TMS and the current uses for Addiction Therapy!


SAN DIEGO—Transcranial magnetic stimulation (TMS), particularly repetitive TMS (rTMS), shows promise for use in addiction treatment, according to a literature review presented Saturday during a poster session at the American Psychiatric Association’s annual meeting.

“Since its inception in 1985 as a diagnostic and therapeutic tool in neurology, therapeutic effects of TMS are being studied increasingly in psychiatry as well,” wrote presenter and psychiatry resident Tapan Parikh, MD, MPH, and colleagues in a poster abstract. “After the US Food and Drug Administration approved rTMS for treatment-resistant depression (2008), its therapeutic role has been extended to anxiety disorders, post-traumatic stress disorder, attention deficit hyperactivity disorder, and, more recently, addiction. However, research on its efficacy in addiction is in its infancy phase.”

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The literature review included randomized controlled trials, articles, and meta-analyses from single- and multicenter sites through September 2016.

“Because brain areas modulating addiction are mostly subcortical (mostly medial prefrontal cortex), needing deeper penetration, deep rTMS using H-coil and higher frequency stimulation with higher motor threshold (MT 120%) are better,” researchers reported “compared to the figure-of-eight coil used in conventional rTMS.”

Stimulation of the dorsolateral prefrontal cortex and insula with 10 Hz rTMS H-coil reduced drug cravings in adults age 21-70, according to the poster abstract. For nicotine addiction, the effects lasted 6 months.

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Data also revealed a significant reduction in nicotine cravings in 9 studies, cocaine-related cravings in 3 studies, food cravings in 4 studies, and alcohol-related cravings in 2 studies and 4 case reports.

However, no effect on addiction was identified in 3 studies on food cravings and 4 studies on alcohol-related cravings. A single, small amphetamine study showed a temporary increase in cue-induced cravings.

Studies have consistently suggested TMS is safe with no significant side effects, but researchers said more studies with larger populations are necessary to confirm the treatment’s safety and efficacy in people with addiction.

Coauthors of the literature review were Ramkrishna D. Makani, MD, MPH, Umang Shah, and Basant K. Pradhan, MD. They are affiliated with Cooper University Hospital/AtlantiCare Regional Medical Center, Cooper Medical School of Rowan University, Camden, New Jersey.

—Jolynn Tumolo


“Scope and utility of transcranial magnetic stimulation (TMS) in addictive disorders: an updated literature review.” Abstract presented at: the American Psychiatric Association Annual Meeting; May 20, 2017; San Diego, CA.

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