Melanie L Bozzay1, Sydney Brigido2, Mascha van 't Wout-Frank1, Emily Aiken2, Robert Swift1, Noah S Philip3. 1. VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System; Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island 02908, United States. 2. VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System. 3. VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System; Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island 02908, United States. Electronic address: Noah_Philip@brown.edu.
Abstract
BACKGROUND: Alcohol use disorder (AUD) is highly comorbid with depression and posttraumatic stress disorder (PTSD) and can complicate their treatment. Transcranial magnetic stimulation is a promising treatment for these disorders, yet prior research often excluded AUD patients out of concern for safety or poorer outcomes. To this end, we revisited a prior study of intermittent theta burst stimulation (iTBS) for PTSD, to evaluate whether mild AUD impacted safety and clinical outcomes. METHODS: Fifty veterans with PTSD (n=17, with comorbid AUD) received 10 days of sham-controlled iTBS, followed by 10 unblinded sessions. Stimulation was delivered at 80% of the motor threshold for 1800 pulses to the right dorsolateral prefrontal cortex. Safety, PTSD and depressive outcomes were evaluated with repeated measures analysis of variance, to examine the effects of time, treatment group and comorbid AUD. RESULTS: iTBS was safe, although AUD patients reported more adverse events, regardless of whether they received active or sham stimulation. Regarding clinical outcomes, patients with AUD who received active stimulation demonstrated a greater rate of improvement in depression symptoms than those without comorbid AUD. The presence of AUD did not impact PTSD symptom change. LIMITATIONS: Limitations include a modest sample size and use of a categorical, rather than continuous, index of AUD diagnosis. CONCLUSION: While these results require replication, they indicate that iTBS is likely safe in patients with mild comorbid AUD. We propose that comorbid AUD should not preclude clinical use of iTBS, and that iTBS should be further investigated as a novel treatment option for AUD.
BACKGROUND: Alcohol use disorder (AUD) is highly comorbid with depression and posttraumatic stress disorder (PTSD) and can complicate their treatment. Transcranial magnetic stimulation is a promising treatment for these disorders, yet prior research often excluded AUD patients out of concern for safety or poorer outcomes. To this end, we revisited a prior study of intermittent theta burst stimulation (iTBS) for PTSD, to evaluate whether mild AUD impacted safety and clinical outcomes. METHODS: Fifty veterans with PTSD (n=17, with comorbid AUD) received 10 days of sham-controlled iTBS, followed by 10 unblinded sessions. Stimulation was delivered at 80% of the motor threshold for 1800 pulses to the right dorsolateral prefrontal cortex. Safety, PTSD and depressive outcomes were evaluated with repeated measures analysis of variance, to examine the effects of time, treatment group and comorbid AUD. RESULTS: iTBS was safe, although AUD patients reported more adverse events, regardless of whether they received active or sham stimulation. Regarding clinical outcomes, patients with AUD who received active stimulation demonstrated a greater rate of improvement in depression symptoms than those without comorbid AUD. The presence of AUD did not impact PTSD symptom change. LIMITATIONS: Limitations include a modest sample size and use of a categorical, rather than continuous, index of AUD diagnosis. CONCLUSION: While these results require replication, they indicate that iTBS is likely safe in patients with mild comorbid AUD. We propose that comorbid AUD should not preclude clinical use of iTBS, and that iTBS should be further investigated as a novel treatment option for AUD.
Authors: Noah S Philip; Jennifer Barredo; Emily Aiken; Victoria Larson; Richard N Jones; M Tracie Shea; Benjamin D Greenberg; Mascha van 't Wout-Frank Journal: Am J Psychiatry Date: 2019-06-24 Impact factor: 18.112
Authors: Yechiel Levkovitz; Moshe Isserles; Frank Padberg; Sarah H Lisanby; Alexander Bystritsky; Guohua Xia; Aron Tendler; Zafiris J Daskalakis; Jaron L Winston; Pinhas Dannon; Hisham M Hafez; Irving M Reti; Oscar G Morales; Thomas E Schlaepfer; Eric Hollander; Joshua A Berman; Mustafa M Husain; Uzi Sofer; Ahava Stein; Shmulik Adler; Lisa Deutsch; Frederic Deutsch; Yiftach Roth; Mark S George; Abraham Zangen Journal: World Psychiatry Date: 2015-02 Impact factor: 49.548
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: Daniel M Blumberger; Fidel Vila-Rodriguez; Kevin E Thorpe; Kfir Feffer; Yoshihiro Noda; Peter Giacobbe; Yuliya Knyahnytska; Sidney H Kennedy; Raymond W Lam; Zafiris J Daskalakis; Jonathan Downar Journal: Lancet Date: 2018-04-26 Impact factor: 79.321
Authors: Noah S Philip; Andrew F Leuchter; Ian A Cook; Joe Massaro; John W Goethe; Linda L Carpenter Journal: Depress Anxiety Date: 2018-11-27 Impact factor: 6.505