TMS Deemed a Prospective Tool for Male Withdrawal Symptoms

Ti-Fei Yuan, PhD

Withdrawal syndrome is a common occurrence in individuals abstaining from addictive drugs like methamphetamine, which can result in fatigue, irritability, disturbed sleep, exhaustion, and symptoms of depression and anxiety that can last for months. With limited pharmaceutical tools for detoxification though, improving withdrawal symptoms can be difficult.

But a study conducted at Nanjing Shifosi Addiction Rehabilitation Center, Nan-jing, China, has shown that targeting the left dorsal-lateral prefrontal cortex (DLPFC) with transcranial magnetic stimulation (rTMS) may be a potential tool for improving withdrawal symptoms.

“There are only few drugs that alleviate withdrawal symptoms,” Ti-Fei Yuan, PhD, investigator on the study, told MD Magazine^Ò. “This is the first effort to manage drug withdrawal using brain stimulation technique, and it opens the possibility to help drug addicts in the first few days or weeks off from drug and may prevent relapse.”

From August 1, 2017, to February 15, 2018, 48 males with methamphetamine addiction participated in the double-blind, randomized, clinical, parallel-group intervention trial. The men were randomly assigned to treatment with either real rTMS (24 men) or sham rTMS (24 men).

The left DLPFC was targeted with high (10 Hz for 10 minutes) rTMS, and the intervention lasted for 10 days, with 2 days rest after the first 5 days (total, 12 days).

Bonferroni adjustments for multiple comparisons were used by post hoc t tests, and all post hoc t tests’ level of significance were designated at P < .05/5 = .01. All other P values were from two-sided tests and results were deemed statistically significant at P < .05, investigators noted.

Gleaned results showed that after 10 days of rTMS treatments, significant changes in withdrawal symptoms like craving, quality of sleep, and mood status (depression and anxiety), which all decreased (F3,32 = 198.18; P < .001; ηp2 = 0.81).

Specifically, craving decreased for the real rTMS group, according to the post hoc t test (t23 = 8.59; P < .001), compared to the sham rTMS group (t21 = 2.40; P = .046) following application of the Bonferroni correction for multiple comparisons.

Decreases in sleep difficulties were significant for the real rTMS group, according to the post hoc t test (t23 = 8.85; P < .001), compared to the sham rTMS group (t21 = 1.08; P = .29).

Depression decreased for the real rTMS group, according to the post hoc t test (t23 = 11.97; P < .001) compared to the sham rTMS group (t21 = 1.86; P = .08).

Anxiety also significantly decreased for the real rTMS group (t23 = 5.28; P < .001) compared to the sham rTMS group (t21 = 2.35; P = .03) after applying Bonferroni correction for multiple comparisons.

“Employing brain stimulation to help drug addict at all stages during rehabilitation is important—from early stage to off withdrawal, to middle stage of craving modulation, and to end stage of cognition recovery,” Yuan added.

Looking forward, Yuan and his team hope to encourage more scientists and clinicians to improve current TMS procedures as many unknowns still remain. Such unknowns Yuan hopes to investigate in the future include the relapse prevention effect or the long-lasting effect; the proper target, frequency and intensity for different individuals; pharmacological agents that can be taken to enhance the TMS treatment effect; and the effect of TMS on social behavior, risky behavior, and even criminal behaviors of addicts.

The study, "Targeting Withdrawal Symptoms in Men Addicted to Methamphetamine With Transcranial Magnetic Stimulation," was published online in JAMA on Wednesday.