Skip to main content
SpringerLink
Log in

A Review of Transcranial Magnetic Stimulation as a Treatment for Post-Traumatic Stress Disorder

  • Military Mental Health (CH Warner, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Patients with post-traumatic stress disorder (PTSD) may fail to achieve adequate relief despite treatment with psychotherapy, pharmacotherapy, or complementary medicine treatments. Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation procedure that can alter neuronal activity through administration of various pulse sequences and frequencies. TMS may theoretically have promise in correcting alterations observed in patients with PTSD. While the precise treatment location and pulse sequences remain undefined, current evidence suggests two promising targets, the right dorsolateral prefrontal cortex and the medial prefrontal cortex. The beneficial effects may be due to the secondary or indirect regulation of other brain structures that may be involved in the mood regulatory network. TMS may be an effective part of a comprehensive treatment program for PTSD, although significant work remains to define optimal treatment parameters and clarify how it fits within a broader traditional treatment program.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Benedek DM, Wynn G. Epidemiology. In: Benedek DM, Wynn G, editors. Clinical Management of PTSD. Arlington: American Psychiatric Publishing; 2011. p. 11–43.

    Google Scholar 

  2. Taylor S. Clinician's Guide to PTSD: A Cognitive-behavioral Approach. New York: The Guildord Press; 2006.

    Google Scholar 

  3. Boggio PS, Rocha M, Oliveira MO, Fecteau S, Cohen RB, Campanha C, et al. Noninvasive brain stimulation with high-frequency and low-intensity repetitive transcranial magnetic stimulation treatment for posttraumatic stress disorder. J Clin Psychiatry. 2010;71:992–9. This study showed a clear difference in response following left or right sided stimulation, with right sided being more effective in alleviating PTSD symptoms.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Alexander B, Lund BC, Bernardy NC, Christopher ML, Friedman MJ. Early discontinuation and suboptimal dosing of prazosin: a potential missed opportunity for veterans with posttraumatic stress disorder. J Clin Psychiatry. 2015;76:e639–644.

    Article  PubMed  Google Scholar 

  5. Bolognini N, Ro T. Transcranial magnetic stimulation: disrupting neural activity to alter and assess brain function. J Neurosc Off J Soc Neurosci. 2010;30:9647–50.

    Article  CAS  Google Scholar 

  6. Horvath JC, Perez JM, Forrow L, Fregni F, Pascual-Leone A. Transcranial magnetic stimulation: a historical evaluation and future prognosis of therapeutically relevant ethical concerns. J Med Ethics. 2011;37:137–43.

    Article  PubMed  Google Scholar 

  7. McCann UD, Kimbrell TA, Morgan CM, Anderson T, Geraci M, Benson BE, et al. Repetitive transcranial magnetic stimulation for posttraumatic stress disorder. Arch Gen Psychiatry. 1998;55:276–9.

    Article  CAS  PubMed  Google Scholar 

  8. Hallett M. Transcranial magnetic stimulation: a primer. Neuron. 2007;55:187–99.

    Article  CAS  PubMed  Google Scholar 

  9. Deng ZD, Lisanby SH, Peterchev AV. Electric field depth-focality tradeoff in transcranial magnetic stimulation: simulation comparison of 50 coil designs. Brain Stimul. 2013;6:1–13. This study reviews the use of different coil designs which could be informative to clinicians developing either research or clinical studies on the uses of TMS as a treatment for PTSD.

    Article  PubMed Central  PubMed  Google Scholar 

  10. O'Reardon JP, Peshek AD, Romero R, Cristancho P. Neuromodulation and transcranial magnetic stimulation (TMS): a 21st century paradigm for therapeutics in psychiatry. Psychiatry. 2006;3:30–40. Edgmont (Pa. : Township).

    PubMed Central  PubMed  Google Scholar 

  11. Wassermann EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalogr Clin Neurophysiol. 1998;108:1–16.

    Article  CAS  PubMed  Google Scholar 

  12. George MS, Raman R, Benedek DM, Pelic CG, Grammer GG, Stokes KT, et al. A two-site pilot randomized 3 day trial of high dose left prefrontal repetitive transcranial magnetic stimulation (rTMS) for suicidal inpatients. Brain Stimul. 2014;7:421–31.

    Article  PubMed  Google Scholar 

  13. Semple WE, Goyer P, McCormick R, Morris E, Compton B, Muswick G, et al. Preliminary report: brain blood flow using PET in patients with posttraumatic stress disorder and substance-abuse histories. Biol Psychiatry. 1993;34:115–8.

    Article  CAS  PubMed  Google Scholar 

  14. Shin LM, Kosslyn SM, McNally RJ, Alpert NM, Thompson WL, Rauch SL, et al. Visual imagery and perception in posttraumatic stress disorder A positron emission tomographic investigation. Arch Gen Psychiatry. 1997;54:233–41.

    Article  CAS  PubMed  Google Scholar 

  15. McNally RJ. Cognitive abnormalities in post-traumatic stress disorder. Trends Cogn Sci. 2006;10:271–7.

    Article  PubMed  Google Scholar 

  16. Moore DF, Jerusalem A, Nyein M, Noels L, Jaffee MS, Radovitzky RA. Computational biology—modeling of primary blast effects on the central nervous system. NeuroImage. 2009;47 Suppl 2:T10–20.

    Article  PubMed  Google Scholar 

  17. Etkin A, Wager TD. Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. Am J Psychiatry. 2007;164:1476–88.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Patel R, Spreng RN, Shin LM, Girard TA. Neurocircuitry models of posttraumatic stress disorder and beyond: a meta-analysis of functional neuroimaging studies. Neurosci Biobehav Rev. 2012;36:2130–42.

    Article  PubMed  Google Scholar 

  19. Rossi S, De Capua A, Tavanti M, Calossi S, Polizzotto NR, Mantovani A, et al. Dysfunctions of cortical excitability in drug-naïve posttraumatic stress disorder patients. Biol Psychiatry. 2009;66(1):54-61.

  20. Kim SY, Lee DW, Kim H, Bang E, Chae JH, Choe BY. Chronic repetitive transcranial magnetic stimulation enhances GABAergic and cholinergic metabolism in chronic unpredictable mild stress rat model: (1)H-NMR spectroscopy study at 11.7T. Neurosci Lett. 2014;572:32–7.

    Article  CAS  PubMed  Google Scholar 

  21. Francati V, Vermetten E, Bremner JD. Functional neuroimaging studies in posttraumatic stress disorder: review of current methods and findings. Depress Anxiety. 2007;24:202–18.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Shin LM, Handwerger K. Is posttraumatic stress disorder a stress-induced fear circuitry disorder? J Trauma Stress. 2009;22:409–15.

    Article  PubMed  Google Scholar 

  23. Isserles M, Shalev AY, Roth Y, Peri T, Kutz I, Zlotnick E, et al. Effectiveness of deep transcranial magnetic stimulation combined with a brief exposure procedure in post-traumatic stress disorder--a pilot study. Brain Stimul. 2013;6:377–83. This study evaluated the use of rTMS therapy in conjuction with exposure therapy, a combination which may be the ideal clinical treatment as compared to stand-alone rTMS therapy.

    Article  PubMed  Google Scholar 

  24. Grisaru N, Amir M, Cohen H, Kaplan Z. Effect of transcranial magnetic stimulation in posttraumatic stress disorder: a preliminary study. Biol Psychiatry. 1998;44:52–5.

    Article  CAS  PubMed  Google Scholar 

  25. Rosenberg PB, Mehndiratta RB, Mehndiratta YP, Wamer A, Rosse RB, Balish M. Repetitive transcranial magnetic stimulation treatment of comorbid posttraumatic stress disorder and major depression. J Neuropsychiatry Clin Neurosci. 2002;14:270–6.

    Article  PubMed  Google Scholar 

  26. Cohen H, Kaplan Z, Kotler M, Kouperman I, Moisa R, Grisaru N. Repetitive transcranial magnetic stimulation of the right dorsolateral prefrontal cortex in posttraumatic stress disorder: a double-blind, placebo-controlled study. Am J Psychiatry. 2004;161:515–24.

    Article  PubMed  Google Scholar 

  27. Nam DH, Pae CU, Chae JH. Low-frequency, repetitive transcranial magnetic stimulation for the treatment of patients with posttraumatic stress disorder: a double-blind, sham-controlled study. Clin Psychopharmacol Neurosci Off Sci J Kor Coll Neuropsychopharmacol. 2013;11:96–102.

    Article  Google Scholar 

  28. Oznur T, Akarsu S, Celik C, Bolu A, Ozdemir B, Akcay BD, et al. Is transcranial magnetic stimulation effective in treatment-resistant combat related posttraumatic stress disorder? Neurosciences (Riyadh, Saudi Arabia). 2014;19:29–32.

    Google Scholar 

  29. Osuch EA, Benson BE, Luckenbaugh DA, Geraci M, Post RM, McCann U. Repetitive TMS combined with exposure therapy for PTSD: a preliminary study. J Anxiety Disord. 2009;23:54–9.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Wahbeh H, Senders A, Neuendorf R, Cayton J. Complementary and alternative medicine for posttraumatic stress disorder symptoms: a systematic review. J Evid Based Complement Altern Med. 2014;19:161–75.

    Article  Google Scholar 

  31. Watts BV, Landon B, Groft A, Young-Xu Y. A sham controlled study of repetitive transcranial magnetic stimulation for posttraumatic stress disorder. Brain Stimul. 2012;5:38–43.

    Article  PubMed  Google Scholar 

  32. Berlim MT, Van Den Eynde F. Repetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex for treating posttraumatic stress disorder: an exploratory meta-analysis of randomized, double-blind and sham-controlled trials. Can J Psychiatry. 2014;59:487–96.

    PubMed Central  PubMed  Google Scholar 

  33. Karsen EF, Watts BV, Holtzheimer PE. Review of the effectiveness of transcranial magnetic stimulation for post-traumatic stress disorder. Brain Stimul. 2014;7:151–7.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Caroline Clark, Jeffrey Cole, Christine Winter, Kathy Williams, and Geoffrey Grammer declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclaimer

The views expressed in this article are those of the authors and do not reflect the official policy of the Departments of Army/Navy/Air Force, Department of Defense, or U.S. Government. The use of trade names in this publication does not imply endorsement by the authors or the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government, nor does it imply criticism of similar products or devices not mentioned. This study did not receive external direct or indirect funding. The authors declare no financial, commercial or other conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA

    Caroline Clark & Christine Winter

  2. National Intrepid Center of Excellence, Walter Reed National Military Medical Center, 4860 South Palmer Road, Bethesda, MD, 20889-5649, USA

    Jeffrey Cole, Kathy Williams & Geoffrey Grammer

Authors
  1. Caroline Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey Cole
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christine Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kathy Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Geoffrey Grammer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Geoffrey Grammer.

Additional information

This article is part of the Topical Collection on Military Mental Health

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Clark, C., Cole, J., Winter, C. et al. A Review of Transcranial Magnetic Stimulation as a Treatment for Post-Traumatic Stress Disorder. Curr Psychiatry Rep 17, 83 (2015). https://doi.org/10.1007/s11920-015-0621-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-015-0621-x

Keywords

Search

Navigation