Blyth Sophia H, Zabik Nicole L, Krosche Amanda, Prisciandaro James J, Ward Heather Burrell
Department of Psychiatry and Behavioral Sciences, Vanderbilt Psychiatric Hospital, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37232, USA.
Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA.
Curr Addict Rep. 2024 Apr;11(2):342-351. doi: 10.1007/s40429-024-00542-6. Epub 2024 Feb 5.
PURPOSE OF REVIEW: Co-occurring substance use disorders (SUDs) are highly common in individuals with psychiatric illnesses. Individuals with comorbid psychiatric illness and SUDs may experience poorer mental health and decreased treatment efficacy. However, there are no FDA-approved treatments for co-occurring substance use and psychiatric disorders. Repetitive transcranial magnetic stimulation (rTMS), a form of non-invasive brain stimulation that uses an electromagnetic field to change brain activity and behavior, may be a promising treatment for co-occurring disorders. A comprehensive literature search of PubMed, MEDLINE, and Google Scholar databases was conducted, and records were manually reviewed to include all studies testing the effects of rTMS for co-occurring SUDs. RECENT FINDINGS: Eleven studies met our inclusion criteria. The majority (7/11) assessed rTMS for the treatment of schizophrenia and co-occurring substance use, and the remaining three studies assessed rTMS for the treatment of SUDs in mood and anxiety disorders. Potential neural circuitry targets for the treatment of co-occurring substance use and post-traumatic stress disorder, anxiety disorder, and bipolar disorder are discussed. We identify future directions and considerations for rTMS treatment and research. Namely, we recommend identification of novel treatment targets, the use of pragmatic treatment approaches, the evaluation of rTMS for substance withdrawal, the evaluation of state dependence as a predictor of treatment efficacy, the use of neurobiological measurements to identify underlying neural circuitry, and the assessment of individual predictors of rTMS treatment response. SUMMARY: There is preliminary evidence suggesting rTMS may be effective to treat co-occurring disorders, but additional research is needed.
综述目的：物质使用障碍（SUDs）与精神疾病共病在个体中极为常见。患有精神疾病和物质使用障碍共病的个体可能心理健康状况较差且治疗效果降低。然而，目前尚无美国食品药品监督管理局（FDA）批准的针对物质使用与精神障碍共病的治疗方法。重复经颅磁刺激（rTMS）是一种非侵入性脑刺激形式，利用电磁场改变大脑活动和行为，可能是治疗共病障碍的一种有前景的方法。我们对PubMed、MEDLINE和谷歌学术数据库进行了全面的文献检索，并人工筛选记录以纳入所有测试rTMS对共病物质使用障碍影响的研究。 最新发现：11项研究符合我们的纳入标准。大多数研究（7/11）评估了rTMS治疗精神分裂症及共病物质使用障碍的效果，其余3项研究评估了rTMS治疗情绪和焦虑障碍中共病物质使用障碍的效果。文中讨论了治疗共病物质使用障碍与创伤后应激障碍、焦虑障碍和双相情感障碍的潜在神经回路靶点。我们确定了rTMS治疗及研究的未来方向和需要考虑的因素。具体而言，我们建议确定新的治疗靶点，采用务实的治疗方法，评估rTMS对物质戒断的作用，评估状态依赖性作为治疗效果预测指标，利用神经生物学测量来识别潜在神经回路，以及评估rTMS治疗反应的个体预测因素。 总结：有初步证据表明rTMS可能对治疗共病障碍有效，但仍需更多研究。
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