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Transcranial magnetic stimulation for post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a debilitating psychiatric disorder. While current treatment options are effective for some, many individuals fail to respond to first-line psychotherapies and pharmacotherapy. Transcranial magnetic stimulation (TMS) has emerged over the past several decades...

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Autores principales: Petrosino, Nicholas J., Cosmo, Camila, Berlow, Yosef A., Zandvakili, Amin, van ’t Wout-Frank, Mascha, Philip, Noah S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558793/
https://www.ncbi.nlm.nih.gov/pubmed/34733479
http://dx.doi.org/10.1177/20451253211049921
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author Petrosino, Nicholas J.
Cosmo, Camila
Berlow, Yosef A.
Zandvakili, Amin
van ’t Wout-Frank, Mascha
Philip, Noah S.
author_facet Petrosino, Nicholas J.
Cosmo, Camila
Berlow, Yosef A.
Zandvakili, Amin
van ’t Wout-Frank, Mascha
Philip, Noah S.
author_sort Petrosino, Nicholas J.
collection PubMed
description Post-traumatic stress disorder (PTSD) is a debilitating psychiatric disorder. While current treatment options are effective for some, many individuals fail to respond to first-line psychotherapies and pharmacotherapy. Transcranial magnetic stimulation (TMS) has emerged over the past several decades as a noninvasive neuromodulatory intervention for psychiatric disorders including depression, with mounting evidence for its safety, tolerability, and efficacy in treating PTSD. While several meta-analyses of TMS for PTSD have been published to date showing large effect sizes on PTSD overall, there is marked variability between studies, making it difficult to draw simple conclusions about how best to treat patients. The following review summarizes over 20 years of the existing literature on TMS as a PTSD treatment, and includes nine randomized controlled trials and many other prospective studies of TMS monotherapy, as well as five randomized controlled trials investigating TMS combined with psychotherapy. While the majority of studies utilize repetitive TMS targeted to the right dorsolateral prefrontal cortex (DLPFC) at low frequency (1 Hz) or high frequency (10 or 20 Hz), others have used alternative frequencies, targeted other regions (most commonly the left DLPFC), or trialed different stimulation protocols utilizing newer TMS modalities such as synchronized TMS and theta-burst TMS (TBS). Although it is encouraging that positive outcomes have been shown, there is a paucity of studies directly comparing available approaches. Biomarkers, such as functional imaging and electroencephalography, were seldomly incorporated yet remain crucial for advancing our knowledge of how to predict and monitor treatment response and for understanding mechanism of action of TMS in this population. Effects on PTSD are often sustained for up to 2–3 months, but more long-term studies are needed in order to understand and predict duration of response. In short, while TMS appears safe and effective for PTSD, important steps are needed to operationalize optimal approaches for patients suffering from this disorder.
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spelling pubmed-85587932021-11-02 Transcranial magnetic stimulation for post-traumatic stress disorder Petrosino, Nicholas J. Cosmo, Camila Berlow, Yosef A. Zandvakili, Amin van ’t Wout-Frank, Mascha Philip, Noah S. Ther Adv Psychopharmacol Review Article Post-traumatic stress disorder (PTSD) is a debilitating psychiatric disorder. While current treatment options are effective for some, many individuals fail to respond to first-line psychotherapies and pharmacotherapy. Transcranial magnetic stimulation (TMS) has emerged over the past several decades as a noninvasive neuromodulatory intervention for psychiatric disorders including depression, with mounting evidence for its safety, tolerability, and efficacy in treating PTSD. While several meta-analyses of TMS for PTSD have been published to date showing large effect sizes on PTSD overall, there is marked variability between studies, making it difficult to draw simple conclusions about how best to treat patients. The following review summarizes over 20 years of the existing literature on TMS as a PTSD treatment, and includes nine randomized controlled trials and many other prospective studies of TMS monotherapy, as well as five randomized controlled trials investigating TMS combined with psychotherapy. While the majority of studies utilize repetitive TMS targeted to the right dorsolateral prefrontal cortex (DLPFC) at low frequency (1 Hz) or high frequency (10 or 20 Hz), others have used alternative frequencies, targeted other regions (most commonly the left DLPFC), or trialed different stimulation protocols utilizing newer TMS modalities such as synchronized TMS and theta-burst TMS (TBS). Although it is encouraging that positive outcomes have been shown, there is a paucity of studies directly comparing available approaches. Biomarkers, such as functional imaging and electroencephalography, were seldomly incorporated yet remain crucial for advancing our knowledge of how to predict and monitor treatment response and for understanding mechanism of action of TMS in this population. Effects on PTSD are often sustained for up to 2–3 months, but more long-term studies are needed in order to understand and predict duration of response. In short, while TMS appears safe and effective for PTSD, important steps are needed to operationalize optimal approaches for patients suffering from this disorder. SAGE Publications 2021-10-28 /pmc/articles/PMC8558793/ /pubmed/34733479 http://dx.doi.org/10.1177/20451253211049921 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review Article
Petrosino, Nicholas J.
Cosmo, Camila
Berlow, Yosef A.
Zandvakili, Amin
van ’t Wout-Frank, Mascha
Philip, Noah S.
Transcranial magnetic stimulation for post-traumatic stress disorder
title Transcranial magnetic stimulation for post-traumatic stress disorder
title_full Transcranial magnetic stimulation for post-traumatic stress disorder
title_fullStr Transcranial magnetic stimulation for post-traumatic stress disorder
title_full_unstemmed Transcranial magnetic stimulation for post-traumatic stress disorder
title_short Transcranial magnetic stimulation for post-traumatic stress disorder
title_sort transcranial magnetic stimulation for post-traumatic stress disorder
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558793/
https://www.ncbi.nlm.nih.gov/pubmed/34733479
http://dx.doi.org/10.1177/20451253211049921
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