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Efficacy and acceptability of noninvasive brain stimulation for treating posttraumatic stress disorder symptoms: A network meta‐analysis of randomized controlled trials.

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Title: Efficacy and acceptability of noninvasive brain stimulation for treating posttraumatic stress disorder symptoms: A network meta‐analysis of randomized controlled trials.
Authors: Tseng, Ping‐Tao (AUTHOR), Zeng, Bing‐Yan (AUTHOR), Wang, Hung‐Yu (AUTHOR), Zeng, Bing‐Syuan (AUTHOR), Liang, Chih‐Sung (AUTHOR), Chen, Yang‐Chieh Brian (AUTHOR), Stubbs, Brendon (AUTHOR), Carvalho, Andre F. (AUTHOR), Brunoni, Andre R. (AUTHOR), Su, Kuan‐Pin (AUTHOR), Tu, Yu‐Kang (AUTHOR), Wu, Yi‐Cheng (AUTHOR), Chen, Tien‐Yu (AUTHOR), Li, Dian‐Jeng (AUTHOR), Lin, Pao‐Yen (AUTHOR), Chen, Yen‐Wen (AUTHOR), Hsu, Chih‐Wei (AUTHOR), Hung, Kuo‐Chuan (AUTHOR), Shiue, Yow‐Ling (AUTHOR), Li, Cheng‐Ta (AUTHOR)
Source: Acta Psychiatrica Scandinavica. Jul2024, Vol. 150 Issue 1, p5-21. 17p.
Subjects: Brain stimulation, Virtual reality therapy, Post-traumatic stress disorder, Transcranial direct current stimulation, Vagus nerve stimulation, Randomized controlled trials, Transcranial magnetic stimulation, Cervical plexus
Abstract: Introduction: Despite its high lifetime prevalence rate and the elevated disability caused by posttraumatic stress disorder (PTSD), treatments exhibit modest efficacy. In consideration of the abnormal connectivity between the dorsolateral prefrontal cortex (DLPFC) and amygdala in PTSD, several randomized controlled trials (RCTs) addressing the efficacy of different noninvasive brain stimulation (NIBS) modalities for PTSD management have been undertaken. However, previous RCTs have reported inconsistent results. The current network meta‐analysis (NMA) aimed to compare the efficacy and acceptability of various NIBS protocols in PTSD management. Methods: We systematically searched ClinicalKey, Cochrane Central Register of Controlled Trials, Embase, ProQuest, PubMed, ScienceDirect, Web of Science, and ClinicalTrials.gov to identify relevant RCTs. The targeted RCTs was those comparing the efficacy of NIBS interventions, such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and transcutaneous cervical vagal nerve stimulation, in patients with PTSD. The NMA was conducted using a frequentist model. The primary outcomes were changes in the overall severity of PTSD and acceptability (to be specific, rates of dropouts for any reason). Results: We identified 14 RCTs that enrolled 686 participants. The NMA demonstrated that among the investigated NIBS types, high‐frequency rTMS over bilateral DLPFCs was associated with the greatest reduction in overall PTSD severity. Further, in comparison with the sham controls, excitatory stimulation over the right DLPFC with/without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD‐related symptoms, including depression and anxiety symptoms, and overall PTSD severity. Conclusions: This NMA demonstrated that excitatory stimulation over the right DLPFC with or without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD‐related symptoms. Trial registration: PROSPERO CRD42023391562. [ABSTRACT FROM AUTHOR]
Copyright of Acta Psychiatrica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Efficacy and acceptability of noninvasive brain stimulation for treating posttraumatic stress disorder symptoms: A network meta‐analysis of randomized controlled trials.
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  Data: <searchLink fieldCode="AR" term="%22Tseng%2C+Ping‐Tao%22">Tseng, Ping‐Tao</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zeng%2C+Bing‐Yan%22">Zeng, Bing‐Yan</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wang%2C+Hung‐Yu%22">Wang, Hung‐Yu</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zeng%2C+Bing‐Syuan%22">Zeng, Bing‐Syuan</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Liang%2C+Chih‐Sung%22">Liang, Chih‐Sung</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Chen%2C+Yang‐Chieh+Brian%22">Chen, Yang‐Chieh Brian</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Stubbs%2C+Brendon%22">Stubbs, Brendon</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Carvalho%2C+Andre+F%2E%22">Carvalho, Andre F.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Brunoni%2C+Andre+R%2E%22">Brunoni, Andre R.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Su%2C+Kuan‐Pin%22">Su, Kuan‐Pin</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tu%2C+Yu‐Kang%22">Tu, Yu‐Kang</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wu%2C+Yi‐Cheng%22">Wu, Yi‐Cheng</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Chen%2C+Tien‐Yu%22">Chen, Tien‐Yu</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Li%2C+Dian‐Jeng%22">Li, Dian‐Jeng</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lin%2C+Pao‐Yen%22">Lin, Pao‐Yen</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Chen%2C+Yen‐Wen%22">Chen, Yen‐Wen</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hsu%2C+Chih‐Wei%22">Hsu, Chih‐Wei</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hung%2C+Kuo‐Chuan%22">Hung, Kuo‐Chuan</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Shiue%2C+Yow‐Ling%22">Shiue, Yow‐Ling</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Li%2C+Cheng‐Ta%22">Li, Cheng‐Ta</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Acta+Psychiatrica+Scandinavica%22">Acta Psychiatrica Scandinavica</searchLink>. Jul2024, Vol. 150 Issue 1, p5-21. 17p.
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  Data: <searchLink fieldCode="DE" term="%22Brain+stimulation%22">Brain stimulation</searchLink><br /><searchLink fieldCode="DE" term="%22Virtual+reality+therapy%22">Virtual reality therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Post-traumatic+stress+disorder%22">Post-traumatic stress disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Transcranial+direct+current+stimulation%22">Transcranial direct current stimulation</searchLink><br /><searchLink fieldCode="DE" term="%22Vagus+nerve+stimulation%22">Vagus nerve stimulation</searchLink><br /><searchLink fieldCode="DE" term="%22Randomized+controlled+trials%22">Randomized controlled trials</searchLink><br /><searchLink fieldCode="DE" term="%22Transcranial+magnetic+stimulation%22">Transcranial magnetic stimulation</searchLink><br /><searchLink fieldCode="DE" term="%22Cervical+plexus%22">Cervical plexus</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Introduction: Despite its high lifetime prevalence rate and the elevated disability caused by posttraumatic stress disorder (PTSD), treatments exhibit modest efficacy. In consideration of the abnormal connectivity between the dorsolateral prefrontal cortex (DLPFC) and amygdala in PTSD, several randomized controlled trials (RCTs) addressing the efficacy of different noninvasive brain stimulation (NIBS) modalities for PTSD management have been undertaken. However, previous RCTs have reported inconsistent results. The current network meta‐analysis (NMA) aimed to compare the efficacy and acceptability of various NIBS protocols in PTSD management. Methods: We systematically searched ClinicalKey, Cochrane Central Register of Controlled Trials, Embase, ProQuest, PubMed, ScienceDirect, Web of Science, and ClinicalTrials.gov to identify relevant RCTs. The targeted RCTs was those comparing the efficacy of NIBS interventions, such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and transcutaneous cervical vagal nerve stimulation, in patients with PTSD. The NMA was conducted using a frequentist model. The primary outcomes were changes in the overall severity of PTSD and acceptability (to be specific, rates of dropouts for any reason). Results: We identified 14 RCTs that enrolled 686 participants. The NMA demonstrated that among the investigated NIBS types, high‐frequency rTMS over bilateral DLPFCs was associated with the greatest reduction in overall PTSD severity. Further, in comparison with the sham controls, excitatory stimulation over the right DLPFC with/without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD‐related symptoms, including depression and anxiety symptoms, and overall PTSD severity. Conclusions: This NMA demonstrated that excitatory stimulation over the right DLPFC with or without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD‐related symptoms. Trial registration: PROSPERO CRD42023391562. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Acta Psychiatrica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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