Journal: Biological Psychiatry (2021)
Authors: M Isserles, A Tendler, Y Roth, A Bystritsky, DM Blumberger, H Ward, D Feifel, L Viner, W Duffy, J Zohar, CJ Keller, MT Bhati, A Etkin, MS George, I Filipcic, K Lapidus, L Casuto, S Vaishnavi, A Stein, L Deutsch, F Deutsch, O Morales, ZJ Daskalakis, A Zangen, KJ Ressler
Background:
PTSD is both prevalent and debilitating. While Deep TMS has shown preliminary efficacy, exposure therapy remains the most efficacious, though limited, treatment in PTSD. The medial prefrontal cortex (mPFC) is implicated in extinction learning, suggesting that concurrent mPFC stimulation may enhance exposure therapy.
Objective:
This randomized controlled multicenter trial set out to examine the efficacy and safety of mPFC Deep TMS combined with a brief exposure procedure in patients with PTSD.
Methods:
Immediately following exposure to their trauma narrative, 125 outpatients were randomly assigned to receive Deep TMS or sham. Twelve sessions were administered over 4 weeks, with a primary end point of change in 5-week Clinician-Administered PTSD Scale for DSM-5 score. This clinical study did not include biological markers.
Results:
Clinician-Administered PTSD Scale for DSM-5 score improved significantly in both groups at 5 weeks, though the improvement was smaller in the Deep TMS group (16.32) compared with the sham group (20.52; p=0.027). At 9 weeks, improvement continued in Clinician-Administered PTSD Scale for DSM-5 score in both groups but remained smaller in Deep TMS (19.0) versus sham (24.4; p=0.024).
Conclusions:
Both groups showed significant PTSD symptom improvement, possibly from the brief script-driven imagery exposure. While this design was unable to rule out placebo effects, the magnitude and durability of improvement suggest that repeated ultra–brief exposure therapy alone may be an effective treatment for PTSD, warranting additional study. The surprising and unexpected effect in the Deep TMS group also suggests that repeated mPFC stimulation with the H7 Coil may interfere with trauma memory–mediated extinction. These results provide new insight for Deep TMS approaches for possible future avenues to treat PTSD.
View Full Publication: Deep Transcranial Magnetic Stimulation Combined With Brief Exposure for Posttraumatic Stress Disorder: A Prospective Multisite Randomized Trial – ScienceDirect
