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The following is a summary of “Assessment and Management of Concurrent Substance Use in Patients Receiving Repetitive Transcranial Magnetic Stimulation for Depressive, Obsessive-Compulsive, Psychotic, and Trauma-Related Disorders: A Delphi Consensus Study and Guideline,” published in the March 2025 issue of American Journal of Psychiatry by Tang et al. 

Clinicians lack guidance on managing substance use in patients receiving repetitive transcranial magnetic stimulation (rTMS) for psychiatric disorders. Experts developed a consensus guideline to address this gap. 

Researchers conducted a prospective study to develop a consensus guideline on managing substance use in patients receiving rTMS for psychiatric disorders. 

They used a Delphi method survey with expert opinions over consecutive rounds, incorporating feedback after each round. Recommendation statements were based on very high (≥80%) agreement. 

The results showed that 3 survey rounds were sufficient to reach a consensus on most topics, with panel discussions on unresolved areas. The expert panel provided recommendations on screening, monitoring, risk assessment, and mitigation for alcohol, cannabis, stimulants, and opioids. Instead of exclusion, a risk-based approach was advised. The primary safety risk was intoxication or withdrawal, with seizure risk in unstable alcohol or nonmedical stimulant use. No evidence showed reduced rTMS efficacy with substance use, but data limitations warrant caution. 

Investigators provided clinically applicable recommendations and a framework for future research. They emphasized the need for greater attention, standardization, and further study in managing substance use in patients receiving rTMS. 

Source: psychiatryonline.org/doi/10.1176/appi.ajp.20240403