Table 3.
Case reports and case series of TMS monotherapy for PTSD..
| Study | Participants | n | TMS type | Groups (frequency, target) | MT (%) | Total dose | Outcome measures | Assessment times | Main outcomes |
|---|---|---|---|---|---|---|---|---|---|
| McCann et al. 26 | PTSD/MDD PTSD |
2 | rTMS | 1 Hz right DLPFC | 80% | 17 or 30 sessions 20-min sessions (1200 pulses per session) |
Modified PTSD Symptom Scale | Baseline Weekly Post-TMS Follow-up 1 month |
Both participants showed significant reductions in PTSD symptoms at variable assessment times during treatment. Effects degraded with return to baseline symptoms at 1-month follow-up. |
| Tillman et al. 40 | PTSD/MDD | 1 | rTMS | 1 Hz right DLPFC 1 Hz left DLPFC |
100% | 1200 pulses per session separated by 1 week | Behavioral Semantic Memory Test | Baseline Post right-sided TMS Post left-sided TMS |
TMS to the right DLPFC and not the left DLPFC reduced hyperarousability to specific combat-related threat stimuli as marked by reduction in P3a amplitude (which was exaggerated at baseline), and this corresponded to subjective symptom reduction. Authors concluded that TMS interference with right frontal lobe functioning can temporarily ameliorate hyperarousal to threat stimuli. |
| Nakama et al. 41 | PTSD/MDD | 1 | rTMS | 10 Hz left DLPFC | 120% | 22 sessions 66,000 pulses |
PCL-M BDI |
Baseline Weekly Follow-up 3 weeks |
Depression protocol TMS led to remission not only for MDD but also for PTSD, and effects were sustained at 3-week follow-up. |
| Oznur et al. 42 | PTSD/MDD (veterans) | 20 | rTMS | 1 Hz right DLPFC | 80% | 20 sessions 12,000 pulses |
IES BDI BAI |
Baseline Post-TMS |
Participants showed significant reduction in hyperarousal symptoms only and not for intrusion, avoidance, depression, or anxiety. |
| Philip et al. 43 | PTSD/MDD | 10 | rTMS | 5 Hz left DLPFC | 120% | Up to 30 sessions + 6-session taper 3000–4000 pulses per session |
PCL QIDS |
Baseline Every five sessions Post-TMS |
Comorbid MDD/PTSD participants showed significant reduction in both PTSD and depressive symptoms. |
| Woodside et al. 44 | PTSD/Eating Disorders | 14 | rTMS TBS |
10 Hz bilateral 20 Hz bilateral TBS bilateral |
120% | 20–30 sessions Variable pulse dosing per group |
PCL-C DERS |
Baseline Post-TMS |
Participants showed significant reduction in PTSD symptoms (52% mean reduction on the PCL-C with 57% response rate). Emotion regulation scores were also improved. TBS was most effective though the study was limited by sample size. |
| Nursey et al. 45 | PTSD (veterans) | 8 | TBS | TBS bilateral DLPFC | 120% | 20 sessions 12,000 pulses (600 pulses per 3.2 min sessions) |
CAPS HAM-D Neuropsychological testing |
Baseline Session 20 Follow-up 3 months |
Participants showed significant reduction in PTSD symptoms with large effect size (d = –1.78), though this was a small pilot study. Depressive symptoms were also significantly reduced. Effects were sustained at 3 months. |
BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; CAPS, Clinician Administered PTSD Scale; DERS, Difficulties in Emotion Regulation Scale; HAM-D, Hamilton Depression Rating Scale; IES, Impact of Event Scale; MDD, major depressive disorder; MT, motor threshold; PCL, PTSD Symptom Checklist; PCL-C, PTSD Checklist Civilian version; PCL-M, PTSD Checklist Military; PTSD, post-traumatic stress disorder; QIDS, Quick Inventory of Depressive Symptomatology; rTMS, repetitive transcranial magnetic stimulation; TBS, theta-burst transcranial magnetic stimulation.