Accelerated TMS for PTSD: Improving Treatment Response
Accelerated TMS for PTSD: Improving Treatment Response
February 3
Accelerated transcranial magnetic stimulation (TMS) is an advanced form of brain stimulation, emerging as a groundbreaking treatment option for patients who suffer from a variety of mental health conditions.
Part of what makes Accelerated TMS so promising is that it can treat patients that have previously been deemed treatment-resistant. This means that Accelerated TMS can be an effective treatment, even in cases where medication and psychotherapy have been inadequate.
The emergence of Accelerated TMS is considered a crucial addition to the treatment arsenal for post-traumatic stress disorder (PTSD), where it’s estimated that one-third of all patients are treatment-resistant.
This article examines how Accelerated TMS is able to treat PTSD. First, it’s important to understand PTSD and its wide-ranging impacts. We’ll then cover the mechanism of action for Accelerated TMS, including how it targets the root causes of PTSD symptoms and can provide individualized support to those affected by the condition.
Understanding PTSD and Its Impact
According to the Diagnostic and Statistical Manual of Mental Disorders, PTSD is characterized by exposure to a traumatic event, followed by a cluster of symptoms that cause significant distress. These symptoms can be severe, impairing an individual’s ability to navigate life’s daily challenges.
The common symptoms of PTSD fall into four main categories:
Intrusive thoughts: This includes recurrent, involuntary memories of the traumatic event, such as distressing dreams or flashbacks, where the person feels as if the event is happening again.
Avoidance: Individuals with PTSD often try to avoid thoughts, feelings, or external reminders associated with the trauma.
Negative alterations in cognition: This can manifest as persistent negative emotions, an inability to experience positive emotions, feelings of detachment, and distorted beliefs about oneself or the world.
Alterations in reactivity: This includes irritable or aggressive behavior, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbances.
These symptoms can have a significant impact. People with PTSD may struggle with maintaining relationships and engaging in activities that they used to enjoy. They might struggle with trust, intimacy, and social interactions, which can have serious knock-on effects in terms of performance at work or at school.
The National Center for PTSD estimates that 5 in 100 Americans suffer from PTSD, or 5% of the population in a given year. Higher rates of PTSD can be observed in certain subgroups of the general population, such as military veterans or survivors of sexual assault. This demonstrates that the root cause of PTSD is an intensely traumatic set of events which can permanently alter the individual’s perception of the world around them.
Co-occurring mental health conditions
It's important to note that PTSD often co-occurs with other mental health disorders. Common comorbidities include major depressive disorder, anxiety disorders (such as generalized anxiety disorder or panic disorder), and substance use disorders. Some individuals may also develop obsessive-compulsive disorder or bipolar disorder alongside PTSD.
The relationship between PTSD and these comorbid conditions is complex. Sometimes, the additional disorders may develop as a result of PTSD symptoms or as a means of coping with them. In other cases, pre-existing mental health conditions may increase vulnerability to developing PTSD after trauma exposure.
Traditional PTSD Treatments
Traditional PTSD treatments encompass a range of psychotherapeutic and pharmacological approaches, each with its own strengths and limitations.
Cognitive Processing Therapy (CPT)
Cognitive Processing Therapy focuses on helping individuals identify and challenge distorted thoughts related to their trauma. It aims to modify negative beliefs and thought patterns that contribute to PTSD symptoms. Through CPT, patients learn to process their traumatic experiences more effectively and develop healthier coping mechanisms.
Exposure Therapy
Exposure Therapy, on the other hand, involves gradually exposing individuals to trauma-related memories, situations, or objects in a safe, controlled environment. This approach helps patients confront and process their fears, reducing avoidance behaviors and diminishing the power of trauma-related triggers over time.
Pharmacological Treatments
Selective Serotonin Reuptake Inhibitors (SSRIs) are often the first-line medication for PTSD, helping to alleviate symptoms such as depression, anxiety, and sleep disturbances. Other medications, including prazosin for nightmares and mood stabilizers for emotional regulation, may also be prescribed.
The Limitations of Traditional Treatment Approaches for PTSD
Both psychotherapeutic interventions and pharmacological treatments have shown efficacy for many PTSD sufferers, but they are not without their challenges.
In the case of psychotherapy, some patients find the process of revisiting traumatic memories extremely distressing, which can lead to treatment dropout. Additionally, these therapies often require significant time and emotional investment, which can be difficult to maintain.
Pharmacological treatments, meanwhile, do not always reduce PTSD symptoms and some patients can also struggle with side effects. Medications are not designed to address trauma processing, which can be crucial for long-term recovery. A study conducted by Walter Alexander found that only 20-30% of combat veterans achieve remission from SSRIs alone.
Treatment-Resistant PTSD
It’s thought that one-in-three (33%) PTSD patients can be classified as treatment-resistant, meaning that they do not respond adequately to pharmacological or psychotherapeutic interventions.
Treatment resistance in PTSD can stem from various factors, including the severity and complexity of the trauma, comorbid mental health conditions, and individual neurobiological differences. The presence of ongoing stressors or lack of social support can also impede treatment progress.
Since traditional treatment approaches have proven ineffective in a high proportion of PTSD patients, developing alternative therapies has become an important field of research. Effective treatment solutions are paramount — not only for symptom relief, but also for improving overall quality of life.
Finding effective alternative treatments can reduce the risk of chronic health issues and prevent the cascading effects of untreated PTSD on personal relationships and societal functioning.
Introduction to Transcranial Magnetic Stimulation (TMS)
In recent years, Transcranial Magnetic Stimulation (TMS) has emerged as a potential solution for treatment-resistant PTSD. A non-invasive brain stimulation technique, TMS has gained significant traction due to its ability to target specific areas of the brain that are associated with PTSD.
By design, TMS therapy is able to alter key neurological pathways, targeting the root cause of PTSD symptoms instead of suppressing or minimizing their effect.
TMS devices generate brief magnetic pulses that pass through the skull and induce small electrical currents in affected regions of the brain. These currents can modulate neuronal activity, aiming to stabilize brain circuits that are involved in fear processing, emotional regulation, and memory reconsolidation.
What is Accelerated TMS and How Effective is it for Treating PTSD?
Accelerated Transcranial Magnetic Stimulation (aTMS) builds upon the foundation of standard TMS protocols, aiming to deliver treatment in a shorter time frame and achieve quicker symptom relief. Standard TMS protocols involve daily treatment sessions over a period of 4-6 weeks. Comparatively, Accelerated TMS can help PTSD patients to achieve remission in as little as 5 days.
One of the most notable characteristics of Accelerated TMS is that the shorter treatment duration does not compromise its effectiveness.
One notable study published in the American Journal of Psychiatry in 2019 examined the effects of accelerated TMS on PTSD symptoms. This randomized, double-blind, sham-controlled trial involved 50 veterans with treatment-resistant PTSD. Participants received either active or sham intermittent theta-burst stimulation (iTBS) to the right dorsolateral prefrontal cortex. The active treatment group showed a statistically significant reduction in PTSD symptoms compared to the sham group, as measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).
Another study, published in Frontiers in Psychiatry in 2023, investigated the effects of Accelerated TMS on PTSD and comorbid major depressive disorder. This open-label study included 80 participants who received 10 sessions of iTBS over 5 days. The results showed significant improvements in both PTSD and depressive symptoms, with effects maintained at 1-month follow-up.
Testing the Effectiveness of Accelerated TMS
The studies mentioned above, among others, have utilized various outcome measures to assess the efficacy of accelerated TMS for PTSD, including Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Davidson Trauma Scale (DTS).
Studies have consistently shown that Accelerated TMS not only improves core PTSD symptoms but also has positive effects on these related symptoms. Chung-Hung Chang et. al found in their 2023 study that PTSD patients reported a 33% reduction in DTS symptoms immediately after the treatment protocol, and reported a 52% reduction in DTS symptoms in the follow-up questionnaire one month later.
These findings, while promising, demonstrate why physicians see Accelerated TMS as one of the most exciting discoveries in psychiatry in recent decades. aTMS has been found to reduce symptoms of mental health disorders with a high rate of efficacy, and research shows clear improvements in the rate of remission compared to traditional treatment options.
Future Directions and Considerations
The body of research that demonstrates the effectiveness of Accelerated TMS for PTSD is rapidly evolving, and ongoing clinical trials are continually shaping our understanding of this promising treatment modality. As we look to the future, several key directions emerge, offering both exciting possibilities and important challenges to address.
Research into Accelerated TMS for PTSD is very much active, with numerous clinical trials underway across the globe. These studies aim to refine treatment protocols, identify optimal stimulation parameters, and better understand the long-term effects of Accelerated TMS. For instance, researchers are exploring various stimulation frequencies, intensities, and target locations to maximize therapeutic benefits while minimizing side effects, with significant progress being made by Stanford University in developing SAINT-TMS and by researchers at Acacia Clinics in developing HOPE-TMS.
Taking an evidence-based approach to innovative PTSD treatments allows for more personalized protocols to be developed, helping individuals who suffer from debilitating mental health conditions to achieve a greater level of care than traditional approaches can afford. HOPE-TMS uses individualized neuroimaging techniques to precisely locate target areas in each patient’s brain, and combining these advanced TMS therapies with standard medication and psychotherapy has been found to improve patient satisfaction.
As our understanding of PTSD neurobiology deepens, there's growing interest in personalizing these TMS protocols for optimal results. Accelerated TMS shows great promise, and it’s generally considered a safe procedure with a favorable side effect profile compared to many pharmacological interventions. As evidence for the treatment expands, there will likely be increased focus on its cost-effectiveness and a greater emphasis placed on making it more readily available to patients who suffer from treatment-resistant PTSD.
A Final Word from Acacia Clinics
Accelerated TMS represents a promising frontier in the treatment of Post-Traumatic Stress Disorder (PTSD). This innovative approach offers several potential advantages over traditional therapies, including rapid symptom relief, non-invasive application, and a favorable side effect profile. By targeting specific brain regions implicated in PTSD pathophysiology, Accelerated TMS has shown the ability to modulate neural circuits involved in fear processing, emotional regulation, and memory reconsolidation.
The growing body of research supporting accelerated TMS for PTSD is encouraging, with multiple studies demonstrating statistically significant improvements in PTSD symptoms as well as associated conditions like depression and anxiety. The rapid pace of scientific advancement in this field reflects that accelerated TMS has become a valuable addition to the therapeutic arsenal against this challenging disorder.
For individuals suffering from PTSD, especially those who have not found adequate relief through traditional treatments, accelerated TMS offers a ray of hope. If you or a loved one are struggling with PTSD and are interested in exploring accelerated TMS as a treatment option, we encourage you to reach out to Acacia Clinics. Our team of experienced physicians and medical researchers can provide more information about TMS therapy, assess your individual case, and help determine if this innovative treatment can help to improve your quality of life.
