Repetitive Transcranial Magnetic Stimulation for the Treatment of Depression, Post-Traumatic Stress Disorder, and Suicidal Ideation in Military Populations: A Scholarly Review

Abstract

Introduction: Military mental health conditions, such as depression, PTSD, and suicidal ideation, are currently understudied and undertreated. Repetitive transcranial magnetic stimulation (rTMS) is currently being considered as a treatment for these conditions; however, there exists a paucity of research in this area. This scholarly review will examine the limitations of the existing literature on the use of rTMS to treat depression, PTSD, and suicidal ideation in service members (SMs) and veterans. Materials and Methods: Publications that evaluated rTMS for the treatment of depression, PTSD, or suicidal ideation in military samples were identified via a PubMed search. Non-interventional rTMS studies, studies where the sample could not be confirmed to be primarily composed of SMs or veteran participants, studies without psychiatric outcome measures, and studies not published in a peer-reviewed journal were excluded from this review. Results: This literature search identified 20 total publications (eight primary analyses of randomized controlled trials (RCTs), one longitudinal analysis of an RCT, five open label trials, and six retrospective analyses of clinical data), inclusive of 879 participants. Eighteen studies utilized a protocol targeting the prefrontal cortex (PFC), and one of these also targeted the supplementary motor area (SMA) with the PFC (one study did not specify the stimulation site). Eight studies applied standard 10 Hz frequency stimulation, and four applied standard 1 Hz frequency stimulation. The remainder of studies applied alternative stimulation protocols including 5 Hz (two studies), 20 Hz (one study), a combination of 1 and 10 Hz (two studies), and theta burst stimulation (TBS) (two studies). Twelve studies reported significant results, including four RCTs, three open label studies, and five retrospective analyses. Conclusions: rTMS offers a promising area of research for mental health conditions in military populations. However, the number of studies that focus specifically on this population are few in number and have many notable limitations. Further research is needed to validate the effectiveness of this tool for SMs and veterans.