Repetitive transcranial magnetic stimulation for the treatment of suicidality in opioid use disorder: a pilot feasibility randomized controlled trial
Abstract Background Opioid use disorder (OUD) is a devastating condition with frequent suicidality, contributing to overdose deaths. Theta burst stimulation (TBS) to the dorsolateral prefrontal cortex (DLPFC) is used to treat major depressive disorder (MDD) and is effective in treating suicidal id...
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Cambridge University Press
2025-01-01
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| Series: | European Psychiatry |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933825000288/type/journal_article |
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| author | Victor M. Tang Bernard Le Foll Zafiris J. Daskalakis An-Li Wang Leslie Buckley Daniel M. Blumberger Daphne Voineskos |
| author_facet | Victor M. Tang Bernard Le Foll Zafiris J. Daskalakis An-Li Wang Leslie Buckley Daniel M. Blumberger Daphne Voineskos |
| author_sort | Victor M. Tang |
| collection | DOAJ |
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Abstract
Background
Opioid use disorder (OUD) is a devastating condition with frequent suicidality, contributing to overdose deaths. Theta burst stimulation (TBS) to the dorsolateral prefrontal cortex (DLPFC) is used to treat major depressive disorder (MDD) and is effective in treating suicidal ideation. We piloted a randomized, double-blind, sham-controlled trial of bilateral rTMS for patients with OUD and MDD experiencing suicidality.
Methods
Sequential bilateral TBS was delivered guided by structural neuroimaging: continuous TBS to the right then intermittent TBS to the left DLPFC, daily (20 treatments). The primary objective was to determine the feasibility of this population. The primary clinical outcome was the scale for suicidal ideation (SSI), secondary outcomes included depressive symptoms and opioid cue-induced craving. ClinicalTrials.gov: NCT04785456.
Results
Eighty-seven individuals were pre-screened. The most common reasons for ineligibility included being unreachable by the study team, difficulty with scheduling/travel requirements, and medical/psychiatric instability. Six participants (5:1 M:F) were enrolled (3/arm), four had a fentanyl use history; two completed per protocol (1/arm). Of the participants with follow-up data, SSI scores decreased in 2/3 in the sham arm and 2/2 in the active arm; depression and opioid craving scores decreased in all participants.
Conclusion
We present the first data piloting a structural neuroimaging-guided, multi-session rTMS treatment course in outpatients with suicidality and OUD in the current North American context. Recruitment and retention were the main challenges given the highly unstable medical and psychosocial context of this patient population. Future trials should consider a suitable environment to improve the feasibility of delivering this treatment.
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| format | Article |
| id | doaj-art-06ebcbbc0ad94537a062bc390fc722d6 |
| institution | Kabale University |
| issn | 0924-9338 1778-3585 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj-art-06ebcbbc0ad94537a062bc390fc722d62025-08-20T03:45:47ZengCambridge University PressEuropean Psychiatry0924-93381778-35852025-01-016810.1192/j.eurpsy.2025.28Repetitive transcranial magnetic stimulation for the treatment of suicidality in opioid use disorder: a pilot feasibility randomized controlled trialVictor M. Tang0https://orcid.org/0000-0001-5365-9683Bernard Le Foll1https://orcid.org/0000-0002-6406-4973Zafiris J. Daskalakis2An-Li Wang3Leslie Buckley4https://orcid.org/0000-0002-3134-7504Daniel M. Blumberger5https://orcid.org/0000-0002-8422-5818Daphne Voineskos6https://orcid.org/0000-0002-7450-4434Institute of Medical Science, University of Toronto, Toronto, ON, Canada Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, CanadaInstitute of Medical Science, University of Toronto, Toronto, ON, Canada Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON CanadaDepartment of Psychiatry, University of California, San Diego, CA, USAIcahn School of Medicine at Mount Sinai, New York, NY, USADepartment of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, CanadaInstitute of Medical Science, University of Toronto, Toronto, ON, Canada Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, CanadaInstitute of Medical Science, University of Toronto, Toronto, ON, Canada Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada Poul Hansen Family Centre for Depression, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada Abstract Background Opioid use disorder (OUD) is a devastating condition with frequent suicidality, contributing to overdose deaths. Theta burst stimulation (TBS) to the dorsolateral prefrontal cortex (DLPFC) is used to treat major depressive disorder (MDD) and is effective in treating suicidal ideation. We piloted a randomized, double-blind, sham-controlled trial of bilateral rTMS for patients with OUD and MDD experiencing suicidality. Methods Sequential bilateral TBS was delivered guided by structural neuroimaging: continuous TBS to the right then intermittent TBS to the left DLPFC, daily (20 treatments). The primary objective was to determine the feasibility of this population. The primary clinical outcome was the scale for suicidal ideation (SSI), secondary outcomes included depressive symptoms and opioid cue-induced craving. ClinicalTrials.gov: NCT04785456. Results Eighty-seven individuals were pre-screened. The most common reasons for ineligibility included being unreachable by the study team, difficulty with scheduling/travel requirements, and medical/psychiatric instability. Six participants (5:1 M:F) were enrolled (3/arm), four had a fentanyl use history; two completed per protocol (1/arm). Of the participants with follow-up data, SSI scores decreased in 2/3 in the sham arm and 2/2 in the active arm; depression and opioid craving scores decreased in all participants. Conclusion We present the first data piloting a structural neuroimaging-guided, multi-session rTMS treatment course in outpatients with suicidality and OUD in the current North American context. Recruitment and retention were the main challenges given the highly unstable medical and psychosocial context of this patient population. Future trials should consider a suitable environment to improve the feasibility of delivering this treatment. https://www.cambridge.org/core/product/identifier/S0924933825000288/type/journal_articlemajor depressive disorderopioid use disordersuicidetheta burst stimulationtranscranial magnetic stimulation |
| spellingShingle | Victor M. Tang Bernard Le Foll Zafiris J. Daskalakis An-Li Wang Leslie Buckley Daniel M. Blumberger Daphne Voineskos Repetitive transcranial magnetic stimulation for the treatment of suicidality in opioid use disorder: a pilot feasibility randomized controlled trial European Psychiatry major depressive disorder opioid use disorder suicide theta burst stimulation transcranial magnetic stimulation |
| title | Repetitive transcranial magnetic stimulation for the treatment of suicidality in opioid use disorder: a pilot feasibility randomized controlled trial |
| title_full | Repetitive transcranial magnetic stimulation for the treatment of suicidality in opioid use disorder: a pilot feasibility randomized controlled trial |
| title_fullStr | Repetitive transcranial magnetic stimulation for the treatment of suicidality in opioid use disorder: a pilot feasibility randomized controlled trial |
| title_full_unstemmed | Repetitive transcranial magnetic stimulation for the treatment of suicidality in opioid use disorder: a pilot feasibility randomized controlled trial |
| title_short | Repetitive transcranial magnetic stimulation for the treatment of suicidality in opioid use disorder: a pilot feasibility randomized controlled trial |
| title_sort | repetitive transcranial magnetic stimulation for the treatment of suicidality in opioid use disorder a pilot feasibility randomized controlled trial |
| topic | major depressive disorder opioid use disorder suicide theta burst stimulation transcranial magnetic stimulation |
| url | https://www.cambridge.org/core/product/identifier/S0924933825000288/type/journal_article |
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