Theta Burst Stimulation in Patients With Methamphetamine Use Disorder: A Meta-Analysis and Systematic Review

Area of Science:

• Neuroscience
• Psychiatry
• Addiction Medicine

Background:

• Methamphetamine use disorder (MUD) lacks FDA-approved treatments, necessitating novel interventions.
• Transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (L. dlPFC) has shown potential in reducing methamphetamine craving.
• Theta burst stimulation (TBS) is an evolving TMS technique for substance use disorders.

Purpose of the Study:

• To systematically review and meta-analyze randomized controlled trials (RCTs) evaluating TBS for reducing cue-induced methamphetamine cravings in MUD.
• To assess the efficacy of intermittent TBS (iTBS) compared to sham iTBS in MUD patients.
• To identify gaps in current research regarding TBS for MUD.

Main Methods:

• Systematic review of RCTs from PubMed/Medline, EMBASE, and Google Scholar up to September 1, 2024.
• Meta-analysis of four RCTs using iTBS versus sham iTBS for MUD.
• Inclusion of two additional RCTs without sham arms in the systematic review.

Main Results:

• iTBS significantly reduced cue-induced methamphetamine cravings compared to sham iTBS (SMD = 1.04; 95% CI [0.16, 1.92]).
• One RCT without a sham comparator demonstrated significant craving reduction with accelerated iTBS.
• The review focused on unique participant cohorts, addressing limitations of previous meta-analyses.

Conclusions:

• iTBS is a promising intervention for reducing methamphetamine cravings in MUD.
• Future research should explore iTBS's impact on clinical outcomes beyond craving, such as actual methamphetamine use.
• Further investigation into accelerated iTBS, continuous TBS (cTBS), and MUD biomarkers is warranted.