Evidence for safety and tolerability of transcranial magnetic stimulation for substance use disorders

OBJECTIVE: Transcranial magnetic stimulation (TMS) is an exciting novel treatment for substance use disorders (SUDs). While TMS is safe and effective in the general population, there have been concerns about its safety with concurrent substance use. To date, guidelines on managing substance use during TMS have been vague - recommending caution and weighing risks and benefits - and solely based on expert opinion, rather than based on quantitative data on the prevalence of TMS side effects with concurrent substance use. METHODS: We performed a systematic review with meta-analysis of TMS studies for a SUD - a clinically impairing level of substance use where we would be more likely to detect adverse effects - to quantify the safety of TMS in the setting of substance use. We searched PubMed, Embase, PsycINFO, and the Cochrane Library for TMS studies for SUDs that reported adverse effects. We extracted adverse effects and tested the difference between the prevalence of events in the active and sham conditions. RESULTS: Forty-seven studies comprising 2865 participants with a SUD were included. The prevalence of neck pain and cognitive impairment was higher for sham compared to active TMS (p < .05). The prevalence of all other adverse effects, including seizure, was not significantly different between active and sham TMS. CONCLUSIONS: TMS is safe and well-tolerated for people with SUDs. The prevalence of side effects from TMS in people with SUDs is comparable to that in the general population. TMS can be just as safely administered for SUDs as for any other psychiatric disorder.