Current Status of Transcranial Direct Current Stimulation in Posttraumatic Stress and Other Anxiety Disorders
Several empirically supported treatments have been identified for posttraumatic stress disorder (PTSD), yet a sizable number of patients are either unable to tolerate these approaches or remain symptomatic following treatment. Transcranial direct current stimulation (tDCS) is a well-tolerated method of modulating neuronal excitability that may hold promise as a novel intervention in PTSD and related disorders. The current review summarizes literature on the disrupted neural circuitry in PTSD and discusses the rationale for the commonly targeted prefrontal cortex (PFC) as it relates to PTSD. We then review the few prior (case) studies that have evaluated tDCS in patients with PTSD (1 study) and other anxiety disorders (4 studies). There was considerable variability in both the methods/justification for selecting the targeted brain region(s) and the tDCS montage used, which obscured any clear trends in the data. Finally, we describe the rationale for our ongoing study that specifically targets the lateral temporal cortex as a method of treating the symptoms of hyperarousal and re-experiencing in PTSD. Overall, it is clear that additional work is needed to establish dosing (e.g., intensity and duration of sessions, number of sessions) and optimal treatment targets as well as to identify synergistic effects with existing treatments.
KeywordsTranscranial direct current stimulation tDCS Posttraumatic stress disorder PTSD Anxiety Generalized anxiety disorder Panic disorder Obsessive compulsive disorder Brain stimulation Neuromodulation Functional neuroimaging
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- 5.Van Etten ML, Taylor S. Comparative efficacy of treatment for posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev. 1998;5:126–44.Google Scholar
- 19.Heller W, Nitschke JB. The puzzle of regional brain activity in depression and anxiety: the importance of subtypes and comorbidity. Cognition and Emotion. 1988;12(3):421–7.Google Scholar
- 27.Boggio PS et al. A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Int J Neuropsychopharmacol. 2009;11(2):249–54.Google Scholar
- 48.Li BJ, et al. Altered resting-state functional connectivity in post-traumatic stress disorder: a perfusion MRI study. Medical Imaging 2013: Image Perception, Observer Performance, and Technology Assessment, 2013; 8673.Google Scholar