Substance Abuse Residential Rehabilitation Treatment Program, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Department of Psychiatry, School of Medicine, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA.
Department of Psychiatry, School of Medicine, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA; VISN-19 Whole Health Flagship Site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA.
Psychiatry Res. 2024 Aug;338:115995. doi: 10.1016/j.psychres.2024.115995. Epub 2024 May 29.
The use of methamphetamine in the United States is increasing, contributing now to the "fourth wave" in the national opioid epidemic crisis. People who suffer from methamphetamine use disorder (MUD) have a higher risk of death. No pharmacological interventions are approved by the FDA and psychosocial interventions are only moderately effective. Transcranial Magnetic Stimulation (TMS) is a relatively novel FDA-cleared intervention for the treatment of Major Depressive Disorder (MDD) and other neuropsychiatric conditions. Several lines of research suggest that TMS could be useful for the treatment of addictive disorders, including MUD. We will review those published clinical trials that show potential effects on craving reduction of TMS when applied over the dorsolateral prefrontal cortex (DLPFC) also highlighting some limitations that affect their generalizability and applicability. We propose the use of the Koob and Volkow's neurocircuitry model of addiction as a frame to explain the brain effects of TMS in patients with MUD. We will finally discuss new venues that could lead to a more individualized and effective treatment of this complex disorder including the use of neuroimaging, the exploration of different areas of the brain such as the frontopolar cortex or the salience network and the use of biomarkers.
在美国,甲基苯丙胺的使用正在增加,这导致了全国阿片类药物流行危机的“第四波”。患有甲基苯丙胺使用障碍(MUD)的人死亡风险更高。目前,FDA 尚未批准任何药物干预措施,而心理社会干预措施的效果也只是中等。经颅磁刺激(TMS)是一种相对较新的 FDA 批准的干预措施,用于治疗重度抑郁症(MDD)和其他神经精神疾病。有几条研究线索表明,TMS 可能对治疗成瘾障碍(包括 MUD)有用。我们将回顾那些显示 TMS 对减少外侧前额叶皮层(DLPFC)上的渴望有潜在影响的已发表临床试验,同时也强调了一些影响其普遍性和适用性的局限性。我们建议使用 Koob 和 Volkow 的成瘾神经回路模型作为解释 TMS 对 MUD 患者大脑影响的框架。最后,我们将讨论一些新的途径,这些途径可能会导致对这种复杂疾病的更个体化和有效的治疗,包括使用神经影像学、探索大脑的不同区域,如额极皮层或突显网络,以及使用生物标志物。
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