Comparison of the Effectiveness of Repetitive Transcranial Magnetic Stimulation and Drug Therapy in the Treatment of Post-Traumatic Stress

Document Type : Original Article

Authors

1 Department of Psychology, Semnan Branch, Islamic Azad University, Semnan, Iran

2 Professor, Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

3 Shahid Beheshti University, Tehran, Iran

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) to address Post-Traumatic Stress Disorder (PTSD) displays considerable potential and has received approval.

Objectives: The present study aimed to assess the relative efficacy of rTMS and pharmacological therapy in the treatment of PTSD. 
 
Methods: The study was conducted based on a quasi-experimental control group pretest-posttest design. The statistical population consisted of all patients referred to specialized clinics in the 2nd, 3rd, and 7th districts of Tehran between July and September 2022. For the purposeful selection, 45 individuals with PTSD were recruited and assigned to two experimental groups (rTMS, drug therapy) and a control group (each group consisting of 15 participants). The rTMS treatment comprised three sessions per week over four weeks, employing the specified parameters outlined about the variables of the study. Specifically, PTSD was targeted using a frequency of 1 Hz for 20 min and 1200 pulses, with the stimulation centered around the F4 areas. Pre and post-interventions were measured using the Millon Clinical Multiaxial Inventory-III or Checklist-90-Revision. The data analysis was conducted in SPSS software (version 26) using g an analysis of the covariance test. 
 
Results: As evidenced by the results, the reduction of PTSD symptoms achieved through rTMS surpasses that of drug therapy(P= 0.0001).
 
Conclusion: The obtained results indicated that rTMS interventions exhibited superior efficacy compared to others. In particular, protocols aimed at stimulating the right dorsolateral prefrontal cortex appear to outperform placebo interventions. Nonetheless, further knowledge is still needed regarding the optimal configurations for rTM treatment. 

Keywords

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

1. Yan T, Xie Q, Zheng Z, Zou K, Wang L. Different frequency repetitive transcranial magnetic stimulation (rTMS) for post-traumatic stress disorder (PTSD): A systematic review and meta-analysis. J Psychiatr Res. 2017; 89:125-135. doi: 10.1016/j.jpsychires.2017.02.021. [PubMed: 28278422].
https://doi.org/10.1016/j.jpsychires.2017.02.021
PMid:28278422
 
2. Edinoff AN, Hegefeld TL, Petersen M, Patterson JC, Yossi C, Slizewski J, Osumi A, Cornett EM, Kaye A, Kaye JS, Javalkar V. Transcranial magnetic stimulation for post-traumatic stress disorder. Front Psychiatry. 2022; 13:701348. doi:10.3389/fpsyt.2022.701348. [PubMed: 35711594].
https://doi.org/10.3389/fpsyt.2022.701348
PMid:35711594 PMCid:PMC9193572
 
3. Rumball F, Happé F, Grey N. Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM-5 and Non-DSM-5 Traumatic Life Events. Autism Res. 2020;13(12):2122-2132. doi: 10.1002/aur.2306. [PubMed: 32319731].
https://doi.org/10.1002/aur.2306
PMid:32319731
 
4. Armenta RF, Walter KH, Geronimo-Hara TR, Porter B, Stander VA, LeardMann CA; Millennium Cohort Study Team. Longitudinal trajectories of comorbid PTSD and depression symptoms among U.S. service members and veterans. BMC Psychiatry. 2019;19(1):396. doi: 10.1186/s12888-019-2375-1 [PubMed: 31836015].
https://doi.org/10.1186/s12888-019-2375-1
PMid:31836015 PMCid:PMC6911296
 
5. Olff M. Sex and gender differences in post-traumatic
 
stress disorder: an update. Eur J Psychotraumatol. 2017;8(sup4):1351204. doi: 10.1080/20008198.2017.1351204. [PubMed: PMC5632782].
https://doi.org/10.1080/20008198.2017.1351204
PMCid:PMC5632782
 
6. Maldonado R, Torrens M. Cannabis research: Risks of recreational use and potential medical applications. Eur Neuropsychopharmacol. 2020; 36:167-168. doi: 10.1016/j.euroneuro.2020.06.009. [PubMed: 32620256].
https://doi.org/10.1016/j.euroneuro.2020.06.009
PMid:32620256 PMCid:PMC7326423
 
7. Philip NS, Doherty RA, Faucher C, Aiken E, van 't Wout‐Frank M. Transcranial magnetic stimulation for post-traumatic stress disorder and major depression: comparing commonly used clinical protocols. J Trauma Stress. 2022;35(1):101-8. doi:10.1002/jts.22686. [PubMed: 33973681].
https://doi.org/10.1002/jts.22686
PMid:33973681 PMCid:PMC8581062
 
8. Philip NS, Barredo J, Aiken E, Carpenter LL. Neuroimaging Mechanisms of Therapeutic Transcranial Magnetic Stimulation for Major Depressive Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging. 2018;3(3):211-222. doi: 10.1016/j.bpsc.2017.10.007 .[PubMed: 29486862].
https://doi.org/10.1016/j.bpsc.2017.10.007
PMid:29486862 PMCid:PMC5856477
 
9. Jiang C, Li Z, Wang J, Liu L, Luo G, Zheng X. Effectiveness of repetitive transcranial magnetic stimulation combined with a brief exposure procedure for post-stroke post-traumatic stress disorder. J Affect Disord. 2023; 326:89-95. doi: 10.1016/j.jad.2023.01.096. [PubMed: 36717030].
https://doi.org/10.1016/j.jad.2023.01.096
PMid:36717030
 
10. Belsher BE, Beech EH, Reddy MK, Smolenski DJ, Rauch SAM, Kelber M, Issa F, Lewis C, Bisson JI. Advances in repetitive transcranial magnetic stimulation for post-traumatic
 
stress disorder: A systematic review. J Psychiatr Res.
 
2021; 138:598-606. doi:10.1016/j.jpsychires.2021.05.011. [PubMed: 33992983].
https://doi.org/10.1016/j.jpsychires.2021.05.011
PMid:33992983
 
11. Du J, Diao H, Zhou X, Zhang C, Chen Y, Gao Y, Wang Y. Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention. Med. Rev. 2022;2(3):219-43. doi:10.1515/mr-2022-0012
https://doi.org/10.1515/mr-2022-0012
PMid:37724188 PMCid:PMC10388753
 
12. Kind S, Otis JD. The Interaction Between Chronic Pain and PTSD. Curr Pain Headache Rep. 2019;23(12):91. doi: 10.1007/s11916-019-0828-3. [PubMed: 31781875].
https://doi.org/10.1007/s11916-019-0828-3
PMid:31781875
 
13. Richter-Levin, G, Stork, O, Schmidt, MV. Animal models of PTSD: a challenge to be met. Mol Psychiatr. 2019; 24:1135-56. doi:10.1038/s41380-018-0272-5. [PubMed: 30816289].
https://doi.org/10.1038/s41380-018-0272-5
PMid:30816289 PMCid:PMC6756084
 
14. Millon T, Davis R. Millon Clinical Multiaxial Inventory-II: MCMI-II. Minneapolis, MN: National Computer Systems; 1987. https://www.scirp.org/(S(351jmbntvnsjt1aadkposzje))/reference/ReferencesPapers.aspx?ReferenceID=1302321
 
15. Sharifi AA, Moulavi H, Namdari K. The validity of MCMI-III scales. Knowledge & Res in Appl Psychol. 2008; 34: 27-38. file:///C:/Users/javan/Downloads/33413863402.pdf
 
16. Alavi SS, Alaghemandan H, Maracy MR, Jannatifard F, Eslami M, Ferdosi M. Impact of addiction to internet on a number of psychiatric symptoms in students of Isfahan universities, Iran, 2010. Int J Prev Med. 2012;3(2):122. [PubMed: 22347609].
 
17. Cheng P, Zhou Y, Xu LZ, Chen YF, Hu RL, Zou YL, Li ZX, Zhang L, Shun Q, Yu X, Li LJ, Li WH. Clinical application of repetitive transcranial magnetic stimulation for post-traumatic stress disorder: A literature review. World J Clin Cases. 2021; 9: 8658-8665. doi:10.12998/wjcc. v9. i29.8658. [PubMed: 34734044].
https://doi.org/10.12998/wjcc.v9.i29.8658
PMid:34734044 PMCid:PMC8546820
 
18. Harris A, Reece J. Transcranial magnetic stimulation as a treatment for post-traumatic stress disorder: A meta-analysis. J Affect Disord. 2021; 289: 55-65. doi: 10.1016/j.jad.2021.04.003]. [PubMed: 33940319].
https://doi.org/10.1016/j.jad.2021.04.003
PMid:33940319
 
19. Kozel FA, Van Trees K, Larson V, Phillips S, Hashimie J, Gadbois B, Johnson S, Gallinati J, Barrett B, Toyinbo P, Weisman M, Centorino M, Gibson CA, Catalano G. One hertz versus ten hertz repetitive TMS treatment of PTSD: A randomized clinical trial. Psychiatry Res. 2019;273:153-162. doi: 10.1016/j.psychres.2019.01.004. [PubMed: 30641346].
https://doi.org/10.1016/j.psychres.2019.01.004
PMid:30641346
 
20. McGirr A, Devoe DJ, Raedler A, Debert CT, Ismail Z, Berlim MT. Repetitive Transcranial Magnetic Stimulation for the Treatment of Post-traumatic Stress Disorder: A Systematic Review and Network Meta-analysis: La Stimulation Magnétique Transcrânienne Répétitive Pour le Traitement du Trouble de Stress Post-Traumatique : Une Revue Systématique et une Méta-Analyse en Réseau. Can J Psychiatry. 2021;66(9):763-773. doi: 10.1177/0706743720982432. [PubMed: 33355483].
https://doi.org/10.1177/0706743720982432
PMid:33355483 PMCid:PMC8504289
 
21. Edinoff AN, Hegefeld TL, Petersen M, Patterson JC 2nd, Yossi C, Slizewski J, Osumi A, Cornett EM, Kaye A, Kaye JS, Javalkar V, Viswanath O, Urits I, Kaye AD. Transcranial Magnetic Stimulation for Post-Traumatic Stress Disorder. Front Psychiatry. 2022; 13:701348. doi: 10.3389/fpsyt.2022.701348. [PubMed: 35711594].
https://doi.org/10.3389/fpsyt.2022.701348
PMid:35711594 PMCid:PMC9193572
 
22. Meister L, Dietrich AC, Stefanovic M, Bavato F, Rosi-Andersen A, Rohde J, Offenhammer B, Seifritz E, Schäfer I, Ehring T, Barth J, Kleim B. Pharmacological memory modulation to augment trauma-focused psychotherapy for PTSD: a systematic review of randomised controlled trials. Transl Psychiatry. 2023 Jun 15;13(1):207. doi: 10.1038/s41398-023-02495-2. [PubMed: 37321998].
https://doi.org/10.1038/s41398-023-02495-2
PMid:37321998 PMCid:PMC10272208
 
23. Amos T, Stein DJ, Ipser JC. Pharmacological interventions for preventing post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2014;(7):CD006239. doi: 10.1002/14651858.CD006239.pub2. [PubMed: 25001071].
https://doi.org/10.1002/14651858.CD006239.pub2
PMid:25001071 PMCid:PMC11064759
 
24. Zanos P, Gould TD. Mechanisms of ketamine action as an antidepressant. Mol Psychiatry. 2018 Apr;23(4):801-811. doi: 10.1038/mp.2017.255. PMID: 29532791].
https://doi.org/10.1038/mp.2017.255
PMid:29532791 PMCid:PMC5999402
 
25. Sessa B. MDMA and PTSD treatment: "PTSD: From novel pathophysiology to innovative therapeutics". Neurosci Lett. 2017; 649:176-180. doi: 10.1016/j.neulet.2016.07.004. [PubMed: 27394687].
https://doi.org/10.1016/j.neulet.2016.07.004
PMid:27394687
 
26. Schrader C, Ross A. A Review of PTSD and Current Treatment Strategies. Mo Med. 2021; 118:546-51. [PubMed: 34924624].
 
27. Langevin JP, Koek RJ, Schwartz HN, Chen JWY, Sultzer DL, Mandelkern MA, Kulick AD, Krahl SE. Neuromodulation for Treatment-Refractory PTSD. Fed Pract. 2017;34(Suppl 2):20S-33S. [PubMed: 30766304].
Razavi International Journal of Medicine
Volume 12, Issue 2
May 2024
Pages 8-14

Files

Share

How to cite

Statistics