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iTBS as a Possible Treatment for PTSD in Veterans


TMS-for-Veterans-with-PTSD

A new transcranial magnetic stimulation (TMS) technology, called intermittent theta-burst stimulation (iTBS), has shown promise for veterans diagnosed with post-traumatic stress disorder (PTSD). 

Post-traumatic stress disorder is a condition in which someone develops stress reactions after experiencing or witnessing a traumatic event. It is often accompanied by flashbacks and nightmares and can be triggered by stimulants such as certain sounds and smells. PTSD can have a significant detrimental impact on someone’s mood and can affect their ability to function normally in social and occupational (work) situations. 

TMS for PTSD Treatment

TMS is a noninvasive treatment that uses a magnetic coil placed over a certain area of the head. This coil, when activated, creates a magnetic field that stimulates nerve cells in certain regions of the brain associated with mood. (1) To learn more about how TMS works, click here

Currently, TMS is approved by the FDA (US Food and Drug Administration) to treat depression and obsessive-compulsive disorder. (2,3) But some clinics also use TMS as an off-label treatment to improve symptoms of PTSD. For example, the US Department of Veterans Affairs Center for Compassionate Care Innovation (CCI) supports the use of TMS for PTSD. The Providence VA Medical Center in Rhode Island is currently administering TMS treatments to veterans diagnosed with PTSD. (4)

Moreover, a study published in 2019 in Neuropsychiatric Disease and Treatment reports that TMS can improve symptoms of PTSD and traumatic brain injury (TBI). Patients who participated in this study had been diagnosed with both PTSD and TBI — these two conditions often occur together. (5)

iTBS Shows Promise as a Potential Treatment for PTSD

iTBS, also referred to as theta-burst transcranial magnetic stimulation, may be a promising treatment for individuals diagnosed with PTSD. A recent study published in the American Journal of Psychiatry explored the use of iTBS to relieve PTSD symptoms. Fifty veterans between the ages of 18 and 70, and diagnosed with PTSD participated in this study. It should be noted that almost 90 percent of participants were also diagnosed with depression. 

Half of the participants were given sham (placebo) iTBS treatment while the other half of participants were given active iTBS treatment. iTBS was administered over the dorsolateral prefrontal cortex of the brain— this is also where traditional TMS is administered. After two weeks of treatment, participants who received active iTBS showed improvement in their ability to function in social and work situations. After one month of treatment, patients who received active iTBS showed remarkable improvement in PTSD symptoms (both self-reported and clinician-reported), depression, and their ability to function in social and work situations. (6) 

Researchers Continue to Explore How TMS and iTBS Can Help Veterans Diagnosed With PTSD 

These results of the aforementioned study are consistent with previous studies that explore the use of TMS to relieve PTSD symptoms — this strengthens the hypothesis that TMS and iTBS are viable treatment options for patients with PTSD. Although recent studies show that iTBS is a promising option for improving symptoms of PTSD in veterans, more research is needed to understand the use of iTBS and TMS for patients with comorbid diagnoses, such as PTSD with depression and/or traumatic brain injury (TBI). 


Resources:

1. Transcranial magnetic stimulation. Mayo Clinic. Published November 27, 2018. Click Here. Accessed August 21, 2019. 

2. Horvath JC, Mathews J, Demitrack MA, Pascual-Leone A. The NeuroStar TMS device: conducting the FDA approved protocol for treatment of depression. The Journal of Visualized Experiments. 2010;12(45):2345. Click Here. Accessed August 21, 2019.

3. Rebecca Voelker, MSJ. Brain Stimulation Approved for Obsessive-Compulsive Disorder. The Journal of the American Medical Association. 2018;18;320(11):1098. Click Here. Accessed August 21, 2019.

4. Weistreich T. Veterans with PTSD treated with Transcranial Magnetic Stimulation. US Department of Veterans Affairs. Published June 1, 2018. Click Here. Accessed August 21, 2019

5. Namgung E, Kim M, and Yoon S. Repetitive transcranial magnetic stimulation in trauma-related conditions. Neuropsychiatric Disease and Treatment. 2019;15:701–712. Click Here. Accessed August 21, 2019.6. Philip NS, Barredo J, Aiken E, Larson V, Jones RN, Shea MT, Greenberg BD, and van ‘t Wout-Frank M. Theta-Burst Transcranial Magnetic Stimulation for Posttraumatic Stress Disorder. American Journal of Psychiatry. Published June 24, 2019. Click Here. Accessed August 21, 2019.

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.