New York State Psychiatric Institute, New York, NY, USA; Columbia University Irving Medical Center, New York, NY, USA.
New York State Psychiatric Institute, New York, NY, USA; Columbia University Irving Medical Center, New York, NY, USA.
Prog Neuropsychopharmacol Biol Psychiatry. 2021 Jul 13;109:110290. doi: 10.1016/j.pnpbp.2021.110290. Epub 2021 Mar 4.
The expanding legalization of cannabis across the United States is associated with increases in cannabis use, and accordingly, an increase in the number and severity of individuals with cannabis use disorder (CUD). The lack of FDA-approved pharmacotherapies and modest efficacy of psychotherapeutic interventions means that many of those who seek treatment for CUD relapse within the first few months. Consequently, there is a pressing need for innovative, evidence-based treatment development for CUD. Preliminary evidence suggests that repetitive transcranial magnetic stimulation (rTMS) may be a novel, non-invasive therapeutic neuromodulation tool for the treatment of a variety of substance use disorders (SUDs), including recently receiving FDA clearance (August 2020) for use as a smoking cessation aid in tobacco cigarette smokers. However, the potential of rTMS for CUD has not yet been reviewed. This paper provides a primer on therapeutic neuromodulation techniques for SUDs, with a particular focus on reviewing the current status of rTMS research in people who use cannabis. Lastly, future directions are proposed for rTMS treatment development in CUD, with suggestions for study design parameters and clinical endpoints based on current gold-standard practices for therapeutic neuromodulation research.
美国大麻合法化范围不断扩大与大麻使用量增加相关,相应地,大麻使用障碍(CUD)患者的数量和严重程度也有所增加。由于缺乏 FDA 批准的药物治疗和心理治疗干预措施的疗效有限,许多寻求 CUD 治疗的患者在最初几个月内就会复发。因此,迫切需要为 CUD 开发创新的、基于证据的治疗方法。初步证据表明,重复经颅磁刺激(rTMS)可能是一种新颖的、非侵入性的神经调节治疗工具,可用于治疗多种物质使用障碍(SUDs),包括最近于 2020 年 8 月获得 FDA 批准,可用于帮助烟草烟民戒烟。然而,rTMS 治疗 CUD 的潜力尚未得到审查。本文提供了 SUD 治疗性神经调节技术的入门知识,特别关注了 rTMS 在使用大麻人群中的研究现状。最后,针对 CUD 中 rTMS 治疗开发提出了未来的方向,并根据治疗性神经调节研究的当前黄金标准实践,提出了研究设计参数和临床终点的建议。
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