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Borzooee B, Aghayan S, Hassani-Abharian P, Emamian MH. Effect of Transcranial Direct Current Stimulation on Craving, Cognitive Functions, and Serum Brain-Derived Neurotrophic Factor Level in Individuals on Maintenance Treatment for Opioid Use Disorder, A Randomized Sham-Controlled Trial. J ECT 2024:00124509-990000000-00184. [PMID: 38981034 DOI: 10.1097/yct.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
OBJECTIVES To investigate the effects of transcranial direct current stimulation (tDCS) on brain-derived neurotrophic factor (BDNF) levels, craving, and executive functions in individuals on maintenance treatment for opioid use. METHODS We randomized 70 right-handed men aged 18-55 years into 2 groups: the intervention group and the sham group. The intervention was 10 sessions of 2 mA stimulation over 5 days. Each session in the sham group ended after 30 seconds. Craving was measured using the Desire for Drug Questionnaire (DDQ), Obsessive Compulsive Drug Use Scale (OCDUS), and visual analog scale (VAS). The measurements were taken before and after the intervention, as well as 2 months later. BDNF was measured before and after the intervention. Repeated-measures analysis of variance, the generalized estimating equation model, and independent t test were used for data analysis. RESULTS The mean differences (95% confidence intervals) in pre and post craving scores in the intervention group were (12.71 [9.10 to 16.32], P = 0.167) for VAS, (1.54 [1.12 to 1.96], P = 0.012) for OCDUS, and (1.71 [1.27 to 2.15], P = 0.125) for DDQ. These measures in the control group were -0.44 (-1.19 to 0.30), 0.01 (-0.21 to 0.23), and 0.126 (-0.11 to 0.36), respectively. BDNF serum levels significantly increased after the intervention (difference, 0.84 [0.69 to 0.99], P < 0.001); however, this change was not significant in the generalized estimating equation model. The effect of tDCS on craving was significant in OCDUS, but not significant in VAS and DDQ. CONCLUSIONS The tDCS reduces craving and improves executive functions in the short term. BDNF serum level was not associated with tDCS.
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Affiliation(s)
| | - Shahrokh Aghayan
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud
| | - Peyman Hassani-Abharian
- Department of Cognitive Psychology and Cognitive Rehabilitation, Institute for Cognitive Science Studies, Tehran
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
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Lisoni J, Nibbio G, Baldacci G, Cicale A, Zucchetti A, Bertoni L, Calzavara Pinton I, Necchini N, Deste G, Barlati S, Vita A. What impact can brain stimulation interventions have on borderline personality disorder? Expert Rev Neurother 2024; 24:343-360. [PMID: 38349069 DOI: 10.1080/14737175.2024.2316133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severe mental disorder characterized by emotion dysregulation, impulsivity, neuropsychological impairment, and interpersonal instability, presenting with multiple psychiatric comorbidities, functional disability and reduced life expectancy due suicidal behaviors. AREAS COVERED In this perspective, the authors explore the application of noninvasive brain stimulation (NIBS) (rTMS, tDCS, and MST) in BPD individuals by considering a symptom-based approach, focusing on general BPD psychopathology, impulsivity and neuropsychological impairments, suicidality and depressive/anxious symptoms, and emotion dysregulation. EXPERT OPINION According to a symptoms-based approach, NIBS interventions (particularly rTMS and tDCS) are promising treatment options for BPD individuals improving core symptoms such as emotional and behavioral dysregulation, neuropsychological impairments and depressive symptoms. However, the heterogeneity of stimulation protocols and of assessment tools used to detect these changes limits the possibility to provide definitive recommendations according to a symptom-based approach. To implement such armamentarium in clinical practice, future NIIBS studies should further consider a lifespan perspective due to clinical variability over time, the role of psychiatric comorbidities affecting BPD individuals and the need to combine NIBS with specialized psychotherapeutic approaches for BPD patients and with functional neuroimaging studies.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Yarbakhsh E, van der Sterren A, Bowles D. Screening and Treatment for Co-occurring Gambling and Substance Use: A Scoping Review. J Gambl Stud 2023; 39:1699-1721. [PMID: 37493839 PMCID: PMC10628029 DOI: 10.1007/s10899-023-10240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/27/2023]
Abstract
There is a high prevalence of gambling harms co-occurring with substance use harms. Where harms are co-occurring, they may be experienced as more severe. However, there is little evidence that services are systematically screening for such co-occurring harms in treatment-seeking populations. Furthermore, treatment modalities remain relatively under-developed, with treatment usually addressing only one source of harm.This scoping review looks at the current literature on screening and therapeutic interventions for co-occurring gambling and substance use harms to understand how co-occurring harms may be managed in a treatment setting. It draws together available data on the intersections of substance use harms and gambling related harms, in a treatment context.This research identifies a range of potentially useful validated tools for clinicians in substance use treatment settings to screen for gambling harms. For workers in gambling treatment settings who are seeking validated tools to screen for co-occurring substance use harms, the literature provides less guidance.The validated toolbox of therapeutic interventions for those experiencing co-occurring substance use and gambling harms is relatively sparse. Psychosocial interventions appear to offer the best outcomes on gambling measures for those experiencing co-occurring substance use harms. Further research is needed to establish the benefits of different combinations of treatment and treatment types in achieving reductions across both substance use and gambling harms, when these harms are experienced concurrently.
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Affiliation(s)
- Elisabeth Yarbakhsh
- Alcohol, Tobacco and Other Drug Association, ACT (ATODA), Canberra, Australia.
- College of Arts and Social Sciences, Australian National University, Canberra, Australia.
| | - Anke van der Sterren
- Alcohol, Tobacco and Other Drug Association, ACT (ATODA), Canberra, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Devin Bowles
- ACT Council of Social Service (ACTCOSS), Canberra, Australia
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Gwon SH, Lee HJ, Brian Ahn H. Transcranial Direct Current Stimulation in Nicotine Use: Nursing Implications for Patient Outcomes. J Addict Nurs 2023; 34:E74-E78. [PMID: 37669347 DOI: 10.1097/jan.0000000000000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
ABSTRACT Tobacco use is a leading cause of cancer, cardiovascular and respiratory disease, and preventable death in the United States. The brains of individuals with nicotine dependence are characterized by damaged mesolimbic pathways in the medial portion of the limbic and frontal lobes, creating positive reinforcing mechanisms. Transcranial direct current stimulation (tDCS) targets this neuroadaptation to improve smokers' nicotine-related outcomes, such as craving and smoking behavior, by depolarizing or hyperpolarizing the neurons of the brain. Recent literature reported promising outcomes in smokers after tDCS treatment interventions. tDCS has great potential for clinical nursing research for tobacco control given its multiple methodological advantages and few disadvantages. Nurse researchers can consider individualized and home-based tDCS interventions for community-based tobacco control research and may need to consider objective outcome measures (e.g., cotinine in urine) and addiction-related cognitive variables (e.g., self-regulation). Users of electronic nicotine delivery systems also need to be considered as participants in tDCS interventions. Additional considerations for nursing research are discussed.
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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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Pallanti S, Grassi E, Knotkova H, Galli G. Transcranial direct current stimulation in combination with cognitive training in individuals with mild cognitive impairment: a controlled 3-parallel-arm study. CNS Spectr 2022; 28:1-6. [PMID: 36093863 DOI: 10.1017/s1092852922000979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Several studies showed that transcranial direct current stimulation (tDCS) enhances cognition in patients with mild cognitive impairment (MCI), however, whether tDCS leads to additional gains when combined with cognitive training remains unclear. This study aims to compare the effects of a concurrent tDCS-cognitive training intervention with either tDCS or cognitive training alone on a group of patients with MCI. METHODS The study was a 3-parallel-arm study. The intervention consisted of 20 daily sessions of 20 minutes each. Patients (n = 62) received anodal tDCS to the left dorsolateral prefrontal cortex, cognitive training on 5 cognitive domains (orientation, attention, memory, language, and executive functions), or both. To examine intervention gains, we examined global cognitive functioning, verbal short-term memory, visuospatial memory, and verbal fluency pre- and post-intervention. RESULTS All outcome measures improved after the intervention in the 3 groups. The improvement in global cognitive functioning and verbal fluency was significantly larger in patients who received the combined intervention. Instead, the intervention gain in verbal short-term memory and visuospatial memory was similar across the 3 groups. DISCUSSION tDCS, regardless of the practicalities, could be an efficacious treatment in combination with cognitive training given the increased effectiveness of the combined treatment. CONCLUSIONS Future studies will need to consider individual differences at baseline, including genetic factors and anatomical differences that impact the electric field generated by tDCS and should also consider the feasibility of at-home treatments consisting of the application of tDCS with cognitive training.
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Affiliation(s)
- Stefano Pallanti
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, USA
- Institute of Neuroscience, Florence, Italy
| | | | - Helena Knotkova
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, USA
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA
| | - Giulia Galli
- Department of Psychology, Kingston University, Kingston, UK
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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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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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Yuen J, Kouzani AZ, Berk M, Tye SJ, Rusheen AE, Blaha CD, Bennet KE, Lee KH, Shin H, Kim JH, Oh Y. Deep Brain Stimulation for Addictive Disorders-Where Are We Now? Neurotherapeutics 2022; 19:1193-1215. [PMID: 35411483 PMCID: PMC9587163 DOI: 10.1007/s13311-022-01229-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 10/18/2022] Open
Abstract
In the face of a global epidemic of drug addiction, neglecting to develop new effective therapies will perpetuate the staggering human and economic costs of substance use. This review aims to summarize and evaluate the preclinical and clinical studies of deep brain stimulation (DBS) as a novel therapy for refractory addiction, in hopes to engage and inform future research in this promising novel treatment avenue. An electronic database search (MEDLINE, EMBASE, Cochrane library) was performed using keywords and predefined inclusion criteria between 1974 and 6/18/2021 (registered on Open Science Registry). Selected articles were reviewed in full text and key details were summarized and analyzed to understand DBS' therapeutic potential and possible mechanisms of action. The search yielded 25 animal and 22 human studies. Animal studies showed that DBS of targets such as nucleus accumbens (NAc), insula, and subthalamic nucleus reduces drug use and seeking. All human studies were case series/reports (level 4/5 evidence), mostly targeting the NAc with generally positive outcomes. From the limited evidence in the literature, DBS, particularly of the NAc, appears to be a reasonable last resort option for refractory addictive disorders. We propose that future research in objective electrophysiological (e.g., local field potentials) and neurochemical (e.g., extracellular dopamine levels) biomarkers would assist monitoring the progress of treatment and developing a closed-loop DBS system. Preclinical literature also highlighted the prefrontal cortex as a promising DBS target, which should be explored in human research.
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Affiliation(s)
- Jason Yuen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong VIC 3216, Australia
| | - Abbas Z Kouzani
- School of Engineering, Deakin University, Geelong VIC 3216, Australia
| | - Michael Berk
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong VIC 3216, Australia
| | - Susannah J Tye
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, 4072, Australia
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, 55455, USA
- Department of Psychiatry, Emory University, Atlanta, GA, 30322, USA
| | - Aaron E Rusheen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Charles D Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kevin E Bennet
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
- Division of Engineering, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, USA
| | - Hojin Shin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jee Hyun Kim
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong VIC 3216, Australia.
| | - Yoonbae Oh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, USA.
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Bollen Z, Dormal V, Maurage P. How Should Transcranial Direct Current Stimulation be Used in Populations With Severe Alcohol Use Disorder? A Clinically Oriented Systematic Review. Clin EEG Neurosci 2022; 53:367-383. [PMID: 33733871 DOI: 10.1177/15500594211001212] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background and rationale. Severe alcohol use disorder (SAUD) is a major public health concern, given its massive individual, interpersonal, and societal consequences. The available prevention and treatment programs have proven limited effectiveness, as relapse rates are still high in this clinical population. Developing effective interventions reducing the appearance and persistence of SAUD thus constitutes an experimental and clinical priority. Among the new therapeutic approaches, there is a growing interest for noninvasive neuromodulation techniques, and particularly for transcranial direct current stimulation (tDCS) as an adjunctive treatment in neuropsychiatric disorders, including SAUD. Methods. We propose a systematic review, based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, evaluating the available evidence on the effectiveness of tDCS to improve clinical interventions in SAUD. Results. We provide an integrative overview of studies applying tDCS in clinical populations with SAUD, together with a standardized methodological quality assessment. We show that the currently available data remain inconsistent. Some data suggested that tDCS can (1) reduce craving, relapse or alcohol-cue reactivity and (2) improve cognitive control and inhibition. However, other studies did not observe any beneficial effect of tDCS in SAUD. Conclusions. Capitalizing on the identified strengths and shortcomings of available results, we present evidence-based clinical guidelines to integrate tDCS in current clinical settings and to combine it with neurocognitive training.
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Affiliation(s)
- Zoé Bollen
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, 83415UCLouvain, Louvain-la-Neuve, Belgium
| | - Valérie Dormal
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, 83415UCLouvain, Louvain-la-Neuve, Belgium
| | - Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, 83415UCLouvain, Louvain-la-Neuve, Belgium
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11
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Tseng PT, Jeng JS, Zeng BS, Stubbs B, Carvalho AF, Brunoni AR, Su KP, Tu YK, Wu YC, Chen TY, Lin PY, Liang CS, Hsu CW, Chen YW, Li CT. Efficacy of non-invasive brain stimulation interventions in reducing smoking frequency in patients with nicotine dependence: a systematic review and network meta-analysis of randomized controlled trials. Addiction 2022; 117:1830-1842. [PMID: 34347916 DOI: 10.1111/add.15624] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 06/09/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Nicotine is a highly addictive substance in tobacco products that dysregulates several neurotransmitters in the brain and impairs executive function. Non-invasive brain stimulation (NIBS) methods such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are promising treatments for nicotine dependence. We investigated the efficacy and acceptability of NIBS in managing smoking cessation through a systematic review and network meta-analysis (NMA). METHODS We conducted a systematic review to identify randomized controlled trials (RCTs) that investigated the efficacy of NIBS for smoking cessation. All pairwise meta-analyses and NMA procedures were conducted using random-effects and frequentist models. The co-primary outcomes were (1) the change in number of cigarettes smoked per day (change in frequency of smoking) in patients with nicotine dependence after NIBS and (2) acceptability (the dropout rate). The effect sizes for co-primary outcomes of change in frequency of smoking and acceptability were assessed according to standardized mean difference (SMD) and odds ratio, respectively. RESULTS Twelve RCTs with 710 participants (mean age: 44.2 years, 31.2% female) were included. Compared with the sham control, 10-Hz rTMS over the left dorsolateral prefrontal cortex (DLPFC) was associated with the largest changes in smoking frequency [SMD = -1.22, 95% confidence interval (95% CI) = -1.77 to -0.66]. The 2-mA bifrontal tDCS (SMD = -0.97, 95% CI = -1.32 to -0.62) and 10-Hz deep rTMS over the bilateral DLPFC with cue provocation (SMD = -0.77, 95% CI = -1.20 to -0.34) were associated with a significantly larger decrease in smoking frequency versus the sham. None of the investigated NIBSs was associated with dropout rates significantly different from those of the sham control groups. CONCLUSION Prefrontal non-invasive brain stimulation interventions appear to reduce the number of cigarettes smoked with good acceptability.
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Affiliation(s)
- Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Jia-Shyun Jeng
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing-Syuan Zeng
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Positive Ageing Research Institute (PARI), Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Andre R Brunoni
- Service of Interdisciplinary, Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27), University of Sao Paulo, Sao Paulo, Brazil.,Interdisciplinary Center for Applied Neuromodulation University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Kuan-Pin Su
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Sung Liang
- School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan.,Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan.,Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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12
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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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13
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Nardone R, Sebastianelli L, Versace V, Ferrazzoli D, Brigo F, Schwenker K, Saltuari L, Trinka E. TMS for the functional evaluation of cannabis effects and for treatment of cannabis addiction: A review. Psychiatry Res 2022; 310:114431. [PMID: 35219263 DOI: 10.1016/j.psychres.2022.114431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/15/2022]
Abstract
The knowledge about the effects of cannabis on human cortical brain processes is increasing. In this regard, transcranial magnetic stimulation (TMS) enables the evaluation of central nervous system function, including drug effects. Moreover, repetitive TMS (rTMS) has been used therapeutically in several substance use disorders. In this scoping review, we summarize and discuss studies that have employed TMS and rTMS techniques in users of cannabis for recreational purposes. In subjects with a history of persistent cannabis use, TMS studies showed reduced short-interval cortical inhibition (SICI). This observation points more at neurobiological changes of chronic cannabis use than to a direct effect of cannabis on gamma-aminobutyric acid (GABA) A receptors. Moreover, individuals vulnerable to becoming long-term users of cannabis may also have underlying pre-existing abnormalities in SICI. Of note, the use of cannabis is associated with an increased risk of schizophrenia, and the down-regulation of GABAergic function may play a role. Less frequent cannabis use and spontaneous craving were observed following rTMS applied to the dorsolateral prefrontal cortex (DLPFC). There is emerging evidence that the posterior cingulate cortex and the precuneus are potential targets for rTMS intervention in cannabis use disorder. However, larger and randomized trials should corroborate these encouraging findings.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria; Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria; UMIT, University for Medical Informatics and Health Technology, Hall in Tirol, Austria
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14
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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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15
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Patel H, Naish K, Soreni N, Amlung M. The Effects of a Single Transcranial Direct Current Stimulation Session on Impulsivity and Risk Among a Sample of Adult Recreational Cannabis Users. Front Hum Neurosci 2022; 16:758285. [PMID: 35210999 PMCID: PMC8861082 DOI: 10.3389/fnhum.2022.758285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with substance use disorders exhibit risk-taking behaviors, potentially leading to negative consequences and difficulty maintaining recovery. Non-invasive brain stimulation techniques such as transcranial direct current stimulation (tDCS) have yielded mixed effects on risk-taking among healthy controls. Given the importance of risk-taking behaviors among substance-using samples, this study aimed to examine the effects of tDCS on risk-taking among a sample of adults using cannabis. Using a double-blind design, 27 cannabis users [M(SD) age = 32.48 (1.99), 41% female] were randomized, receiving one session of active or sham tDCS over the bilateral dorsolateral prefrontal cortex (dlPFC). Stimulation parameters closely followed prior studies with anodal right dlPFC and cathodal left dlPFC stimulation. Risk-taking-assessed via a modified Cambridge Gambling Task-was measured before and during tDCS. Delay and probability discounting tasks were assessed before and after stimulation. No significant effects of stimulation on risk-taking behavior were found. However, participants chose the less risky option ∼86% of the trials before stimulation which potentially contributed to ceiling effects. These results contradict one prior study showing increased risk-taking among cannabis users following tDCS. There was a significant increase in delay discounting of a $1000 delayed reward during stimulation for the sham group only, but no significant effects for probability discounting. The current study adds to conflicting and inconclusive literature on tDCS and cognition among substance-using samples. In conclusion, results suggest the ineffectiveness of single session dlPFC tDCS using an established stimulation protocol on risk-taking, although ceiling effects at baseline may have also prevented behavior change following tDCS.
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Affiliation(s)
- Herry Patel
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Katherine Naish
- Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton & McMaster University, Hamilton, ON, Canada
| | - Noam Soreni
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Michael Amlung
- Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton & McMaster University, Hamilton, ON, Canada
- Department of Applied Behavioral Science, The University of Kansas, Lawrence, KS, United States
- Cofrin Logan Center for Addiction Research and Treatment, The University of Kansas, Lawrence, KS, United States
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16
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Webber HE, Schmitz JM. The potential of brain stimulation techniques for substance use disorder treatment. REVISTA BRASILEIRA DE PSIQUIATRIA 2022; 44:239-241. [PMID: 35081209 PMCID: PMC9169471 DOI: 10.1590/1516-4446-2021-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/21/2022]
Affiliation(s)
| | - Joy M. Schmitz
- University of Texas Health Science Center at Houston, USA
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17
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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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18
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Strang CE, Amthor FR. Effects of tACS-Like Electrical Stimulation on Off- and On-Off Center Retinal Ganglion Cells: Part II. Eye Brain 2022; 14:17-33. [PMID: 35115857 PMCID: PMC8800591 DOI: 10.2147/eb.s313090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Transcranial alternating current stimulation (tACS) is used as a brain stimulation mechanism to enhance learning, ameliorate some psychiatric disorders, and modify behavior. This study assessed the effects of near threshold tACS-like currents on Off-center and On-Off retinal ganglion cell responsiveness in the rabbit retina eyecup preparation as a model for central nervous system effects. Materials and Methods We made extracellular recordings in the isolated rabbit eyecup preparation using single electrodes and microelectrode arrays to measure light-evoked spike responses in different classes of Off-center and On-Off retinal ganglion cells before, during, and after brief applications of alternating currents of 1–2 microamperes, at frequencies of 10, 20, 30, and 40 Hz. Results tACS application sculpted the light-evoked response profiles without directly driving spiking activity of the 20 Off-center and On-Off ganglion cells we recorded from. During tACS application, Off responses were significantly enhanced for 6 cells and significantly suppressed for 14 cells, but after tACS application, Off responses were significantly enhanced for 7 cells and suppressed for 12 cells. The Off responses of the remaining two cells returned to baseline. On responses were less affected during and after tACS. Conclusion tACS sculpts Off-center and On-Off retinal ganglion cell responsiveness. The dissimilarity of effects in different cells within the same class and the differential effects on the On and Off components of the light response within the same cell are consistent with the hypothesis that tACS acts at threshold on amacrine cells in the inner plexiform layer.
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Affiliation(s)
- Christianne E Strang
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
| | - Franklin R Amthor
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
- Correspondence: Franklin R Amthor, Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA, Tel +1 205 934-2694, Fax +1 205 975-6110, Email
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19
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Chang CH, Liou MF, Liu CY, Lu WH, Chen SJ. Efficacy of Repetitive Transcranial Magnetic Stimulation in Patients With Methamphetamine Use Disorder: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials. Front Psychiatry 2022; 13:904252. [PMID: 35711590 PMCID: PMC9197111 DOI: 10.3389/fpsyt.2022.904252] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has demonstrated therapeutic potential for treating patients with methamphetamine use disorder (MUD). However, the most effective target and stimulation frequency of rTMS for treating MUD remains unclear. This meta-analysis explored the effect of rTMS on MUD. METHODS In this study, PubMed, Cochrane Systematic Reviews, and the Cochrane Collaboration Central Register of Controlled Clinical Trials were searched electronically for double-blind randomized controlled trials that used rTMS for treating MUD. We used published trials to investigate the efficacy of rTMS in MUD up to March 5, 2022, and pooled studies using a random-effect model to compare rTMS treatment effects. Patients who were diagnosed with MUD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders were recruited. Clinical craving scores between baseline and after rTMS were compared using the standardized mean difference (SMD) with 95% confidence intervals (CIs). The heterogeneity of the included trials was evaluated through a visual inspection of funnel plots and the I2 statistic. RESULTS We identified seven trials with 462 participants with MUD that met the inclusion criteria. All the studies evaluated craving scores, with rTMS demonstrating a more significant effect than the sham treatment on reducing craving scores (SMD = 0.983, CI = 0.620-1.345, p ≤ 0.001). A subgroup meta-analysis revealed that intermittent theta-burst stimulation (iTBS) had a greater positive effect than 10-Hz rTMS. A metaregression revealed that the SMDs increased with the increase in baseline craving scores, whereas they decreased with the increase in the proportion of men and duration of abstinence. CONCLUSION The meta-analysis suggests that rTMS may be associated with treatment effect on craving symptoms in patients with MUD. iTBS may have a greater positive effect on craving reduction than 10-z rTMS.
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Affiliation(s)
- Chun-Hung Chang
- An Nan Hospital, China Medical University, Tainan City, Taiwan.,Institute of Clinical Medical Science, China Medical University, Taichung City, Taiwan.,Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung City, Taiwan
| | - Meng-Fen Liou
- An Nan Hospital, China Medical University, Tainan City, Taiwan
| | - Chieh-Yu Liu
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Biostatistical Consulting Lab, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Wei-Hsin Lu
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Taitung MacKay Memorial Hospital, Taitung, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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20
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Gibson BC, Votaw VR, Stein ER, Clark VP, Claus E, Witkiewitz K. Transcranial Direct Current Stimulation Provides no Additional Benefit to Improvements in Self-Reported Craving Following Mindfulness-Based Relapse Prevention. Mindfulness (N Y) 2022; 13:92-103. [PMID: 35833199 PMCID: PMC9272998 DOI: 10.1007/s12671-021-01768-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 01/03/2023]
Abstract
Objectives Mindfulness-Based Relapse Prevention (MBRP) and transcranial direct current stimulation (tDCS) have each demonstrated efficacy in improving outcomes in those with alcohol use disorder (AUD), however a recent study that combined MBRP with tDCS found tDCS provided no additional benefit to MBRP for AUD. Differences in treatment adherence between active versus sham tDCS groups may have contributed to this result. The current study examined whether treatment adherence interacted with tDCS condition in predicting post-treatment mindfulness and craving. Methods This study was a secondary data analysis from a randomized sham-controlled trial comparing MBRP paired with tDCS. Linear regression analyses were conducted examining the interaction between tDCS condition and two measures of treatment adherence (i.e., number of groups attended, number of tDCS administrations) on post-treatment mindfulness and craving. Results There was no effect of treatment adherence by tDCS condition in predicting mindfulness, however the interaction between treatment adherence and tDCS condition significantly predicted post-treatment craving. There was a significant negative association between treatment adherence and post-treatment craving in the sham group, but there was no association in the active tDCS group. Conclusions MBRP coupled with sham stimulation led to significant reductions in self-reported craving when patients attended more sessions and received a greater number of sham tDCS administrations, while no relationship was observed between treatment adherence and craving among those who received active tDCS. This result provides tentative evidence that, rather than improve the effects of MBRP on craving, this active tDCS protocol provides no additional benefit to MBRP in reducing craving. Pre-registration This study was registered with clinicaltrials.gov (NCT02861807).
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Affiliation(s)
- Benjamin C. Gibson
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- The Mind Research Network, Department of Translational Neuroscience, 1101 Yale Blvd. NE, Albuquerque, NM 87106
| | - Victoria R. Votaw
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- Center on Alcohol, Substance use, And Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106
| | - Elena R. Stein
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- Center on Alcohol, Substance use, And Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106
| | - Vincent P. Clark
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- The Mind Research Network, Department of Translational Neuroscience, 1101 Yale Blvd. NE, Albuquerque, NM 87106
| | - Eric Claus
- The Mind Research Network, Department of Translational Neuroscience, 1101 Yale Blvd. NE, Albuquerque, NM 87106
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA 16802
| | - Katie Witkiewitz
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- Center on Alcohol, Substance use, And Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106
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21
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Cerebellar Transcranial Direct Current Stimulation in Children with Autism Spectrum Disorder: A Pilot Study on Efficacy, Feasibility, Safety, and Unexpected Outcomes in Tic Disorder and Epilepsy. J Clin Med 2021; 11:jcm11010143. [PMID: 35011884 PMCID: PMC8745597 DOI: 10.3390/jcm11010143] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with autism spectrum disorder (ASD) display distinctive neurophysiological characteristics associated with significant cognitive, emotional, and behavioral symptoms. Transcranial direct current stimulation (tDCS) applied to the frontal or temporoparietal lobes has demonstrated potential to reduce the severity of ASD-related symptoms. Recently, the cerebellum has been identified as a brain area involved in ASD pathophysiology. In this open-label pilot study, seven ASD patients aged between 9 and 13 years underwent 20 daily sessions of 20 min cathodal stimulation of the right cerebellar lobe. At the end of the treatment, the Aberrant Behavior Checklist (ABC) scores showed a 25% mean reduction in global severity of symptoms, with a more pronounced reduction in the “social withdrawal and lethargy” (−35%), “hyperactivity and noncompliance” (−26%), and “irritability, agitation, and crying” (−25%) subscales. Minor and no improvement were observed in the “stereotypic behavior” (−18%) and “inappropriate speech” (−0%) subscales, respectively. Improvements were not detected in the two patients who were taking psychotropic drugs during the study. Clinical response showed a symptom-specific time course. Quality of sleep and mood improved earlier than hyperactivity and social withdrawal. The treatment was generally accepted by patients and well tolerated. No serious adverse events were reported. Stimulation also appeared to markedly reduce the severity of tics in a patient with comorbid tic disorder and led to the disappearance of a frontal epileptogenic focus in another patient with a history of seizures. In conclusion, cerebellar tDCS is safe, feasible, and potentially effective in the treatment of ASD symptoms among children. Strategies to improve recruitment and retention are discussed.
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Ghin F, Beste C, Stock AK. Neurobiological mechanisms of control in alcohol use disorder - moving towards mechanism-based non-invasive brain stimulation treatments. Neurosci Biobehav Rev 2021; 133:104508. [PMID: 34942268 DOI: 10.1016/j.neubiorev.2021.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 12/13/2022]
Abstract
Alcohol use disorder (AUD) is characterized by excessive habitual drinking and loss of control over alcohol intake despite negative consequences. Both of these aspects foster uncontrolled drinking and high relapse rates in AUD patients. Yet, common interventions mostly focus on the phenomenological level, and prioritize the reduction of craving and withdrawal symptoms. Our review provides a mechanistic understanding of AUD and suggests alternative therapeutic approaches targeting the mechanisms underlying dysfunctional alcohol-related behaviours. Specifically, we explain how repeated drinking fosters the development of rigid drinking habits and is associated with diminished cognitive control. These behavioural and cognitive effects are then functionally related to the neurobiochemical effects of alcohol abuse. We further explain how alterations in fronto-striatal network activity may constitute the neurobiological correlates of these alcohol-related dysfunctions. Finally, we discuss limitations in current pharmacological AUD therapies and suggest non-invasive brain stimulation (like TMS and tDCS interventions) as a potential addition/alternative for modulating the activation of both cortical and subcortical areas to help re-establish the functional balance between controlled and automatic behaviour.
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Affiliation(s)
- Filippo Ghin
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany
| | - Ann-Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany; Biopsychology, Faculty of Psychology, TU Dresden, Dresden, Germany.
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Mostafavi H, Dadashi M, Armani Kia A, Ahmadi D, Pirzeh R, Eskandari Z. The effect of bilateral tDCS over dorsolateral prefrontal cortex on the cognitive abilities of men with opioid use disorder under methadone therapy: A sham-controlled clinical trial. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background/aim
Opioid use disorder (OUD) can have negative impact on cognitive functions. This study aims to evaluate the effect of bilateral transcranial direct-current stimulation (tDCS) over the right/left dorsolateral prefrontal cortex (DLPFC) on the cognitive abilities of OUD men.
Methods
This study is a double-blind sham-controlled randomized clinical trial with a pretest/posttest design. Participants were 31 men with OUD living in Zanjan, Iran, assigned to three groups of left anode/right cathode tDCS, right anode/left cathode tDCS, and sham tDCS. The two active groups received tDCS (2 mA) at 10 sessions each for 10–20 min. The Cognitive Abilities Questionnaire (CAQ) in Persian was used to measure their cognitive abilities before and after intervention. Collected data were analyzed in SPSS v.22 software.
Results
Bilateral DLPFC stimulation resulted in a significant improvement in cognitive flexibility, planning, decision making, inhibitory control/selective attention, and memory of patients in the two active tDCS groups, while the sham tDCS had no significant effect on their cognitive abilities.
Conclusion
Bilateral tDCS over DLPFC, as an effective and complementary treatment, can improve the cognitive abilities of men with OUD.
Trial registration: This study is a double-blind sham-controlled clinical trial (Parallel, IRCT20170513033946N5. Registered 19 Jan 2019, https://en.irct.ir/trial/36081).
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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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Amthor FR, Strang CE. Effects of tACS-Like Electrical Stimulation on On-Center Retinal Ganglion Cells: Part I. Eye Brain 2021; 13:175-192. [PMID: 34285622 PMCID: PMC8285569 DOI: 10.2147/eb.s312402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/11/2021] [Indexed: 01/30/2023] Open
Abstract
Purpose Electrical stimulation of the human central nervous system via surface electrodes has been used for both learning enhancement and the amelioration of neurodegenerative or psychiatric disorders. However, data are sparse on how such electrical stimulation affects neural circuits at the cellular level. This study assessed the effects of tACS-like currents at 10 Hz on On-center retinal ganglion cell responsiveness, using the rabbit retina eyecup preparation as a model for central nervous system effects. Methods We made extracellular recordings of light-evoked spike responses in different classes of On-center retinal ganglion cells before, during and after brief applications of 1 microampere alternating currents using single electrodes and microelectrode arrays. Results tACS-like currents (tACS) of 1 microampere produced effects on On-center ganglion cell response profiles immediately after initiation or cessation of tACS, without driving phase-locked firing in the absence of light stimuli. tACS affected the initial transient responses to light stimulation for all cells, sustained response components (if any) more strongly for sustained cells, and the center-surround balance more strongly for transient cells. Conclusion tACS sculpted light-evoked responses that lasted for one or more hours after cessation of current without, itself, directly inducing significant firing changes. Functionally, tACS effects could result in effects on contrast thresholds for both broad classes of cells, but because tACs differentially affects the center-surround balance of transient On-center cells, there may be greater effects on the spatial resolution and gain. The isolated retina appears to be a useful model to understand tACS actions at the neuronal level.
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Affiliation(s)
- Franklin R Amthor
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
| | - Christianne E Strang
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
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Altered patterns of fractional amplitude of low-frequency fluctuation and regional homogeneity in abstinent methamphetamine-dependent users. Sci Rep 2021; 11:7705. [PMID: 33833282 PMCID: PMC8032776 DOI: 10.1038/s41598-021-87185-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/22/2021] [Indexed: 02/01/2023] Open
Abstract
Methamphetamine (MA) could induce functional and structural brain alterations in dependent subjects. However, few studies have investigated resting-state activity in methamphetamine-dependent subjects (MADs). We aimed to investigate alterations of brain activity during resting-state in MADs using fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo). We analyzed fALFF and ReHo between MADs (n = 70) and healthy controls (HCs) (n = 84) and performed regression analysis using MA use variables. Compared to HCs, abstinent MADs showed increased fALFF and ReHo values in the bilateral striatum, decreased fALFF in the left inferior frontal gyrus, and decreased ReHo in the bilateral anterior cingulate cortex, sensorimotor cortex, and left precuneus. We also observed the fALFF values of bilateral striatum were positively correlated with the age of first MA use, and negatively correlated with the duration of MA use. The fALFF value of right striatum was also positively correlated with the duration of abstinence. The alterations of spontaneous cerebral activity in abstinent MADs may help us probe into the neurological pathophysiology underlying MA-related dysfunction and recovery. Since MADs with higher fALFF in the right striatum had shorter MA use and longer abstinence, the increased fALFF in the right striatum might implicate early recovery during abstinence.
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The impact of transcranial Direct Current stimulation on rumination: A systematic review of the sham-controlled studies in healthy and clinical samples. Compr Psychiatry 2021; 106:152226. [PMID: 33581448 DOI: 10.1016/j.comppsych.2021.152226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Broadly considered a transdiagnostic feature of psychological disorders, rumination is associated with lower treatment response, slower recovery rates, and higher relapse rates. Accordingly, research has focused on the development of interventions to alleviate rumination. Recently, transcranial Direct Current Stimulation (tDCS) has emerged as a promising tool to do so. METHODS We performed a systematic review of sham-controlled tDCS studies targeting rumination among healthy participants or patients with psychiatric disorders, investigating the effectiveness of tDCS in reducing rumination, and assessing the research quality of this nascent field. RESULTS We identified nine studies, with five reporting a significant impact of tDCS on rumination. We also outlined a few tDCS parameters (e.g., stimulation duration, electrode size) and research methods' features (e.g., within- versus between-research designs) characterizing those positive-finding studies. However, these studies were characterized by substantial heterogeneity (e.g., methodological flaws, lack of open science practices), precluding any definite statement about the best way to target rumination via tDCS. Moreover, several strong methodological limitations were also present across those studies. DISCUSSION Although our systematic review identifies the strengths and weaknesses of the available research about the impact of tDCS on rumination, it calls for strong efforts to improve this nascent field's current methodological caveats. We discuss how open science practices can help to usher this field forward.
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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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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: 18] [Impact Index Per Article: 6.0] [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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Nik Jaafar NR, Bahar N, Ibrahim N, Baharudin A, Wan Ismail WS, Sim ST, Abdul Aziz M, Tan KA. Are Malaysian Youths Overdependent on the Internet?: A Narrative Review. Front Psychiatry 2021; 12:710790. [PMID: 34484002 PMCID: PMC8414518 DOI: 10.3389/fpsyt.2021.710790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
Overdependence on the internet is a grave concern that has enveloped Malaysian youths which could lead to a variety of sequelae. This narrative review aims to determine the definition of internet overdependence and its associated factors, as well as the potential preventive and treatment strategies for internet overdependence. From the literature, internet overdependence is regarded as a 3-factor model encompassing salience, self-control failure, and serious consequences. Sociodemographic factors such as age, gender, and ethnicity, as well as psychosocial factors such as depression, anxiety, stress, and loneliness, were found to be associated with internet overdependence among Malaysian youths. A multimodal treatment approach is recommended by the implementation of various types of treatments, integrating disciplines such as pharmacology, psychotherapy, and family counseling. Despite various terminologies being used and unclear conceptualization of its nomenclature, overdependence on the internet is prevalent among youths in Malaysia. Future research should go toward establishing a clear definition of its terminology and attaining more robust evidence on treatment strategies.
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Affiliation(s)
- Nik Ruzyanei Nik Jaafar
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Malaysian Society of Internet Addiction Prevention, Serdang, Malaysia
| | - Norharlina Bahar
- Malaysian Society of Internet Addiction Prevention, Serdang, Malaysia.,Department of Psychiatry, Prince Court Medical Center, Kuala Lumpur, Malaysia
| | - Normala Ibrahim
- Malaysian Society of Internet Addiction Prevention, Serdang, Malaysia.,Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Azlin Baharudin
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Malaysian Society of Internet Addiction Prevention, Serdang, Malaysia
| | - Wan Salwina Wan Ismail
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Malaysian Society of Internet Addiction Prevention, Serdang, Malaysia
| | - Su Tein Sim
- Malaysian Society of Internet Addiction Prevention, Serdang, Malaysia.,AHL Specialist Clinic, Petaling Jaya, Malaysia
| | - Melisa Abdul Aziz
- Malaysian Society of Internet Addiction Prevention, Serdang, Malaysia.,Department of Psychiatry and Mental Health, Hospital Ampang, Kuala Lumpur, Malaysia
| | - Kit-Aun Tan
- Malaysian Society of Internet Addiction Prevention, Serdang, Malaysia.,Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Bio-Behavioral Indices of Emotion Regulation: Potential Targets for Treatment in Addiction. CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00330-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lisoni J, Miotto P, Barlati S, Calza S, Crescini A, Deste G, Sacchetti E, Vita A. Change in core symptoms of borderline personality disorder by tDCS: A pilot study. Psychiatry Res 2020; 291:113261. [PMID: 32622171 DOI: 10.1016/j.psychres.2020.113261] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/16/2022]
Abstract
Borderline personality disorder (BPD) recognizes several psychopathological dimensions related to prefrontal cortex impairments. Transcranial Direct Current Stimulation (tDCS) targeting the right prefrontal dorsolateral cortex (DLPFC) positively influence cognitive functions related to impulsivity in healthy subjects. A randomized double-blind study was designed to investigate whether tDCS could modulate core dimensions (impulsivity, aggression, affective dysregulation) of BPD. Also effects on decision making process and substances craving was assessed. Patients were randomized to receive active-tDCS at 2 mA versus sham-tDCS, once a day for 15 sessions. Anode was placed on the right DLPFC (F4), cathode on the left DLPFC (F3). Impulsivity and aggression measures were significantly reduced only in patients treated with active-tDCS. Decision-making process was marginally influenced by the active current. Craving intensity was reduced only in the active-tDCS sample. Both groups showed improvements in the affective dysregulation dimension and anxious and depressive symptoms. The application of bilateral tDCS targeting right DLPFC with anodal stimulation seems to improve core dimensions of BPD (mainly impulsivity and aggression) probably by restoring prefrontal activity. tDCS might be a potential tool for preventing self-harming behaviors.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy Piazzale Spedali Civili 1, 25123, Brescia Italy.
| | - Paola Miotto
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy Piazzale Spedali Civili 1, 25123, Brescia Italy.
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy Piazzale Spedali Civili 1, 25123, Brescia Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. Viale Europa 11, 25123, Brescia Italy.
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy. Viale Europa 11, 25123, Brescia Italy.
| | - Alessandra Crescini
- Department of Mental Health, ASST Valcamonica, Esine, Italy. Via Manzoni 142, Esine, Brescia ITALY
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy Piazzale Spedali Civili 1, 25123, Brescia Italy.
| | - Emilio Sacchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. Viale Europa 11, 25123, Brescia Italy.
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy Piazzale Spedali Civili 1, 25123, Brescia Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. Viale Europa 11, 25123, Brescia Italy.
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Holla B, Biswal J, Ramesh V, Shivakumar V, Bharath RD, Benegal V, Venkatasubramanian G, Chand PK, Murthy P. Effect of prefrontal tDCS on resting brain fMRI graph measures in Alcohol Use Disorders: A randomized, double-blind, sham-controlled study. Prog Neuropsychopharmacol Biol Psychiatry 2020; 102:109950. [PMID: 32339664 DOI: 10.1016/j.pnpbp.2020.109950] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 03/31/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Transcranial Direct Current Stimulation (tDCS) is a promising new adjuvant approach in the treatment of Alcohol Use Disorders (AUDs) that has the potential to ameliorate the aberrations secondary to chronic alcohol use. In this study, using a randomized, double-blind, sham-controlled, parallel-arm design, we examined the effects of prefrontal tDCS on resting-state functional magnetic resonance imaging (rsfMRI) and its correlates with impulsivity and time to first lapse in subjects with AUDs. METHODS Patients with AUD as per DSM-5 criteria were randomly allocated to receive a five-day course of either verum-tDCS (n = 12) or sham-tDCS (n = 12). Of them, 21 patients (verum/sham = 11/10) participated in both baseline and post-intervention 10-min rsfMRI sessions. Outside the scanner, subjects also performed the Stop-Signal Task at two time-points (baseline and post-intervention), which provided a measure of changes in impulsivity following tDCS. After completion of the post-intervention scan, all subjects were discharged and were followed-up for 90 days post-discharge or until lapse to first alcohol use. RESULTS Graph theoretical analysis of rsfMRI data revealed that verum-tDCS (but not sham) resulted in a significant increase in the global efficiency of brain networks with a concurrent significant reduction in global clustering; network-based statistical analysis identified a significant increase in the functional connectivity of a specific sub-network involving prefrontal regions. Furthermore, increased global efficiency of brain networks following verum tDCS predicted a significantly reduced likelihood of relapse. In addition, a reduction in the global clustering had a significant positive correlation with a reduction in the measure of impulsivity. CONCLUSIONS The present study adds further support to the increasing evidence base for the clinical utility of tDCS in AUDs. Importantly, we observed improvement in both whole-brain network efficiency as well as inter-regional connectivity within a specific local prefrontal sub-network that is relevant to the neurobiology of AUDs. Replication and extension of these promising leads from the present study can facilitate clinical translation of tDCS, given its advantages (i.e. safety, cost-effectiveness, administration ease with potential for remotely-supervised / home-based application) for treating patients with AUDs.
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Affiliation(s)
- Bharath Holla
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Jitendriya Biswal
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Vinutha Ramesh
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Venkataram Shivakumar
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Rose Dawn Bharath
- Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Vivek Benegal
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | - Prabhat Kumar Chand
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Pratima Murthy
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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Mezger E, Brunoni AR, Hasan A, Häckert J, Strube W, Keeser D, Padberg F, Palm U. tDCS for auditory verbal hallucinations in a case of schizophrenia and left frontal lesion: efield simulation and clinical results. Neurocase 2020; 26:241-247. [PMID: 32529897 DOI: 10.1080/13554794.2020.1776334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been explored for treatment of several neuropsychiatric disorders. For tDCS use in structural brain lesions there is some evidence from motor stroke rehabilitation and post-stroke depression. Here we report the application of tDCS in a woman previously diagnosed with schizophrenia presenting refractory auditory verbal hallucinations and left prefrontal tissue lesion. Treatment with 20 left fronto-temporal tDCS had no effect on psychiatric symptoms and neuropsychological evaluation. An ex-post electric field simulation and calculation of dorsolateral prefrontal cortex activation showed lower activation in this patient compared to a matched non-lesioned schizophrenia, and healthy control brain.
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Affiliation(s)
- Eva Mezger
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München , Munich, Germany
| | - Andre R Brunoni
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München , Munich, Germany.,Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27), University of Sao Paulo , São Paulo, Brazil
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München , Munich, Germany.,Psychotherapy and Psychosomatics of the University of Augsburg, Bezirkskrankenhaus Augsburg , Augsburg, Germany.,Medizinische Fakultät, Universität Augsburg , Augsburg, Germany
| | - Jan Häckert
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München , Munich, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München , Munich, Germany.,Psychotherapy and Psychosomatics of the University of Augsburg, Bezirkskrankenhaus Augsburg , Augsburg, Germany.,Medizinische Fakultät, Universität Augsburg , Augsburg, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München , Munich, Germany.,Institute for Clinical Radiology, Klinikum der Universität München , Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München , Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München , Munich, Germany.,Hospital for Psychosomatics, Medical Park Chiemseeblick , Bernau-Felden, Germany
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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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Farhat LC, Carvalho AF, Solmi M, Brunoni AR. Evidence-based Umbrella Review of Cognitive Effects of Prefrontal tDCS. Soc Cogn Affect Neurosci 2020; 17:43-60. [PMID: 32577732 PMCID: PMC8866814 DOI: 10.1093/scan/nsaa084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 04/29/2020] [Accepted: 06/15/2020] [Indexed: 12/04/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique, which has been increasingly used as an investigational tool in neuroscience. In social and affective neuroscience research, the prefrontal cortex has been primarily targeted, since this brain region is critically involved in complex psychobiological processes subserving both Șhotș and Școldș domains. Although several studies have suggested that prefrontal tDCS can enhance neuropsychological outcomes, meta-analyses have reported conflicting results. Therefore, we aimed to assess the available evidence by performing an umbrella review of meta-analyses. We evaluated the effects of prefrontal active vs sham tDCS on different domains of cognition among healthy and neuropsychiatric individuals. A MeaSurement Tool to Assess Systematic Reviews 2 was employed to evaluate the quality of meta-analyses, and the GRADE system was employed to grade the quality of evidence of every comparison from each meta-analysis. PubMed/MEDLINE, PsycINFO and the Cochrane Database of Systematic Reviews were searched, and 11 meta-analyses were included resulting in 55 comparisons. Only 16 comparisons reported significant effects favoring tDCS, but 13 of them had either very low or low quality of evidence. Of the remaining 39 comparisons which reported non-significant effects, 38 had either very low or low quality of evidence. Meta-analyses were rated as having critically low and low quality. Among several reasons to explain these findings, the lack of consensus and reproducibility in tDCS research is discussed.
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Affiliation(s)
- Luis C Farhat
- Departamento de Psiquiatria da Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Andre F Carvalho
- Center for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Geelong, Vic., Australia
| | - Marco Solmi
- Padua Neuroscience Center, University of Padua, Padua, Italy.,Department of Neuroscience, University of Padua, Padua, Italy
| | - Andre R Brunoni
- Departamento de Psiquiatria da Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Neurosciences (LIM-27), Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.,Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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38
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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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Gordon G, Brockmeyer T, Schmidt U, Campbell IC. Combining cognitive bias modification training (CBM) and transcranial direct current stimulation (tDCS) to treat binge eating disorder: study protocol of a randomised controlled feasibility trial. BMJ Open 2019; 9:e030023. [PMID: 31640997 PMCID: PMC6830595 DOI: 10.1136/bmjopen-2019-030023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Binge eating disorder (BED) is a common mental disorder, closely associated with obesity. Existing treatments are only moderately effective with high relapse rates, necessitating novel interventions. This paper describes the rationale for, and protocol of, a feasibility randomised controlled trial (RCT), evaluating the combination of transcranial direct current stimulation (tDCS) and a computerised cognitive training, namely approach bias modification training (ABM), in patients with BED who are overweight or obese. The aim of this trial is to obtain information that will guide decision-making and protocol development in relation to a future large-scale RCT of combined tDCS+ABM treatment in this group of patients, and also to assess the preliminary efficacy of this intervention. METHODS AND ANALYSIS 66 participants with Diagnostic and Statistical Manual-5 diagnosis of BED and a body mass index (BMI) of ≥25 kg/m2 will be randomly allocated to one of three groups: ABM+real tDCS; ABM+sham tDCS or a wait-list control group. Participants in both intervention groups will receive six sessions of ABM+real/sham tDCS over 3 weeks; engaging in the ABM task while simultaneously receiving bilateral tDCS to the dorsolateral prefrontal cortex. ABM is based on an implicit learning paradigm in which participants are trained to enact an avoidance behaviour in response to visual food cues. Assessments will be conducted at baseline, post-treatment (3 weeks) and follow-up (7 weeks post-randomisation). Feasibility outcomes assess recruitment and retention rates, acceptability of random allocation, blinding success (allocation concealment), completion of treatment sessions and research assessments. Other outcomes include eating disorder psychopathology and related neurocognitive outcomes (ie, delay of gratification and inhibitory control), BMI, other psychopathology (ie, mood), approach bias towards food and surrogate endpoints (ie, food cue reactivity, trait food craving and food intake). ETHICS AND DISSEMINATION This study has been approved by the North West-Liverpool East Research Ethics Committee. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN35717198.
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Affiliation(s)
- Gemma Gordon
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Gottingen, Goettingen, Niedersachsen, Germany
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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40
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Transcranial Direct Current Stimulation Reduces Craving in Substance Use Disorders: A Double-blind, Placebo-Controlled Study. J ECT 2019; 35:207-211. [PMID: 30844881 DOI: 10.1097/yct.0000000000000580] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The use of transcranial direct current stimulation (tDCS) in addiction disorders is still on its rise in comparison with pharmacological and psychotherapeutic strategies that still show low level of evidence. In this study, we aimed to evaluate the efficacy of the anodic tDCS for the short-term treatment of substance craving and other psychiatric symptoms. METHODS In this randomized, double-blind, sham-controlled trial, inclusion criteria included the diagnosis of substance use disorder and/or gambling disorder. The protocol includes 5 consecutive days of active or sham tDCS session. Cathode was placed over the left dorsolateral prefrontal cortex. Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Young Mania Rating Scale, Barratt Impulsiveness Scale, South Oaks Gambling Screen, and visual analog scale (VAS) 1 to 10 for craving were administered at the baseline (T0) and after 5 days of treatment (T1). RESULTS Thirty-four treatment-seeking subjects were randomized to sham (n = 16) and active stimulation (n = 18) groups. A statistically significant reduction of values at T1 was found in all subjects considering VAS (P < 0.001), Hamilton Depression Rating Scale (P < 0.001), Hamilton Anxiety Rating Scale (P < 0.001), and Barratt Impulsiveness Scale 11 (P = 0.032). A significant reduction for VAS craving in favor of the active stimulation (P = 0.011) was found. CONCLUSIONS Our findings reveal a statistically significant rapid reduction of craving in the active tDCS group on the right dorsolateral prefrontal cortex with respect to sham group, confirming the scientific literature trend. Large samples, with maintenance tDCS therapy and long-term follow-up, are required to establish the potential of this noninvasive and easily delivered brain stimulation strategy.
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41
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Morris VL, Owens MM, Syan SK, Petker TD, Sweet LH, Oshri A, MacKillop J, Amlung M. Associations Between Drinking and Cortical Thickness in Younger Adult Drinkers: Findings From the Human Connectome Project. Alcohol Clin Exp Res 2019; 43:1918-1927. [PMID: 31365137 PMCID: PMC6721970 DOI: 10.1111/acer.14147] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/21/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous neuroimaging studies examining relations between alcohol misuse and cortical thickness have revealed that increased drinking quantity and alcohol-related problems are associated with thinner cortex. Although conflicting regional effects are often observed, associations are generally localized to frontal regions (e.g., dorsolateral prefrontal cortex [DLPFC], inferior frontal gyrus [IFG], and anterior cingulate cortex). Inconsistent findings may be attributed to methodological differences, modest sample sizes, and limited consideration of sex differences. METHODS This study examined neuroanatomical correlates of drinking quantity and heavy episodic drinking in a large sample of younger adults (N = 706; Mage = 28.8; 51% female) using magnetic resonance imaging data from the Human Connectome Project. Exploratory analyses examined neuroanatomical correlates of executive function (flanker task) and working memory (list sorting). RESULTS Hierarchical linear regression models (controlling for age, sex, education, income, smoking, drug use, twin status, and intracranial volume) revealed significant inverse associations between drinks in past week and frequency of heavy drinking and cortical thickness in a majority of regions examined. The largest effect sizes were found for frontal regions (DLPFC, IFG, and the precentral gyrus). Follow-up regression models revealed that the left DLPFC was uniquely associated with both drinking variables. Sex differences were also observed, with significant effects largely specific to men. CONCLUSIONS This study adds to the understanding of brain correlates of alcohol use in a large, gender-balanced sample of younger adults. Although the cross-sectional methodology precludes causal inferences, these findings provide a foundation for rigorous hypothesis testing in future longitudinal investigations.
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Affiliation(s)
- Vanessa L Morris
- Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Max M Owens
- Department of Psychology, University of Georgia, Athens, Georgia
| | - Sabrina K Syan
- Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | | | - Lawrence H Sweet
- Department of Psychology, University of Georgia, Athens, Georgia
| | - Assaf Oshri
- College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
| | - James MacKillop
- Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
| | - Michael Amlung
- Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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42
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Lee SY, Kim MS, Lee HK. Prevention Strategies and Interventions for Internet Use Disorders Due to Addictive Behaviors Based on an Integrative Conceptual Model. CURRENT ADDICTION REPORTS 2019. [DOI: 10.1007/s40429-019-00265-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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43
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Martinotti G, Montemitro C, Pettorruso M, Viceconte D, Alessi MC, Di Carlo F, Lucidi L, Picutti E, Santacroce R, Di Giannantonio M. Augmenting pharmacotherapy with neuromodulation techniques for the treatment of bipolar disorder: a focus on the effects of mood stabilizers on cortical excitability. Expert Opin Pharmacother 2019; 20:1575-1588. [PMID: 31150304 DOI: 10.1080/14656566.2019.1622092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Mood stabilizers and antipsychotics have been demonstrated to be effective in Bipolar Disorder, with lithium as the gold standard. However, the presence of adverse events and treatment-resistance is still a relevant issue. To this respect, the use of brain stimulation techniques may be considered as an augmentation strategy, with both Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) having shown some level of efficacy in bipolar patients although clinical trials are still not sufficient to draw any conclusion. Areas covered: The authors have conducted a systematic review of the literature, in order to evaluate the role of mood stabilizers on neural activity and cortical excitability. Furthermore, the article reviews neuromodulation techniques and highlights the potential of integrating pharmacological first-line therapies with these techniques to treat BD patients. Expert opinion: The combination of neuromodulation techniques and available pharmacotherapies is a valuable opportunity which is not undermined by specific effects on cortical excitability and could improve BD patient outcome. Neurostimulation techniques may be considered safer than antidepressant treatments in BD, with a lower level of manic switches and may represent a new treatment strategy in BD depressive episodes.
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Affiliation(s)
- G Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti , Chieti , Italy.,Department of Pharmacy, Pharmacology, Clinical Science, University of Hertfordshire , Herts , UK
| | - C Montemitro
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti , Chieti , Italy
| | - M Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti , Chieti , Italy
| | - D Viceconte
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti , Chieti , Italy
| | - M C Alessi
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti , Chieti , Italy
| | - F Di Carlo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti , Chieti , Italy
| | - L Lucidi
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti , Chieti , Italy
| | - E Picutti
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti , Chieti , Italy
| | - R Santacroce
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti , Chieti , Italy
| | - M Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti , Chieti , Italy
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Blanco C, Volkow ND. Management of opioid use disorder in the USA: present status and future directions. Lancet 2019; 393:1760-1772. [PMID: 30878228 DOI: 10.1016/s0140-6736(18)33078-2] [Citation(s) in RCA: 247] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/15/2018] [Accepted: 11/26/2018] [Indexed: 02/06/2023]
Abstract
Opioid use disorder is characterised by the persistent use of opioids despite the adverse consequences of its use. The disorder is associated with a range of mental and general medical comorbid disorders, and with increased mortality. Although genetics are important in opioid use disorder, younger age, male sex, and lower educational attainment level and income, increase the risk of opioid use disorder, as do certain psychiatric disorders (eg, other substance use disorders and mood disorders). The medications for opioid use disorder, which include methadone, buprenorphine, and extended-release naltrexone, significantly improve opioid use disorder outcomes. However, the effectiveness of medications for opioid use disorder is limited by problems at all levels of the care cascade, including diagnosis, entry into treatment, and retention in treatment. There is an urgent need for expanding the use of medications for opioid use disorder, including training of health-care professionals in the treatment and prevention of opioid use disorder, and for development of alternative medications and new models of care to expand capabilities for personalised interventions.
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Affiliation(s)
- Carlos Blanco
- National Institute on Drug Abuse, Bethesda, MD, USA.
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45
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Amidfar M, Ko YH, Kim YK. Neuromodulation and Cognitive Control of Emotion. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1192:545-564. [DOI: 10.1007/978-981-32-9721-0_27] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Efficacy of Invasive and Non-Invasive Brain Modulation Interventions for Addiction. Neuropsychol Rev 2018; 29:116-138. [PMID: 30536145 PMCID: PMC6499746 DOI: 10.1007/s11065-018-9393-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 11/08/2018] [Indexed: 12/14/2022]
Abstract
It is important to find new treatments for addiction due to high relapse rates despite current interventions and due to expansion of the field with non-substance related addictive behaviors. Neuromodulation may provide a new type of treatment for addiction since it can directly target abnormalities in neurocircuits. We review literature on five neuromodulation techniques investigated for efficacy in substance related and behavioral addictions: transcranial direct current stimulation (tDCS), (repetitive) transcranial magnetic stimulation (rTMS), EEG, fMRI neurofeedback and deep brain stimulation (DBS) and additionally report on effects of these interventions on addiction-related cognitive processes. While rTMS and tDCS, mostly applied at the dorsolateral prefrontal cortex, show reductions in immediate craving for various addictive substances, placebo-responses are high and long-term outcomes are understudied. The lack in well-designed EEG-neurofeedback studies despite decades of investigation impedes conclusions about its efficacy. Studies investigating fMRI neurofeedback are new and show initial promising effects on craving, but future trials are needed to investigate long-term and behavioral effects. Case studies report prolonged abstinence of opioids or alcohol with ventral striatal DBS but difficulties with patient inclusion may hinder larger, controlled trials. DBS in neuropsychiatric patients modulates brain circuits involved in reward processing, extinction and negative-reinforcement that are also relevant for addiction. To establish the potential of neuromodulation for addiction, more randomized controlled trials are needed that also investigate treatment duration required for long-term abstinence and potential synergy with other addiction interventions. Finally, future advancement may be expected from tailoring neuromodulation techniques to specific patient (neurocognitive) profiles.
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Gallucci A, Lucena PH, Martens G, Thibaut A, Fregni F. Transcranial direct current stimulation to prevent and treat surgery-induced opioid dependence: a systematic review. Pain Manag 2018; 9:93-106. [PMID: 30516441 DOI: 10.2217/pmt-2018-0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Opioid misuse leading to dependence is a major health issue. Recent studies explored valid alternatives to treat pain in postsurgical settings. This systematic review aims to discuss the role of transcranial direct current stimulation (tDCS) in preventing and treating postoperative pain and opioid dependence. PubMed and Embase databases were screened, considering studies testing tDCS effects on pain and opioid consumption in surgical settings and opioid addiction. Eight studies met our inclusion criteria. Results showed a reduction of postoperative pain, opioid consumption and cue-induced craving following cortical stimulation. Despite the limited number of studies, this review shows preliminary encouraging evidence regarding the analgesic role of tDCS. However, future studies are needed to further investigate the application of tDCS in postsurgical settings.
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Affiliation(s)
- Alessia Gallucci
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, 02129, USA.,Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Pedro H Lucena
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, 02129, USA.,Department of Medice, Bahiana School of Medicine & Public Health, Salvador, BA, Brazil
| | - Géraldine Martens
- Coma Science Group, GIGA Research & Neurology Department, University & University Hospital of Liege, Liege, Belgium
| | - Aurore Thibaut
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, 02129, USA.,Coma Science Group, GIGA Research & Neurology Department, University & University Hospital of Liege, Liege, Belgium
| | - Felipe Fregni
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, 02129, USA
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48
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Drug addiction: a curable mental disorder? Acta Pharmacol Sin 2018; 39:1823-1829. [PMID: 30382181 DOI: 10.1038/s41401-018-0180-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/29/2018] [Indexed: 02/06/2023] Open
Abstract
Drug addiction is a chronic, relapsing brain disorder. Multiple neural networks in the brain including the reward system (e.g., the mesocorticolimbic system), the anti-reward/stress system (e.g., the extended amygdala), and the central immune system, are involved in the development of drug addiction and relapse after withdrawal from drugs of abuse. Preclinical and clinical studies have demonstrated that it is promising to control drug addiction by pharmacologically targeting the addiction-related systems in the brain. Here we review the pharmacological targets within the dopamine system, glutamate system, trace amine system, anti-reward system, and central immune system, which are of clinical interests. Furthermore, we discuss other potential therapies, e.g., brain stimulation, behavioral treatments, and therapeutic gene modulation, which could be effective to treat drug addiction. We conclude that, although drug addiction is a complex disorder that involves complicated neural mechanisms and psychological processes, this mental disorder is treatable and may be curable by therapies such as gene modulation in the future.
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Martinotti G, Chillemi E, Lupi M, Risio LD, Pettorruso M, Giannantonio MD. Gambling disorder and bilateral transcranial direct current stimulation: A case report. J Behav Addict 2018; 7:834-837. [PMID: 30264605 PMCID: PMC6426396 DOI: 10.1556/2006.7.2018.85] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Gambling disorder (GD) is a major public health concern with currently no validated and efficacious treatments approved. In this single case study, we report the short- and long-term effect of bilateral transcranial direct current stimulation (tDCS) of dorsolateral prefrontal cortex (DLPFC) on craving and impulse control in a subject with GD. METHODS The patient is a 26-year-old Caucasian male with an 8-year history of GD as well as alcohol and cocaine misuse. Treatment consisted of twice-a-day stimulation for 10 days. According to the literature, both the left (to control craving) and the right (to control emotional impulses) DLPFC were stimulated. Patients subsequently received tDCS once a week for 3 months and then once every 2 weeks for another 3 months. RESULTS After 10 days of treatment, the subject reported improved psychiatric symptoms (depression, anxiety, and impulsivity), as well as reduced gambling craving symptom severity. After 3 and 6 months of treatment, the clinical picture further improved. DISCUSSION This is the first report of tDCS effectiveness in a single case study of GD. Therapeutic effects, both on the addictive behavior and on psychiatric comorbid symptomatology, were lasting and continued over 6 months of tDCS maintenance treatment. Future case-control studies are required to test the efficacy of this tool in patients with GD.
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Affiliation(s)
- Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy,Department of Pharmacy, Pharmacology, Clinical Science, University of Hertfordshire, Herts, UK
| | | | - Matteo Lupi
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy,Corresponding author: Matteo Lupi, MD; Department of Neuroscience and Imaging, University “G. d’Annunzio”, Via dei Vestini 33, 66100, Chieti, Italy; Phone: +39 3385302482; Fax: +39 08713555887; E-mail:
| | - Luisa De Risio
- Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario “A.Gemelli”, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
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Abstract
The study of addiction and impulsion control disorders has shown that behaviors of seeking and consumption of addictive substances are subserved by neurobiological alterations specifically related to brain networks for reward, stress, and executive control, representing the brain's adaptation to the continued use of an addictive substance. In parallel, studies using neuromodulation techniques such as transcranial direct current stimulation (tDCS) have demonstrated promising effects in modulating cognitive and motor functions. This review aims to describe the neurobiology of addiction and some of the most relevant cognitive models of addictive behavior and to clarify how tDCS application modulates the intake and craving for several addictive substances, such as food, alcohol, nicotine, cocaine, crack, methamphetamine, and cannabis. We also discuss the positive and null outcomes of the use of this neuromodulatory technique in the treatment of addiction disorders resulting from the use of these substances. The reviewed findings lead us to conclude that tDCS interventions hold several promising clinical avenues in addiction and impulsive control. However, methodological investigations are necessary for undercover optimal parameters before implementing its clinical application.
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