Treating Stimulant Addiction With Repetitive Transcranial Magnetic Stimulation

Treating Stimulant Addiction With Repetitive Transcranial Magnetic Stimulation

The purpose of this study is to establish a new treatment (repetitive transcranial stimulation (rTMS)) for Veterans with stimulant use disorder (SUD). Despite the large public health burden imposed by SUD, there is currently no FDA-approved or widely recognized effective somatic treatment. rTMS may be a promising treatment option for SUD. In this study, we will demonstrate the feasibility of applying rTMS to Veterans with SUD, examine the efficacy of rTMS in the treatment of SUD, and explore biomarkers that may guide patient selection for rTMS treatment and predict treatment response.

Inclusion Criteria:

• Structured Clinical Interview for DSM Disorders (SCID) confirmed diagnosis of SUD, severe
• Last use of stimulants >1 and <6 weeks
• Stable medication regimen (no change in dose or agents between 2 weeks prior to the start of and throughout the treatment phase of the study)
• Stable social environment and housing to enable regular attendance at clinic visits.
• Ability to undergo cognitive testing, functional magnetic resonance imaging (fMRI) scans, and rTMS (no contraindications)
• Intelligence Quotient (IQ) > 80
• Stable medical health
• Veteran at Palo Alto VA's Addiction Treatment Services

Exclusion Criteria:

• Pregnant or lactating female

• History of prior adverse reaction to TMS

• On medications thought to significantly lower seizure threshold, e.g.:

  • clozapine
  • chlorpromazine
  • clomipramine
  • bupropion > 400 mg/day

• Use of direct dopaminergic antagonists or agonists

• History of seizures or conditions known to substantially increase risk for seizures

• Implants or medical devices incompatible with TMS

• Acute or unstable chronic medical illness that would affect participation or compliance with study procedures, e.g. unstable angina

• Unstable psychiatric symptoms that precludes consistent participation in the study, e.g.:

  • active current suicidal intent or plan
  • severe psychosis

• Inability to undergo fMRI scan, e.g. claustrophobia, presence of ferromagnetic objects in subject's body

• Other substance use disorder not in sustained remission

• Chronic or recurring Axis I psychiatric condition preceding SUD other than PTSD