Meth Use Disorder May Benefit From Accelerated Transcranial Magnetic Stimulation

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In a small open-label feasibility trial, most participants with methamphetamine use disorder completed at least 45 sessions of accelerated intermittent theta burst stimulation over three weeks. Researchers reported reductions in self-reported craving and depression severity after 12 visits, but the study was not designed to establish treatment effectiveness, and follow-up lasted only one week.

A small feasibility trial found that an accelerated course of repetitive transcranial magnetic stimulation (TMS) could be delivered to participants with methamphetamine use disorder, with researchers reporting early reductions in self-reported craving and depression severity. The open-label study does not establish that the treatment works; its main aim was to test whether participants could complete the intensive schedule.

The protocol used 10-minute sessions of intermittent theta burst stimulation, with at least 50 minutes between sessions. Participants were scheduled for 50 sessions over three weeks, and viewed drug-related images before each session to prompt craving. Of 20 participants with methamphetamine use disorder, 94.7% completed at least 45 sessions, according to Manish Jha of UT Southwestern Medical Center, who presented the findings. The mean number of sessions was 46.3.

After 12 visits, participants reported lower methamphetamine craving and lower overall depression severity. Jha said there was little change in craving specifically triggered by the images, while participants reported some change in their current craving before the cue exposure. After the fourth stimulation session of the day, participants also reported improved ability to resist using methamphetamine. These were self-reported outcomes, not evidence that the intervention reduced drug use.

The study was open-label and included people diagnosed with moderate or severe cocaine or methamphetamine use disorder, along with a Patient Health Questionnaire-9 score of at least 5. The report said 23 people were enrolled over two years: three with cocaine use disorder and 20 with methamphetamine use disorder. One participant did not complete 45 or more sessions. The trial’s primary measure was feasibility, defined as completing at least 30 of the planned 50 sessions.

Testing a Shorter Treatment Schedule

The findings address a practical obstacle in studying brain stimulation for substance use disorders: treatment attendance. Conventional repetitive TMS schedules often involve one session a day, five days a week, for six to eight weeks. In an earlier feasibility trial involving stimulant use disorder, Jha said, only 43.9% of participants assigned to treatment attended at least 20 of 30 sessions. The high completion rate in this small study suggests a compressed schedule can be tested in this population, though it does not show that the schedule is more effective or easier to complete than standard care.

The research is relevant because methamphetamine use disorder has few established treatment options. Jha said there are no FDA-approved medications for the disorder, and guidelines from the American Society of Addiction Medicine and the American Academy of Addiction Psychiatry do not recommend medications with high confidence for stimulant use disorder. A 2021 trial found a modest reduction in drug use with extended-release naltrexone plus bupropion: 13.6% of treated participants had negative urine samples after six weeks, compared with 2.5% in the placebo group. That result provides context for the search for additional approaches, not a direct comparison with TMS.

From Daily Sessions to an Accelerated Course

Repetitive TMS uses magnetic pulses to stimulate targeted brain areas. The protocol in this study borrowed elements from the Stanford Accelerated Intelligent Neuromodulation Therapy approach, which was developed for treatment-resistant depression. The researchers adapted an accelerated schedule for participants with stimulant use disorder and co-occurring depressive symptoms. The study’s inclusion criteria allowed cocaine or methamphetamine use disorder; most enrolled participants had methamphetamine use disorder.

Jha described rising methamphetamine-related harms as part of the reason for pursuing new treatments. He said overdose deaths involving methamphetamine had increased almost six- to sevenfold in less than a decade, while deaths attributable to stimulants including methamphetamine and cocaine had continued to rise even as the overall trend in overdose deaths was affected by a decline in opioid-involved deaths. Those figures were remarks made during the presentation; the report did not provide a separate data source or specify a comparison period for the estimate.

“We didn’t see much change in cue-induced craving. What did change a bit was the self-reported craving and how much they were craving currently in the moment before the cue craving. So, there may be some signal.”

— Manish Jha, UT Southwestern Medical Center

Effectiveness and Lasting Benefit Unknown

The trial was small, had no comparison group and was not designed to determine whether accelerated TMS reduces methamphetamine use. Changes in craving and depression were reported by participants, and the study did not establish whether those changes were caused by stimulation, lasted beyond the brief follow-up, or affected drug use in daily life. Follow-up ended one week after treatment, which the researchers identified as a limitation.

The report does not provide enough detail to determine how the treatment compares with usual care, how safe or tolerable it is across a larger group, or which patients might benefit. It also remains unclear whether the cue-exposure component contributed to any changes. The findings are preliminary and should not be read as evidence that TMS is an established treatment for methamphetamine use disorder.

A Randomized Multisite Trial Needed

Jha said the findings support testing the accelerated protocol in a multisite randomized controlled trial. Such a study could compare TMS with a control condition, track drug-use outcomes as well as symptoms, and follow participants for longer than one week. No details about a planned trial, its timeline or its funding were included in the report.

Until larger controlled studies provide results, the key finding is feasibility: most participants in this small group completed a demanding schedule. Whether the approach produces sustained reductions in methamphetamine use or improves longer-term recovery remains to be tested.

Key Questions

What did the accelerated TMS study find?

Most participants with methamphetamine use disorder completed at least 45 of 50 planned sessions. Researchers also reported early reductions in self-reported craving and depression severity, but the study did not establish treatment effectiveness.

How was the TMS schedule organized?

Participants received 10-minute intermittent theta burst stimulation sessions at least 50 minutes apart, with up to 50 sessions scheduled over three weeks. Drug-related images were presented before each session.

Did the treatment reduce methamphetamine use?

The report does not establish that it did. The study focused on feasibility and reported changes in self-reported symptoms; it was not a controlled test of whether TMS reduces drug use.

How long were participants followed after treatment?

Follow-up ended one week after treatment. The researchers said longer follow-up would be difficult in this population, leaving the durability of any changes unknown.

What research is needed next?

Jha said a multisite randomized controlled trial is needed to replicate and extend the findings, including tests of treatment outcomes and longer-term effects.

Source: rss