Objective-We aimed to investigate the efficacy of 20 Hz repetitive transcranial magnetic stimulation (rTMS) of either right or left dorsolateral prefrontal cortex (DLPFC) as compared to sham rTMS for the relief of posttraumatic stress disorder (PTSD)-associated symptoms.Method-In this double-blind, placebo-controlled phase II trial conducted between October 2005 and July 2008, 30 patients with DSM-IV-diagnosed PTSD were randomly assigned to receive 1 of the following treatments: active 20 Hz rTMS of the right DLPFC, active 20 Hz rTMS of the left DLPFC, or sham rTMS. Treatments were administered in 10 daily sessions over 2 weeks. A blinded rater assessed severity of core PTSD symptoms, depression, and anxiety before, during, and after completion of the treatment protocol. In addition, a battery of neuropsychological tests was measured before and after treatment.
Results-Resultsshow that both active conditions-20 Hz rTMS of left and right DLPFCinduced a significant decrease in PTSD symptoms as indexed by the PTSD Checklist and Treatment Outcome PTSD Scale; however, right rTMS induced a larger effect as compared to left rTMS. In addition, there was a significant improvement of mood after left rTMS and a significant reduction of anxiety following right rTMS. Improvements in PTSD symptoms were long lasting; effects were still significant at the 3-month follow-up. Finally, neuropsychological evaluation showed that active 20 Hz rTMS is not associated with cognitive worsening and is safe for use in patients with PTSD.Conclusions-These results support the notion that modulation of prefrontal cortex can alleviate the core symptoms of PTSD and suggest that high-frequency rTMS of right DLPFC might be the optimal treatment strategy. Although selective serotonin reuptake inhibitors (SSRIs)-among other antidepressantshave resulted in various degrees of improvement in patients with PTSD, there is no definitive pharmacotherapy available to date for the treatment of this debilitating disorder. A review of 37 clinical trials of pharmacotherapies 4 found inadequate evidence to determine the value of antidepressants, benzodiazepines, anticonvulsants, α-blockers, and secondgeneration antipsychotics for the treatment of PTSD. Even so, according to an American Psychiatric Association guideline, 5 SSRIs remain the first line of treatment for PTSD. In addition, due to the complex nature of this disorder, individuals with PTSD also seem to benefit from 10 to 12 sessions of cognitive-behavioral therapy, prolonged-exposure therapy, or cognitive-processing therapy. Nevertheless, many individuals respond inadequately to currently available therapies, and research for more effective treatment paradigms is ongoing.
NIH Public AccessMost recently, repetitive transcranial magnetic stimulation (rTMS)-a method of noninvasive neuromodulation-has been emerging as a potentially effective technique in the treatment of PTSD. Indeed, rTMS has already been shown to be highly effective in the treatment of medically refractory depression 6 and is n...