Controversy: Repetitive transcranial magnetic stimulation or transcranial direct current stimulation shows efficacy in treating psychiatric diseases (depression, mania, schizophrenia, obsessive-complusive disorder, panic, posttraumatic stress disorder)

George, Mark S.; Padberg, Frank; Schlaepfer, Thomas E.; O'Reardon, John P.; Fitzgerald, Paul B.; Nahas, Ziad H.; Marcolin, Marco A.

doi:10.1016/j.brs.2008.06.001

« Previous Next »BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation
Volume 2, Issue 1 , Pages 14-21, January 2009

Controversy: Repetitive transcranial magnetic stimulation or transcranial direct current stimulation shows efficacy in treating psychiatric diseases (depression, mania, schizophrenia, obsessive-complusive disorder, panic, posttraumatic stress disorder)

Mark S. George, MD
- Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, Charleston, South Carolina
- Correspondence and reprint requests: Dr. Mark George, Brain Stimulation Laboratory, Department of Psychiatry, Medical University of South Carolina, 502 N, IOP, 67 President St, Charleston, SC 29425.
Frank Padberg, MD
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University Munich, Munich, Germany
Thomas E. Schlaepfer, MD
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Departments of Psychiatry and Mental Health, The Johns Hopkins University, Baltimore, Maryland
John P. O'Reardon, MD
- Neuromodulation Treatment & Research Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
Paul B. Fitzgerald, MBBS, MPM, PhD, FRANZCP
- Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Victoria, Australia
Ziad H. Nahas, MD
- Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, Charleston, South Carolina
Marco A. Marcolin, MD
- Neuromodulation Research Lab, Psychiatry Department, University of São Paulo, SP, Brazil

Received 6 June 2008; accepted 6 June 2008. published online 01 July 2008.

Brain imaging studies performed over the past 20 years have generated new knowledge about the specific brain regions involved in the brain diseases that have been classically labeled as psychiatric. These include the mood and anxiety disorders, and the schizophrenias. As a natural next step, clinical researchers have investigated whether the minimally invasive brain stimulation technologies (transcranial magnetic stimulation [TMS] or transcranial direct current stimulation [tDCS]) might potentially treat these disorders. In this review, we critically review the research studies that have examined TMS or tDCS as putative treatments for depression, mania, obsessive-complusive disorder, posttraumatic stress disorder, panic disorder, or schizophrenia. (Separate controversy articles deal with using TMS or tDCS to treat pain or tinnitus. We will not review here the large number of studies using TMS or tDCS as research probes to understand disease mechanisms of psychiatric disorders.) Although there is an extensive body of randomized controlled trials showing antidepressant effects of daily prefrontal repetitive TMS, the magnitude or durability of this effect remains controversial. US Food and Drug Administration approval of TMS for depression was recently granted. There is much less data in all other diseases, and therapeutic effects in other psychiatric conditions, if any, are still controversial. Several issues and problems extend across all psychiatric TMS studies, including the optimal method for a sham control, appropriate coil location, best device parameters (intensity, frequency, dosage, and dosing schedule) and refining what subjects should be doing during treatment (activating pathologic circuits or not). In general, TMS or tDCS as a treatment for most psychiatric disorders remains exciting but controversial, other than prefrontal TMS for depression.

Keywords: TMS, tDCS, depression, schizophrenia, clinical trials