Theta burst stimulation (TBS) in methamphetamine use disorder: a meta-analysis and systematic review.
Gopalkumar Rakesh, Thomas G Adams, Dylan H Ballard et al.
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In 30 seconds
This systematic review and meta-analysis assessed theta burst stimulation (TBS) for cue-induced methamphetamine craving in people with methamphetamine use disorder (MUD). It included randomized controlled trials using unique participant cohorts, identified through searches up to September 1, 2024. In a meta-analysis of four sham-controlled trials, intermittent TBS (iTBS) reduced craving more than sham iTBS, with a standardized mean difference in change of 1.04 (95% CI [0.16, 1.92]). Two additional trials without sham controls were reviewed; one reported a significant craving reduction after accelerated iTBS.
Key findings
- Across four sham-controlled RCTs, iTBS reduced cue-induced craving more than sham iTBS (SMD in change = 1.04; 95% CI [0.16, 1.92]).
- Of two additional RCTs without sham control arms, one found a significant reduction in craving following accelerated iTBS.
Why it matters
MUD lacks FDA-approved treatments, and craving is a relevant treatment outcome. The pooled result provides evidence that iTBS may reduce cue-induced craving compared with sham, while highlighting the need to assess outcomes beyond craving, including methamphetamine use and return to use.
What to keep in mind
The meta-analysis included only four eligible sham-controlled RCTs and assessed craving rather than methamphetamine use or return to use. Two additional trials lacked sham control arms.