OBJECTIVE:Posttraumatic stress disorder (PTSD) is a highly prevalent psychiatric disorder associated with disruption in social and occupational function. Transcranial magnetic stimulation (TMS) represents a novel approach to PTSD, and intermittent theta-burst stimulation (iTBS) is a new, more rapid administration protocol with data supporting efficacy in depression. The authors conducted a sham-controlled study of iTBS for PTSD. METHODS:Fifty veterans with PTSD received 10 days of sham-controlled iTBS (1,800 pulses/day), followed by 10 unblinded sessions. Primary outcome measures included acceptability (retention rates), changes in PTSD symptoms (clinician- and self-rated), quality of life, social and occupational function, and depression, obtained at the end of 2 weeks; analysis of variance was used to compare active with sham stimulation. Secondary outcomes were evaluated 1 month after treatment, using mixed-model analyses. Resting-state functional MRI was acquired at pretreatment baseline on an eligible subset of participants (N=26) to identify response predictors. RESULTS: Retention was high, side effects were consistent with standard TMS, and blinding was successful. At 2 weeks, active iTBS was significantly associated with improved social and occupational function (Cohen's d=0.39); depression was improved with iTBS compared with the sham treatment (d=-0.45), but the difference fell short of significance, and moderate nonsignificant effect sizes were observed on self-reported PTSD symptoms (d=-0.34). One-month outcomes, which incorporated data from the unblinded phase of the study, indicated superiority of active iTBS on clinician- and self-rated PTSD symptoms (d=-0.74 and -0.63, respectively), depression (d=-0.47), and social and occupational function (d=0.93) (all significant). Neuroimaging indicated that clinical improvement was significantly predicted by stronger (greater positive) connectivity within the default mode network and by anticorrelated (greater negative) cross-network connectivity. CONCLUSIONS: iTBS appears to be a promising new treatment for PTSD. Most clinical improvements from stimulation occurred early, which suggests a need for further investigation of optimal iTBS time course and duration. Consistent with previous neuroimaging studies of TMS, default mode network connectivity played an important role in response prediction.
RCT Entities:
OBJECTIVE:Posttraumatic stress disorder (PTSD) is a highly prevalent psychiatric disorder associated with disruption in social and occupational function. Transcranial magnetic stimulation (TMS) represents a novel approach to PTSD, and intermittent theta-burst stimulation (iTBS) is a new, more rapid administration protocol with data supporting efficacy in depression. The authors conducted a sham-controlled study of iTBS for PTSD. METHODS: Fifty veterans with PTSD received 10 days of sham-controlled iTBS (1,800 pulses/day), followed by 10 unblinded sessions. Primary outcome measures included acceptability (retention rates), changes in PTSD symptoms (clinician- and self-rated), quality of life, social and occupational function, and depression, obtained at the end of 2 weeks; analysis of variance was used to compare active with sham stimulation. Secondary outcomes were evaluated 1 month after treatment, using mixed-model analyses. Resting-state functional MRI was acquired at pretreatment baseline on an eligible subset of participants (N=26) to identify response predictors. RESULTS: Retention was high, side effects were consistent with standard TMS, and blinding was successful. At 2 weeks, active iTBS was significantly associated with improved social and occupational function (Cohen's d=0.39); depression was improved with iTBS compared with the sham treatment (d=-0.45), but the difference fell short of significance, and moderate nonsignificant effect sizes were observed on self-reported PTSD symptoms (d=-0.34). One-month outcomes, which incorporated data from the unblinded phase of the study, indicated superiority of active iTBS on clinician- and self-rated PTSD symptoms (d=-0.74 and -0.63, respectively), depression (d=-0.47), and social and occupational function (d=0.93) (all significant). Neuroimaging indicated that clinical improvement was significantly predicted by stronger (greater positive) connectivity within the default mode network and by anticorrelated (greater negative) cross-network connectivity. CONCLUSIONS:iTBS appears to be a promising new treatment for PTSD. Most clinical improvements from stimulation occurred early, which suggests a need for further investigation of optimal iTBS time course and duration. Consistent with previous neuroimaging studies of TMS, default mode network connectivity played an important role in response prediction.
Authors: Jerome A Yesavage; J Kaci Fairchild; Zhibao Mi; Kousick Biswas; Anne Davis-Karim; Ciaran S Phibbs; Steven D Forman; Michael Thase; Leanne M Williams; Amit Etkin; Ruth O'Hara; Gerald Georgette; Tamara Beale; Grant D Huang; Art Noda; Mark S George Journal: JAMA Psychiatry Date: 2018-09-01 Impact factor: 21.596
Authors: Stephan F Taylor; S Shaun Ho; Tessa Abagis; Mike Angstadt; Daniel F Maixner; Robert C Welsh; Luis Hernandez-Garcia Journal: J Affect Disord Date: 2018-02-21 Impact factor: 4.839
Authors: John P O'Reardon; H Brent Solvason; Philip G Janicak; Shirlene Sampson; Keith E Isenberg; Ziad Nahas; William M McDonald; David Avery; Paul B Fitzgerald; Colleen Loo; Mark A Demitrack; Mark S George; Harold A Sackeim Journal: Biol Psychiatry Date: 2007-06-14 Impact factor: 13.382
Authors: Julia A DiGangi; Armin Tadayyon; Daniel A Fitzgerald; Christine A Rabinak; Amy Kennedy; Heide Klumpp; Sheila A M Rauch; K Luan Phan Journal: Neurosci Lett Date: 2016-01-12 Impact factor: 3.046
Authors: Conor Liston; Ashley C Chen; Benjamin D Zebley; Andrew T Drysdale; Rebecca Gordon; Bruce Leuchter; Henning U Voss; B J Casey; Amit Etkin; Marc J Dubin Journal: Biol Psychiatry Date: 2014-02-05 Impact factor: 13.382
Authors: Bradley V Watts; Paula P Schnurr; Lorna Mayo; Yinong Young-Xu; William B Weeks; Matthew J Friedman Journal: J Clin Psychiatry Date: 2013-06 Impact factor: 4.384
Authors: Noah S Philip; Nicole Cr McLaughlin; Linda L Carpenter; Mary L Phillips; Hesheng Liu; Suzanne N Haber; Benjamin D Greenberg Journal: Brain Stimul Date: 2020-03-25 Impact factor: 8.955
Authors: Kawai Leong; Peter Chan; Larry Ong; Amy Zwicker; Sharon Willan; Raymond W Lam; Alexander McGirr Journal: Can J Psychiatry Date: 2020-05-07 Impact factor: 4.356
Authors: C R Faucher; R A Doherty; N S Philip; A S M Harle; J J E Cole; M Van't Wout-Frank Journal: Behav Neurosci Date: 2021-08-02 Impact factor: 1.912