and a significant dose effect for number of groups attended, B(SE) = -0.259 (0.11), p = 0.01. There were also significant effects of time and dose for number of groups attended on secondary outcomes of percent heavy drinking days and alcohol cue reactivity. There were no effects of active versus sham tDCS on primary or secondary outcomes. CONCLUSIONS Findings from the current study provide initial support for the effectiveness of rolling group MBRP as an outpatient treatment for drinking reduction. The current study did not find additive effects of this tDCS protocol in enhancing MBRP among individuals with drinking reduction goals.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Elena R Stein
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Victoria R Votaw
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Adam D Wilson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Corey R Roos
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Stevi J Gallegos
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Vincent P Clark
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico.,Mind Research Network, Albuquerque, New Mexico
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