Transcranial magnetic stimulation may reduce combat-related post-traumatic stress disorder symptoms

1. In adult patients with combat-related post-traumatic stress disorder (PTSD) undergoing residential treatment (RT), those receiving active transcranial magnetic stimulation (TMS) had significantly reduced PTSD symptoms compared to those receiving sham TMS.

Evidence Rating Level: 1 (Excellent)

PTSD is a debilitating disorder that, in principle, is best treated with RT, an inpatient, long-term program of massed prolonged exposure reinforced with cognitive behavioural therapy. The inpatient setting is also well-suited to adding interventions such as TMS. TMS has been approved for major depressive disorder and obsessive-compulsive disorder, and has been studied for PTSD treatment. However, no randomized controlled trials have assessed the efficacy of TMS in combination with RT. This single-center, randomized controlled trial included active-duty or veteran military service members between the ages of 18 and 65 who met the Diagnostic and Statistical Manual of Mental Disorders-5 criteria for PTSD. All patients were admitted to the RT PTSD program and were randomized 1:1 to receive active TMS (n = 60; mean [SD] age, 37.1 [6.8] years; 8% female) or sham TMS (n = 59; mean [SD] age, 38.1 [6.1] years; 12% female). Patients receiving TMS underwent daily treatments for a maximum of 20 sessions. The primary outcome measure was the change in PTSD Checklist for DSM-5 (PCL-5) scores. At the end of treatment (20 days), the active TMS arm had a significantly greater decrease in PCL-5 scores compared to the sham TMS arm (−5.94 (95% CI, −11.77 to −0.10; P = .02). This difference remained significant at 3-month follow-up (−12.30; 95% CI, −22.03 to −2.57; P = .008). The active TMS arm also had significantly greater decreases in Clinician-Administered Posttraumatic Stress Disorder Scale for DSM-5 scores (−6.03 (95% CI, −10.84 to −1.22; P = .008) and Patient Health Questionnaire–9 scores (−3.45; 95% CI, −0.03 to −6.86; P = .03). There were no serious adverse effects and the frequency of adverse events was similar in both groups.

Click here to read the study in JAMA Network Open

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