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. 2023 Dec:155:105477.
doi: 10.1016/j.neubiorev.2023.105477. Epub 2023 Nov 25.

Managing substance use in patients receiving therapeutic repetitive transcranial magnetic stimulation: A scoping review

Victor M Tang  1 , Christine Ibrahim  2 , Terri Rodak  3 , Rachel Goud  4 , Daniel M Blumberger  5 , Daphne Voineskos  6 , Bernard Le Foll  7
Affiliations

Managing substance use in patients receiving therapeutic repetitive transcranial magnetic stimulation: A scoping review

Victor M Tang et al. Neurosci Biobehav Rev. 2023 Dec.

Abstract

Repetitive Transcranial Magnetic Stimulation (rTMS) is an invaluable treatment option for neuropsychiatric disorders. Co-occurring recreational and nonmedical substance use can be common in those presenting for rTMS treatment, and it is unknown how it may affect the safety and efficacy of rTMS for the treatment of currently approved neuropsychiatric indications. This scoping review aimed to map the literature on humans receiving rTMS and had a history of any type of substance use. The search identified 274 articles providing information on inclusion/exclusion criteria, withdrawal criteria, safety protocols, type of rTMS and treatment parameters, adverse events and effect on primary outcomes that related to substance use. There are neurophysiological effects of substance use on cortical excitability, although the relevance to clinical rTMS practice is unknown. The current literature supports the safety and feasibility of delivering rTMS to those who have co-occurring neuropsychiatric disorder and substance use. However, specific details on how varying degrees of substance use alters the safety, efficacy, and mechanisms of rTMS remains poorly described.

Keywords: Repetitive transcranial magnetic stimulation; Review; Substance use.

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Conflict of interest statement

Declaration of Competing Interest Dr. V.M. Tang has received research support through the Brain & Behavior Research Foundation, the Physician Services Incorporated Foundation, Research in Addiction Medicine Scholars (RAMS) Program (R25DA033211) from the National Institute on Drug Abuse, and the Labatt Family Network for Research on the Biology of Depression. Dr. D. Voineskos received research support from CIHR, the Temerty Centre and through the Centre for Addiction and Mental Health, and holds the Labatt Family Professorship in Depression Biology, a University Named Professorship at the University of Toronto. Dr. D.M. Blumberger has received research support from CIHR, NIH, Brain Canada and the Temerty Family through the CAMH Foundation and the Campbell Family Research Institute. He received research support and in-kind equipment support for an investigator-initiated study from Brainsway Ltd. He is the site principal investigator for three sponsor-initiated studies for Brainsway Ltd. He also receives in-kind equipment support from Magventure for two investigator-initiated studies. He received medication supplies for an investigator-initiated trial from Indivior. Dr Le Foll is supported by CAMH, Waypoint Centre for Mental Health Care, a clinician-scientist award from the department of Family and Community Medicine of the University of Toronto and a Chair in Addiction Psychiatry from the department of Psychiatry of University of Toronto. His only relevant disclosure for the current manuscript is the donation of a coil for a Transcranial magnetic stimulation (TMS) study from Brainsway.

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