New Treatments:
We’re living in a time of greater understanding of mental health conditions. With more understanding and more research comes more treatment options, two of which we’ll be considering for ADHD.
ADHD: Our current understanding:
ADHD, or attention-deficit/hyperactivity disorder, is a neurodevelopmental disorder that affects the ability to pay attention, control impulses, and regulate emotions (2). ADHD is thought to be caused by a combination of genetic and environmental factors, and it is associated with abnormalities in the brain’s reward system (2). The reward system is a network of brain regions that process motivation, pleasure, and learning from positive and negative feedback (2).
DBS as a treatment for ADHD:
DBS stands for deep brain stimulation, a type of brain surgery that involves implanting electrodes in specific areas of the brain and connecting them to a stimulator device under the skin of the chest. The stimulator sends electrical pulses to the brain, which can alter the activity of brain cells and circuits (1). DBS is mainly used to treat movement disorders, such as Parkinson’s disease and dystonia, but it has also been explored as a potential treatment for psychiatric conditions, such as obsessive-compulsive disorder (OCD) and depression (1).
DBS has been proposed as a possible treatment for ADHD, based on the hypothesis that stimulating the reward system could enhance the ability to focus, plan, and follow through on tasks (3). However, there is very little evidence to support this idea, and DBS for ADHD is still in the experimental stage. Only a few case studies have been reported, and the results have been mixed and inconclusive (3).
Risk Considerations:
DBS is a very invasive and risky procedure, and it should only be considered as a last resort for severe and treatment-resistant conditions (1). DBS for ADHD is not a proven or safe option, and it may have serious side effects, such as infection, bleeding, seizures, mood changes, and cognitive impairment (1). Therefore, DBS for ADHD is not a viable treatment at the moment, and more research is needed to understand its potential benefits and harms.
rTMS for ADHD:
rTMS (repetitive transcranial magnetic stimulation), a type of non-invasive brain stimulation that uses magnetic pulses to stimulate specific areas of the brain. Primarily used to treat depression, rTMS has also been explored as a potential treatment for ADHD.
How it Could Work
rTMS could treat ADHD by stimulating the reward system and enhancing dopamine release from the prefrontal cortex, which is involved in attention, planning, and executive function (4). rTMS may also induce neuroplasticity, which is the ability of the brain to change and adapt in response to stimulation (5). By modulating the activity and connectivity of the reward system, rTMS may improve the cognitive and behavioural symptoms of ADHD (5).
Summary:
As previously mentioned, there’s now more choice than ever when looking at treatment for ADHD. There isn’t a one size fits approach; some people may require different or more intense forms of treatment. DBS and rTMS both appear to be potential, additional solutions for ADHD management. However, it appears that, based on the current evidence, rTMS is a much safer, more researched treatment pathway for treating ADHD.
Ben, Smart TMS content writer
References:
- MIND (2023). Home | Mind, the mental health charity – help for mental health problems. [online] Mind. Available at: https://www.mind.org.uk/.
- www.additudemag.com. (n.d.). Brain Stimulation and ADHD / ADD: Cravings and Regulation. [online] Available at: https://www.additudemag.com/brain-stimulation-and-adhd-cravings-dependency-and-regulation/?ssp=1&darkschemeovr=1&setlang=en-gb&cc=GB&safesearch=moderate [Accessed 16 Feb. 2024].
- Mayo Clinic (2018). Deep brain stimulation. [online] Mayoclinic.org. Available at: https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562.
- Repetitive Transcranial Magnetic Stimulation. (n.d.). Available at: https://www.oxfordhealth.nhs.uk/wp-content/uploads/2020/03/OH-253.20-rtms-patient-leaflet-long-version.pdf?ssp=1&darkschemeovr=1&setlang=en-gb&cc=GB&safesearch=moderate [Accessed 16 Feb. 2024].
- Chen, Y.-H., Liang, S.-C., Sun, C.-K., Cheng, Y.-S., Tzang, R., Chiu, H., Wang, M.-Y., Cheng, Y.-C. and Hung, K.-C. (2023). A meta-analysis on the therapeutic efficacy of repetitive transcranial magnetic stimulation for cognitive functions in attention-deficit/hyperactivity disorders. BMC Psychiatry, [online] 23, p.756. doi:https://doi.org/10.1186/s12888-023-05261-2.