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Continuous Theta Burst Stimulation of the Posterior Medial Frontal Cortex to Experimentally Reduce Ideological Threat Responses

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Intermittent Theta Burst Stimulation in Veterans with Mild Alcohol Use Disorder.

Melanie L Bozzay¹, Sydney Brigido², Mascha van 't Wout-Frank¹

¹VA 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.

Journal of Affective Disorders

|July 6, 2021

Summary

Intermittent theta burst stimulation (iTBS) appears safe for treating posttraumatic stress disorder (PTSD) in patients with mild alcohol use disorder (AUD). Patients with AUD showed greater improvement in depression symptoms with active iTBS.

Keywords:

PTSD alcohol use depression neurostimulation

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Area of Science:

Neuroscience
Psychiatry
Clinical Research

Background:

Alcohol use disorder (AUD) frequently co-occurs with depression and PTSD, complicating treatment.
Transcranial magnetic stimulation (TMS) shows promise for these conditions, but AUD patients were often excluded due to safety concerns.
This study re-examined data from a prior intermittent theta burst stimulation (iTBS) trial for PTSD to assess the impact of mild AUD on safety and outcomes.

Purpose of the Study:

To evaluate the safety and clinical outcomes of intermittent theta burst stimulation (iTBS) in veterans with PTSD and mild comorbid alcohol use disorder (AUD).
To determine if the presence of AUD affects the safety profile and treatment efficacy of iTBS for PTSD and depression.

Main Methods:

Fifty veterans with PTSD, including 17 with comorbid AUD, received 10 days of sham-controlled iTBS followed by 10 unblinded sessions.
Stimulation targeted the right dorsolateral prefrontal cortex at 80% of motor threshold for 1800 pulses.
Safety, PTSD, and depression outcomes were analyzed using repeated measures analysis of variance to assess effects of time, treatment, and AUD comorbidity.

Main Results:

Intermittent theta burst stimulation (iTBS) was found to be safe, though patients with AUD reported more adverse events irrespective of active or sham treatment.
Patients with AUD receiving active iTBS demonstrated a significantly higher rate of improvement in depression symptoms compared to those without AUD.
The presence of AUD did not influence the change in PTSD symptom severity.

Conclusions:

Intermittent theta burst stimulation (iTBS) is likely safe for individuals with mild comorbid alcohol use disorder (AUD).
Comorbid AUD should not be a barrier to the clinical application of iTBS.
Further research is warranted to explore iTBS as a potential novel treatment for AUD.