“By positioning the left side of the coil close to the left dorsolateral prefrontal cortex (DLPFC), the H1 coil was used in a multisite study, leading to FDA approval for treatment-resistant depression. In this same position, the H1 coil was also explored as a possible treatment for negative symptoms of schizophrenia, bipolar depression, and migraine. When moved to different positions over the subject’s skull, the H1 coil was also explored as a possible treatment for other conditions. Such manipulation of the H1 coil was demonstrated for PTSD and alcohol dependence by positioning it over the medial prefrontal cortex (mPFC), for anxiety by positioning it over the right prefrontal cortex (rPFC), for auditory hallucinations and tinnitus by positioning it over the temporoparietal junction (TPJ), and for Parkinson’s and fatigue from multiple sclerosis (MS) by positioning it over the motor cortex (MC) and PFC. “

https://www.ncbi.nlm.nih.gov/pubmed/28190035

RCT w/ prelim support

“Case series, open trials, and randomized controlled studies have demonstrated preliminary support for treating PTSD with rTMS alone as well as with rTMS combined with psychotherapy.”

https://www.ncbi.nlm.nih.gov/pubmed/30098656

Comorbid MDD+PTSD

“Clinician-Administered PTSD Symptom scores reflected a general nonsignificant trend toward improvement, and subjects with comorbid major depression appeared to experience significant antidepressant benefit with treatment despite the fact that the doses used in this protocol were much smaller than those used to treat patients with major depressive disorder.”

Methods: “ Repetitive transcranial magnetic stimulation was delivered to the right or left prefrontal cortex with a figure-eight solid core coil at 120% motor threshold, 10 Hz, 5-second train duration, and 10-second intertrain interval for 30 minutes (6000 pulses) weekly for 5 weeks (30,000 stimuli).”

https://www.ncbi.nlm.nih.gov/pubmed/29952863

A study with a sham control group

“Results showed significant differences among the 3 groups. Patients demonstrated significant PTSD symptom reductions in the bilateral group compared to the sham group in session five and endpoint. There were no significant differences between the bilateral and unilateral right groups at endpoint.

Methods: “Sixty-five veterans with current combat-related PTSD symptoms were randomly selected to receive bilateral rTMS (1200 pulses at 20 Hz followed by 1200 pulses per session), unilateral right rTMS (2400 pulses at 20 Hz) or sham rTMS over the dorsolateral prefrontal cortex (DLPFC).”

https://www.ncbi.nlm.nih.gov/pubmed/29883597

Statistically significant results: rTMS decreases PTSD Sx

“Stimulation significantly reduced PTSD symptoms (PCL-5 baseline mean ± SD score 52.2 ± 13.1 versus endpoint 34.0 ± 21.6; p < .001);”

Limitation: Unblinded single-arm study, with modest sample size

Methods: 5 Hz rTMS included up to 40 daily sessions followed by a 5-session taper.

https://www.ncbi.nlm.nih.gov/pubmed/29677606

Another study with sham control group with significant results

The rTMS+CPT group showed greater symptom reductions from baseline on both CAPS and PCL across CPT sessions and follow-up assessments, t(df ≥ 325) ≤ -2.01, p ≤ 0.023, one-tailed and t(df ≥ 303) ≤ -2.14, p ≤ 0.017, one-tailed, respectively.”

Limitations: Participants were predominantly male and limited to one era of conflicts as well as those who could safely undergo rTMS.

Methods: The TMS coil (active or sham) was positioned over the right dorsolateral prefrontal cortex (110% MT, 1Hz continuously for 30min, 1800 pulses/treatment).

https://www.ncbi.nlm.nih.gov/pubmed/29351885

Animal model with Proposed MoA of rTMS in PTSD

Title: “rTMS Ameliorates PTSD Symptoms in Rats by Enhancing Glutamate Transmission and Synaptic Plasticity in the ACC via the PTEN/Akt Signalling Pathway.”

https://www.ncbi.nlm.nih.gov/pubmed/28550530

 

A Meta analysis

“Low-frequency (LF) rTMS resulted in a significant reduction in the PTSDtotal score and the depression score (1. PTSD total score: pooled SMD, 0.92; CI, 0.11-1.72; 2. Depression: pooled SMD, 0.54; CI, 0.08-1.00). High-frequency (HF) rTMS showed the following results: 1. PTSD total score: pooled SMD, 3.24; CI, 2.24-4.25; 2. re-experiencing: pooled SMD, -1.77; CI, -2.49-(-1.04); 3. Avoidance: pooled SMD, -1.57; CI, -2.50-(-0.84); 4. hyperarousal: pooled SMD, -1.32; CI, -2.17-(-0.47); 5. depression: pooled SMD, 1.92; CI, 0.80-3.03; and 6. Anxiety: pooled SMD, 2.67; CI, 1.82-3.52. Therefore, both HF and LF rTMS can alleviate PTSD symptoms. Although the evidence is extremely limited, LF rTMS can reduce overall PTSD and depression symptoms. HF rTMS can improve the main and related symptoms of PTSD. However, additional research is needed to substantiate these findings.”

https://www.ncbi.nlm.nih.gov/pubmed/28278422