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Webber HE, Badawi JC, Schmitz JM, Yoon JH, Calvillo DJ, Becker CI, Lane SD. Objective and subjective measurement of sleep in people who use substances: Emerging evidence and recommendations from a systematic review. J Sleep Res 2024:e14330. [PMID: 39238202 DOI: 10.1111/jsr.14330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 07/30/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024]
Abstract
People who use substances commonly experience sleep disruptions, affecting the regulation of physical and mental health, and presenting a significant barrier to treatment success. Sleep impairments are noted in all phases of substance use; however, differences between subjective versus objective methods used to measure sleep quality have been reported. While polysomnography is the gold-standard for sleep measurement, recent advances in actigraphy may help address the discordance between subjective and objective sleep reports. This systematic review examined emerging evidence (2016-present) for sleep impairment in people who use substances, with the twofold goal of: (1) identifying whether sleep outcomes vary across substance type (alcohol, nicotine, cannabis, cocaine, methamphetamine and opioids); and (2) contrasting results from subjective and objective measures. While some differences between subjective and objective sleep were noted, there was overwhelming evidence of clinically relevant sleep impairment in people who use alcohol, nicotine, cocaine, methamphetamine and opioids, with less consistent results for cannabis. Gaps in the literature are identified and future recommendations are presented, including utilization of common methodological frameworks, identification of mechanisms, and closer examination of sleep across stages of substance use and the interconnection between sleep and return to use.
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Affiliation(s)
- Heather E Webber
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jessica C Badawi
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jin H Yoon
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Douglas J Calvillo
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Psychological Sciences, Rice University, Houston, Texas, USA
| | - Cabrina I Becker
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Scott D Lane
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Zhang X, Huang M, Yu Y, Zhong X, Dai S, Dai Y, Jiang C. Is Transcranial Direct Current Stimulation Effective for Cognitive Dysfunction in Substance Use Disorders? A Systematic Review. Brain Sci 2024; 14:754. [PMID: 39199449 PMCID: PMC11352984 DOI: 10.3390/brainsci14080754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/13/2024] [Accepted: 07/25/2024] [Indexed: 09/01/2024] Open
Abstract
Patients with substance use disorders (SUDs) often suffer from cognitive dysfunction (CD), affecting their quality of life and daily functioning. Current treatments, including pharmacotherapy and psychotherapy, have limited efficacy and notable side effects. Transcranial direct current stimulation (tDCS), a non-invasive technique that modulates cortical activity, shows promise in improving cognitive function with minimal side effects and low cost, and could potentially serve as a valuable adjunct to existing therapies. This systematic review aims to evaluate the literature on the effectiveness of tDCS for CD in SUD patients to inform clinical practice and future research. Following PRISMA guidelines, the review includes studies that used tDCS for SUD-related CD. The criteria for inclusion encompassed participants aged 18 and older with a diagnosis of SUD, the use of tDCS (either conventional or high-definition), control groups receiving sham stimulation or no intervention, and cognitive outcome measures for substance-related cognitive function using validated tools. Databases searched were Ovid MEDLINE, PubMed, Web of Science, Embase, Scopus, and PsycINFO, with specific keywords. Twenty-two studies met the criteria, suggesting tDCS can improve cognitive functions in SUD patients, though results varied. Effectiveness may depend on the brain area targeted, stimulation parameters, task requirements, and individual differences. tDCS shows potential in treating SUD-related CD, but further research is needed to optimize stimulation protocols and address study variability. Future studies should use functional magnetic resonance imaging to explore the brain mechanisms by which tDCS improves cognitive function in SUDs and focus on larger, long-term trials to confirm efficacy and refine tDCS treatment parameters.
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Affiliation(s)
- Xinbi Zhang
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing 100191, China; (X.Z.)
- School of Kinesiology and Health, Capital University of Physical Education and Sports, Beijing 100191, China
| | - Mingming Huang
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing 100191, China; (X.Z.)
- School of Kinesiology and Health, Capital University of Physical Education and Sports, Beijing 100191, China
| | - Ying Yu
- Key Laboratory of Sport Training of General Administration of Sport of China, Beijing Sport University, Beijing 100084, China
- Sports, Exercise and Brain Sciences Laboratory, Beijing Sport University, Beijing 100084, China
| | - Xiaoke Zhong
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing 100191, China; (X.Z.)
- School of Physical Education and Sport Science, Fujian Normal University, No. 18, Wulongjiang Middle Avenue, Shangjie Town, Minhou County, Fuzhou 350108, China
| | - Shengyu Dai
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing 100191, China; (X.Z.)
- School of Kinesiology and Health, Capital University of Physical Education and Sports, Beijing 100191, China
| | - Yuanfu Dai
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing 100191, China; (X.Z.)
- School of Kinesiology and Health, Capital University of Physical Education and Sports, Beijing 100191, China
| | - Changhao Jiang
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing 100191, China; (X.Z.)
- School of Kinesiology and Health, Capital University of Physical Education and Sports, Beijing 100191, China
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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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Sabé M, Hyde J, Cramer C, Eberhard A, Crippa A, Brunoni AR, Aleman A, Kaiser S, Baldwin DS, Garner M, Sentissi O, Fiedorowicz JG, Brandt V, Cortese S, Solmi M. Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders: A Systematic Review and Dose-Response Meta-Analysis. JAMA Netw Open 2024; 7:e2412616. [PMID: 38776083 PMCID: PMC11112448 DOI: 10.1001/jamanetworkopen.2024.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Noninvasive brain stimulation (NIBS) interventions have been shown to be efficacious in several mental disorders, but the optimal dose stimulation parameters for each disorder are unknown. Objective To define NIBS dose stimulation parameters associated with the greatest efficacy in symptom improvement across mental disorders. Data Sources Studies were drawn from an updated (to April 30, 2023) previous systematic review based on a search of PubMed, OVID, and Web of Knowledge. Study Selection Randomized clinical trials were selected that tested transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) for any mental disorder in adults aged 18 years or older. Data Extraction and Synthesis Two authors independently extracted the data. A 1-stage dose-response meta-analysis using a random-effects model was performed. Sensitivity analyses were conducted to test robustness of the findings. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures The main outcome was the near-maximal effective doses of total pulses received for TMS and total current dose in coulombs for tDCS. Results A total of 110 studies with 4820 participants (2659 men [61.4%]; mean [SD] age, 42.3 [8.8] years) were included. The following significant dose-response associations emerged with bell-shaped curves: (1) in schizophrenia, high-frequency (HF) TMS on the left dorsolateral prefrontal cortex (LDLPFC) for negative symptoms (χ2 = 9.35; df = 2; P = .009) and TMS on the left temporoparietal junction for resistant hallucinations (χ2 = 36.52; df = 2; P < .001); (2) in depression, HF-DLPFC TMS (χ2 = 14.49; df = 2; P < .001); (3) in treatment-resistant depression, LDLPFC tDCS (χ2 = 14.56; df = 2; P < .001); and (4) in substance use disorder, LDLPFC tDCS (χ2 = 33.63; df = 2; P < .001). The following significant dose-response associations emerged with plateaued or ascending curves: (1) in depression, low-frequency (LF) TMS on the right DLPFC (RDLPFC) with ascending curve (χ2 = 25.67; df = 2; P = .001); (2) for treatment-resistant depression, LF TMS on the bilateral DLPFC with ascending curve (χ2 = 5.86; df = 2; P = .004); (3) in obsessive-compulsive disorder, LF-RDLPFC TMS with ascending curve (χ2 = 20.65; df = 2; P < .001) and LF TMS on the orbitofrontal cortex with a plateaued curve (χ2 = 15.19; df = 2; P < .001); and (4) in posttraumatic stress disorder, LF-RDLPFC TMS with ascending curve (χ2 = 54.15; df = 2; P < .001). Sensitivity analyses confirmed the main findings. Conclusions and Relevance The study findings suggest that NIBS yields specific outcomes based on dose parameters across various mental disorders and brain regions. Clinicians should consider these dose parameters when prescribing NIBS. Additional research is needed to prospectively validate the findings in randomized, sham-controlled trials and explore how other parameters contribute to the observed dose-response association.
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Affiliation(s)
- Michel Sabé
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Joshua Hyde
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
| | - Catharina Cramer
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Antonia Eberhard
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - André Russowsky Brunoni
- Departamento e Instituto de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Brazil
| | - André Aleman
- Department of Biomedical Sciences of Cells and Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
| | - David S. Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom
- University Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Matthew Garner
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ontario, Canada
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jess G. Fiedorowicz
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, United Kingdom
- Hassenfeld Children’s Hospital at New York University Langone, New York University Child Study Center, New York, New York
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, United Kingdom
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Marco Solmi
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada
- SIENCES Laboratory, Department of Psychiatry, University of Ottawa, Ontario, Canada
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5
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Mehta DD, Praecht A, Ward HB, Sanches M, Sorkhou M, Tang VM, Steele VR, Hanlon CA, George TP. A systematic review and meta-analysis of neuromodulation therapies for substance use disorders. Neuropsychopharmacology 2024; 49:649-680. [PMID: 38086901 PMCID: PMC10876556 DOI: 10.1038/s41386-023-01776-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024]
Abstract
While pharmacological, behavioral and psychosocial treatments are available for substance use disorders (SUDs), they are not always effective or well-tolerated. Neuromodulation (NM) methods, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) may address SUDs by targeting addiction neurocircuitry. We evaluated the efficacy of NM to improve behavioral outcomes in SUDs. A systematic literature search was performed on MEDLINE, PsychINFO, and PubMed databases and a list of search terms for four key concepts (SUD, rTMS, tDCS, DBS) was applied. Ninety-four studies were identified that examined the effects of rTMS, tDCS, and DBS on substance use outcomes (e.g., craving, consumption, and relapse) amongst individuals with SUDs including alcohol, tobacco, cannabis, stimulants, and opioids. Meta-analyses were performed for alcohol and tobacco studies using rTMS and tDCS. We found that rTMS reduced substance use and craving, as indicated by medium to large effect sizes (Hedge's g > 0.5). Results were most encouraging when multiple stimulation sessions were applied, and the left dorsolateral prefrontal cortex (DLPFC) was targeted. tDCS also produced medium effect sizes for drug use and craving, though they were highly variable and less robust than rTMS; right anodal DLPFC stimulation appeared to be most efficacious. DBS studies were typically small, uncontrolled studies, but showed promise in reducing misuse of multiple substances. NM may be promising for the treatment of SUDs. Future studies should determine underlying neural mechanisms of NM, and further evaluate extended treatment durations, accelerated administration protocols and long-term outcomes with biochemical verification of substance use.
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Affiliation(s)
- Dhvani D Mehta
- Addictions Division, CAMH, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Angela Praecht
- Addictions Division, CAMH, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Heather B Ward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Maryam Sorkhou
- Addictions Division, CAMH, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Victor M Tang
- Addictions Division, CAMH, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vaughn R Steele
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Tony P George
- Addictions Division, CAMH, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Chan YH, Chang HM, Lu ML, Goh KK. Targeting cravings in substance addiction with transcranial direct current stimulation: insights from a meta-analysis of sham-controlled trials. Psychiatry Res 2024; 331:115621. [PMID: 38043411 DOI: 10.1016/j.psychres.2023.115621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/06/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023]
Abstract
Addiction is a substantial health concern; craving-the core symptom of addiction-is strongly associated with relapse. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that reduces cravings by altering cortical excitability and connectivity in brain regions. This systematic review and meta-analysis was conducted (following the PRISMA guidelines) to evaluate the efficacy of tDCS in reducing cravings for substances. Our analysis included 43 randomized, sham-controlled trials involving 1,095 and 913 participants receiving tDCS and sham stimulation, respectively. We analyzed the changes in craving scores and found that tDCS led to a moderate reduction in cravings compared with the sham effects. This effect was particularly pronounced when bilateral stimulation was used, the anodal electrode was placed on the right dorsolateral prefrontal cortex, current intensities ranged from 1.5 to 2 mA, stimulation sessions lasted 20 minutes, and the electrodes size was ≥35 cm². Notably, tDCS effectively reduced cravings for opioids, methamphetamine, cocaine, and tobacco but not for alcohol or cannabis. Our findings indicate tDCS as a promising, noninvasive, and low-risk intervention for reducing cravings for opioids, methamphetamine, cocaine, and tobacco. Additional studies are warranted to refine stimulation parameters and evaluate the long-term efficacy of tDCS in managing substance cravings.
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Affiliation(s)
- Yi-Hsun Chan
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hu-Ming Chang
- Department of Addiction Sciences, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kah Kheng Goh
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; The Innovative and Translational Research Center for Brain Consciousness, Taipei Medical University, Taipei, Taiwan.
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Chmiel J, Chojdak-Łukasiewicz J, Leszek J. The Effect of Transcranial Direct Current Stimulation (tDCS) on Cocaine Addiction: A Narrative Review. J Clin Med 2023; 12:6511. [PMID: 37892650 PMCID: PMC10607438 DOI: 10.3390/jcm12206511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Cocaine addiction is a significant problem worldwide. The development of addiction involves a reward system, which consists of certain brain regions like the ventral tegmental area, nucleus accumbens, and prefrontal cortex. Currently, there are no approved medications for treating cocaine dependence, so researchers are actively searching for effective treatments that can impact the brain. One potential treatment under investigation is transcranial direct current stimulation (tDCS), a non-invasive method of stimulating the brain to modulate its activity. In this review, we explore the use of tDCS in treating cocaine addiction. We found nine relevant articles via a literature search, and the results indicate that applying tDCS to the right dorsolateral prefrontal cortex (DLPFC) holds promise for reducing drug cravings in individuals with cocaine addiction. The review also discusses the possible mechanisms by which tDCS works and provides recommendations for future research in this field.
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Affiliation(s)
- James Chmiel
- Institute of Neurofeedback and tDCS Poland, 70-393 Szczecin, Poland
| | | | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
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Bikson M, Ganho-Ávila A, Datta A, Gillick B, Joensson MG, Kim S, Kim J, Kirton A, Lee K, Marjenin T, Onarheim B, Rehn EM, Sack AT, Unal G. Limited output transcranial electrical stimulation 2023 (LOTES-2023): Updates on engineering principles, regulatory statutes, and industry standards for wellness, over-the-counter, or prescription devices with low risk. Brain Stimul 2023; 16:840-853. [PMID: 37201865 PMCID: PMC10350287 DOI: 10.1016/j.brs.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/20/2023] Open
Abstract
The objective and scope of this Limited Output Transcranial Electrical Stimulation 2023 (LOTES-2023) guidance is to update the previous LOTES-2017 guidance. These documents should therefore be considered together. The LOTES provides a clearly articulated and transparent framework for the design of devices providing limited output (specified low-intensity range) transcranial electrical stimulation for a variety of intended uses. These guidelines can inform trial design and regulatory decisions, but most directly inform manufacturer activities - and hence were presented in LOTES-2017 as "Voluntary industry standard for compliance controlled limited output tES devices". In LOTES-2023 we emphasize that these standards are largely aligned across international standards and national regulations (including those in USA, EU, and South Korea), and so might be better understood as "Industry standards for compliance controlled limited output tES devices". LOTES-2023 is therefore updated to reflect a consensus among emerging international standards, as well as best available scientific evidence. "Warnings" and "Precautions" are updated to align with current biomedical evidence and applications. LOTES standards applied to a constrained device dose range, but within this dose range and for different use-cases, manufacturers are responsible to conduct device-specific risk management.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States.
| | - Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention-CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Abhishek Datta
- Research and Development, Soterix Medical Inc., Woodbridge, NJ, United States
| | - Bernadette Gillick
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Sungjin Kim
- Ybrain Research Institute, Seongnam-si, Gyeonggi-do, South Korea
| | - Jinuk Kim
- Ybrain Research Institute, Seongnam-si, Gyeonggi-do, South Korea
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kiwon Lee
- Ybrain Research Institute, Seongnam-si, Gyeonggi-do, South Korea
| | | | - Balder Onarheim
- Research and Development, PlatoScience ApS, Copenhagen, Denmark
| | - Erik M Rehn
- Research and Development, Flow Neuroscience, Malmo, Skane Lan, Sweden
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Gozde Unal
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States.
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9
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King SG, Gaudreault PO, Malaker P, Kim JW, Alia-Klein N, Xu J, Goldstein RZ. Prefrontal-habenular microstructural impairments in human cocaine and heroin addiction. Neuron 2022; 110:3820-3832.e4. [PMID: 36206758 PMCID: PMC9671835 DOI: 10.1016/j.neuron.2022.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/24/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
The habenula (Hb) is central to adaptive reward- and aversion-driven behaviors, comprising a hub for higher-order processing networks involving the prefrontal cortex (PFC). Despite an established role in preclinical models of cocaine addiction, the translational significance of the Hb and its connectivity with the PFC in humans is unclear. Using diffusion tractography, we detailed PFC structural connectivity with the Hb and two control regions, quantifying tract-specific microstructural features in healthy and cocaine-addicted individuals. White matter was uniquely impaired in PFC-Hb projections in both short-term abstainers and current cocaine users. Abnormalities in this tract further generalized to an independent sample of heroin-addicted individuals and were associated, in an exploratory analysis, with earlier onset of drug use across the addiction subgroups, potentially serving as a predisposing marker amenable for early intervention. Importantly, these findings contextualize a plausible PFC-Hb circuit in the human brain, supporting preclinical evidence for its impairment in cocaine addiction.
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Affiliation(s)
- Sarah G King
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Pierre-Olivier Gaudreault
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Pias Malaker
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Joo-Won Kim
- Departments of Radiology and Psychiatry, Baylor College of Medicine, Houston, TX 77030, USA
| | - Nelly Alia-Klein
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Junqian Xu
- Departments of Radiology and Psychiatry, Baylor College of Medicine, Houston, TX 77030, USA
| | - Rita Z Goldstein
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Hong KS, Khan MNA, Ghafoor U. Non-invasive transcranial electrical brain stimulation guided by functional near-infrared spectroscopy for targeted neuromodulation: A review. J Neural Eng 2022; 19. [PMID: 35905708 DOI: 10.1088/1741-2552/ac857d] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/29/2022] [Indexed: 11/12/2022]
Abstract
One of the primary goals in cognitive neuroscience is to understand the neural mechanisms on which cognition is based. Researchers are trying to find how cognitive mechanisms are related to oscillations generated due to brain activity. The research focused on this topic has been considerably aided by developing non-invasive brain stimulation techniques. The dynamics of brain networks and the resultant behavior can be affected by non-invasive brain stimulation techniques, which make their use a focus of interest in many experiments and clinical fields. One essential non-invasive brain stimulation technique is transcranial electrical stimulation (tES), subdivided into transcranial direct and alternating current stimulation. tES has recently become more well-known because of the effective results achieved in treating chronic conditions. In addition, there has been exceptional progress in the interpretation and feasibility of tES techniques. Summarizing the beneficial effects of tES, this article provides an updated depiction of what has been accomplished to date, brief history, and the open questions that need to be addressed in the future. An essential issue in the field of tES is stimulation duration. This review briefly covers the stimulation durations that have been utilized in the field while monitoring the brain using functional-near infrared spectroscopy-based brain imaging.
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Affiliation(s)
- Keum-Shik Hong
- Department of Cogno-mechatronics Engineering, Pusan National University, 2 Busandaehak-ro, Geumgeong-gu, Busan, Busan, 609735, Korea (the Republic of)
| | - M N Afzal Khan
- Pusan National University, Department of Mechanical Engineering, Busan, 46241, Korea (the Republic of)
| | - Usman Ghafoor
- School of Mechanical Engineering, Pusan National University College of Engineering, room 204, Busan, 46241, Korea (the Republic of)
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11
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Lisoni J, Barlati S, Deste G, Ceraso A, Nibbio G, Baldacci G, Vita A. Efficacy and tolerability of Brain Stimulation interventions in Borderline Personality Disorder: state of the art and future perspectives - A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2022; 116:110537. [PMID: 35176417 DOI: 10.1016/j.pnpbp.2022.110537] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 12/28/2022]
Abstract
Treating Borderline Personality Disorder (BPD) is a major challenge for psychiatrists. As Brain Stimulation represents an alternative approach to treat psychiatric disorders, our systematic review is the first to focus on both invasive and Non-Invasive Brain Stimulation (NIBS) interventions in people living with BPD, examining clinical effects over core features and comorbid conditions. Following PRISMA guidelines, out of 422 original records, 24 papers were included regarding Deep Brain Stimulation (n = 1), Electroconvulsive therapy (n = 5), Transcranial Magnetic Stimulation (n = 13) and transcranial Direct Current Stimulation (n = 5). According to impulsivity and emotional dysregulated domain improvements, NIBS in BPD appears to restore frontolimbic network deficiencies. NIBS seems also to modulate depressive features. Safety and tolerability profiles for each technique are discussed. Despite encouraging results, definitive recommendations on Brain Stimulation in BPD are mitigated by protocols heterogeneity, lack of randomized controlled trials and poor quality of included studies, including high risk of methodological biases. To serve as guide for future systematic investigations, protocols optimization proposals are provided, focusing on alternative stimulation sites and suggesting a NIBS symptom-based approach.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 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.
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Anna Ceraso
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 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
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Viale Europa 11, 25123 Brescia, Italy
| | - Giulia Baldacci
- 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 of Brescia, 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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12
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Khajehpour H, Parvaz MA, Kouti M, Hosseini Rafsanjani T, Ekhtiari H, Bakht S, Noroozi A, Makkiabadi B, Mahmoodi M. Effects of Transcranial Direct Current Stimulation on Attentional Bias to Methamphetamine Cues and Its Association With EEG-Derived Functional Brain Network Topology. Int J Neuropsychopharmacol 2022; 25:631-644. [PMID: 35380672 PMCID: PMC9380716 DOI: 10.1093/ijnp/pyac018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/04/2022] [Accepted: 03/30/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Although transcranial direct current stimulation (tDCS) has shown to potentially mitigate drug craving and attentional bias to drug-related stimuli, individual differences in such modulatory effects of tDCS are less understood. In this study, we aimed to investigate a source of the inter-subject variability in the tDCS effects that can be useful for tDCS-based treatments of individuals with methamphetamine (MA) use disorder (IMUD). METHODS Forty-two IMUD (all male) were randomly assigned to receive a single-session of either sham or real bilateral tDCS (anodal right/cathodal left) over the dorsolateral prefrontal cortex. The tDCS effect on MA craving and biased attention to drug stimuli were investigated by quantifying EEG-derived P3 (a measure of initial attentional bias) and late positive potential (LPP; a measure of sustained motivated attention) elicited by these stimuli. To assess the association of changes in P3 and LPP with brain connectivity network (BCN) topology, the correlation between topology metrics, specifically those related to the efficiency of information processing, and the tDCS effect was investigated. RESULTS The P3 amplitude significantly decreased following the tDCS session, whereas the amplitudes increased in the sham group. The changes in P3 amplitudes were significantly correlated with communication efficiency measured by BCN topology metrics (r = -0.47, P = .03; r = -0.49, P = .02). There was no significant change in LPP amplitude due to the tDCS application. CONCLUSIONS These findings validate that tDCS mitigates initial attentional bias, but not the sustained motivated attention, to MA stimuli. Importantly, however, results also show that the individual differences in the effects of tDCS may be underpinned by communication efficiency of the BCN topology, and therefore, these BCN topology metrics may have the potential to robustly predict the effectiveness of tDCS-based interventions on MA craving and attentional bias to MA stimuli among IMUD.
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Affiliation(s)
- Hassan Khajehpour
- Correspondence: Hassan Khajehpour, PhD, Department of Physics, Concordia University, Richard J. Renaud Science Complex, Loyola Campus, 7141 Sherbrooke St. W., Montreal, H4B 1R6, Quebec, Canada ()
| | - Muhammad A Parvaz
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, USA,Department of Neuroscience, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Mayadeh Kouti
- Department of Electrical Engineering, Shohadaye Hoveizeh Campus of Technology, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | | | - Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Bakht
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Alireza Noroozi
- Neuroscience and Addiction Studies Department, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran (Dr Noroozi)
| | - Bahador Makkiabadi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran,Iran,Research Center for Biomedical Technology and Robotics, Institute of Advanced Medical Technologies, Tehran University of Medical Sciences, Tehran,Iran
| | - Maryam Mahmoodi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran,Iran,Research Center for Biomedical Technology and Robotics, Institute of Advanced Medical Technologies, Tehran University of Medical Sciences, Tehran,Iran
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13
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Ceceli AO, Bradberry CW, Goldstein RZ. The neurobiology of drug addiction: cross-species insights into the dysfunction and recovery of the prefrontal cortex. Neuropsychopharmacology 2022; 47:276-291. [PMID: 34408275 PMCID: PMC8617203 DOI: 10.1038/s41386-021-01153-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 01/03/2023]
Abstract
A growing preclinical and clinical body of work on the effects of chronic drug use and drug addiction has extended the scope of inquiry from the putative reward-related subcortical mechanisms to higher-order executive functions as regulated by the prefrontal cortex. Here we review the neuroimaging evidence in humans and non-human primates to demonstrate the involvement of the prefrontal cortex in emotional, cognitive, and behavioral alterations in drug addiction, with particular attention to the impaired response inhibition and salience attribution (iRISA) framework. In support of iRISA, functional and structural neuroimaging studies document a role for the prefrontal cortex in assigning excessive salience to drug over non-drug-related processes with concomitant lapses in self-control, and deficits in reward-related decision-making and insight into illness. Importantly, converging insights from human and non-human primate studies suggest a causal relationship between drug addiction and prefrontal insult, indicating that chronic drug use causes the prefrontal cortex damage that underlies iRISA while changes with abstinence and recovery with treatment suggest plasticity of these same brain regions and functions. We further dissect the overlapping and distinct characteristics of drug classes, potential biomarkers that inform vulnerability and resilience, and advancements in cutting-edge psychological and neuromodulatory treatment strategies, providing a comprehensive landscape of the human and non-human primate drug addiction literature as it relates to the prefrontal cortex.
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Affiliation(s)
- Ahmet O Ceceli
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Rita Z Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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14
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Liu Q, Yuan T. Noninvasive brain stimulation of addiction: one target for all? PSYCHORADIOLOGY 2021; 1:172-184. [PMID: 38666219 PMCID: PMC10917190 DOI: 10.1093/psyrad/kkab016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 04/28/2024]
Abstract
Noninvasive brain stimulation includes repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), and emerges as a prospective approach for addiction treatment in clinical practices. The dorsolateral prefrontal cortex (DLPFC) is regarded as the most effective stimulation target, giving its important position in controlling cue-elicited drug craving and initiating drug abuse. In this paper, through literature searches (e.g. Pubmed, Google Scholar), 34 studies (2003-2021) were identified examining the effect of rTMS, tDCS on cravings, and consumption of substance use disorders, including tobacco, alcohol, opioids, and stimulants. We summarize the main methods, designs, and effects of rTMS or tDCS that are delivered to the DLPFC on different types of addiction. We conclude that targeting DLPFC might be effective for all types of drug addiction.
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Affiliation(s)
- Qingming Liu
- Center for Brain, Mind and Education, Shaoxing University, Shaoxing 312000, China
- School of Teacher Education, Shaoxing University, Shaoxing 312000, China
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 210109, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226019, China
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