Abstract
Major depressive disorder (MDD) and alcohol use disorder (AUD) are leading causes of disability, and patients are frequently affected by both conditions. This comorbidity is known to confer worse outcomes and greater illness severity. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation method that has demonstrated antidepressant effects. However, the study of rTMS for patients with MDD and commonly associated comorbidities, such as AUD, has been largely overlooked, despite significant overlap in clinical presentation and neurobiological mechanisms. This narrative review aims to highlight the interrelated aspects of the literature on rTMS for MDD and rTMS for AUD. First, we summarize the available evidence on the effectiveness of rTMS for each condition, both most studied through stimulation of the dorsolateral prefrontal cortex (DLPFC). Second, we describe common symptom constructs that can be modulated by rTMS, such as executive dysfunction, that are transdiagnostic across these disorders. Lastly, we describe promising approaches in the personalization and optimization of rTMS that may be applicable to both AUD and MDD. By bridging the gap between research efforts in MDD and AUD, rTMS is well positioned to be developed as a treatment for the many patients who have both conditions concurrently.
Highlights
Major depressive disorder (MDD) is highly prevalent in individuals with alcohol use disorder (AUD) [1]
For AUD, there is approximately a decade of publications showing the potential of Repetitive transcranial magnetic stimulation (rTMS) to reduce cravings and consumption
Our review suggests that rTMS for comorbid MDD + AUD may require a bilateral approach, given the strength of evidence of left and bilateral rTMS in MDD and of right and bilateral rTMS in AUD
Summary
Major depressive disorder (MDD) is highly prevalent in individuals with alcohol use disorder (AUD) [1]. RTMS operates by generating a rapidly alternating electric current within a coil that is placed over the scalp, inducing a magnetic field in a localized region of the brain below and creating an electrical current in the brain through neuronal depolarization This is best exemplified through studies of the primary motor system, where a single pulse of TMS to the motor cortex results in a motor-evoked potential measured by electromyography and muscle contraction observed on visual inspection. Through focal modulation of selected regions of the brain, the induced changes on neuronal excitation or inhibition have effects on ameliorating mood and addiction-related mechanisms Illustrative of this are studies showing that rTMS to prefrontal circuits implicated in emotional learning and memory can disrupt learned fear responses [19], which has broad implications for many of the mood and anxiety symptoms we see clinically [20]. We explore some of the current frontiers of rTMS research that aim to optimize and individualize treatment outcomes, again with a focus on findings that appear to overlap in MDD and AUD
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