Neuromodulation

Cerebral neuromodulation makes it possible to target specific brain circuits using non-invasive techniques. At CITA Clinics, we employ two of these: Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS).
Although they are distinct procedures, they share a common goal: to modulate the activity of specific brain areas and foster processes linked to neuroplasticity—the brain’s ability to alter its functioning and reorganize its connections.
At CITA, we utilize neuromodulation as part of an individualized medical approach; we do not apply a standard protocol to every patient. Before treatment begins, a specialized assessment is conducted to evaluate the diagnosis, predominant symptoms, medical history, current medication, previous treatments, and potential contraindications.
Furthermore, our specialized expertise in addiction and mental health allows us to integrate these techniques into broader treatment plans addressing issues such as cravings, impulse control, specific depressive or anxiety symptoms, and other disorders involving altered brain circuits related to emotional and behavioral regulation.

How does TMS affect the brain?

Brain activity relies on electrical and chemical communication between neurons.
With TMS, we can direct magnetic pulses to a specific brain region and modify its activity in a controlled manner.
The effect depends on several factors: the area stimulated, pulse frequency, intensity, the number of stimuli, and the protocol used.
Our equipment allows for various stimulation modalities, including rTMS and theta burst stimulation (TBS).
That is why a preliminary assessment is crucial; two patients with seemingly similar symptoms may require different protocols.

What is a TMS session like?

The patient remains seated and awake.
The practitioner places the coil over the selected area and begins stimulation. During the procedure, a repetitive sound is heard, and a sensation of light tapping on the scalp may be felt.
Before starting certain treatment protocols, the so-called motor threshold may be calculated; this allows for the determination of a stimulation intensity tailored to each patient.
It requires neither anesthesia nor sedation.
Once the session is over, the patient can usually resume their normal activities.

What is TMS used for?

Transcranial Magnetic Stimulation has been studied for years across various fields of neurology and psychiatry.
Applications listed in the equipment documentation include:

• major depressive disorder;
• obsessive-compulsive disorder;
• neuropathic pain;
• Parkinson’s disease;
• stroke;
• certain diagnostic applications involving the nervous system.

Research is also being conducted in other areas, such as chronic pain, neurological rehabilitation, post-traumatic stress, and addiction-related disorders.
The existence of scientific research regarding a condition does not mean the technique is automatically indicated for all patients; each case must be evaluated individually.

Neuromodulation, Anxiety, and Emotional Regulation

Anxiety is linked to complex brain networks involved in emotional regulation, threat perception, and the control of cognitive and physiological responses.
Both TMS and tDCS are being investigated for various anxiety-related disorders and symptoms.
The evidence varies across disorders and protocols; therefore, it would be incorrect to speak of a universal technique to “cure anxiety.”
Nevertheless, it is an area of ​​particular interest within the field of neuromodulation.
Regarding tDCS, a recent systematic review specifically analyzed its use for anxiety symptoms and other related markers.
There is also particularly interesting research concerning the co-occurrence of anxiety, depression, and addiction. A review published in 2025 on tDCS for substance use disorders found favorable results regarding anxiety and depression symptoms, although the authors themselves note that further studies are needed to confirm and clarify these effects.
This point is especially relevant for a clinic like CITA, where it is common to approach the patient from a dual diagnosis perspective rather than limiting treatment solely to addictive behavior.

Does TMS have side effects?

TMS is generally well-tolerated, but it is not without potential adverse effects.

The most common side effects include scalp discomfort, headache, a tingling sensation, minor facial muscle contractions, or a temporary feeling of dizziness.

These effects are typically mild to moderate and tend to diminish as treatment progresses.

There are also certain contraindications related to—among other factors—implanted electronic devices, specific metal materials, and certain neurological conditions.

For this reason, a preliminary medical assessment is part of the treatment process.

tDCS: Transcranial Direct Current Stimulation

What is tDCS?

Transcranial Direct Current Stimulation, known as tDCS, is a technique distinct from TMS.

Instead of using magnetic fields, it delivers a low-intensity continuous electric current via electrodes placed on the scalp.

The goal is to modify the excitability of specific brain regions and promote neuroplasticity processes.

It is a non-invasive technique.

How does tDCS work?

Electrode placement is not random.
Their position depends on the brain areas targeted for modulation and the protocol used.
Other influencing factors include:
polarity, intensity, session duration, the number of sessions, and the frequency of administration.
During stimulation, changes occur in the neuronal membrane potential. Repeated sessions aim to produce a neuromodulatory effect and promote brain plasticity in the selected areas.

What is a tDCS session like?

Several electrodes are placed on the scalp according to the established protocol.
To ensure accurate placement, caps based on the international 10-20 system—used as a reference to locate specific brain areas—may be used.
The patient remains awake during the procedure.
A slight tingling, warming, or itching sensation may be felt beneath the electrodes, especially at the beginning.

What is tDCS used for?

Research into tDCS spans various fields, including psychiatry, neurology, rehabilitation, and pain management.
The device’s technical documentation outlines applications related to:

• neuropathic pain;
• chronic pain;
• fibromyalgia;
• stroke;
• major depressive disorder;
• certain symptoms associated with schizophrenia.

Furthermore, research is ongoing regarding its potential utility for symptoms of anxiety, depression, and various neuropsychiatric disorders.
There is also growing interest in studying its effects on cravings, cognitive control, and associated emotional symptoms in the context of addiction. While the evidence is promising in some areas, it does not support the indiscriminate use of a single protocol for every patient.

TMS vs. tDCS: What is the difference?

Both are non-invasive brain neuromodulation techniques, but they work differently.

The right question is not so much “Which is better?”, but rather “Which …makes more sense for this patient and for this therapeutic goal?”

Can TMS and tDCS be combined with psychotherapy?

Yes, when medically indicated.
In fact, at CITA, we consider it particularly valuable for neuromodulation to be part of a broader treatment plan.
Brain stimulation addresses one dimension of the problem, while psychotherapy, behavioral work, and the patient’s daily experiences address others.
This is particularly important in the context of addiction.
It is not enough to simply address cravings; it is also necessary to work on what triggers them, how the patient responds to them, what alternatives are available, and how the patient will manage upon returning to their usual environment.

Our Neuromodulation Program at CITA Clinics

Every treatment begins with a specialized medical assessment.
During this process, we evaluate:
the reason for the consultation, the diagnosis, predominant symptoms, medical and psychiatric history, previous treatments, current medication, and potential contraindications.
Based on this information, we determine:
whether neuromodulation is indicated, which technique and protocol to use, the frequency of sessions, and how to integrate the procedure into the overall treatment plan.
For patients dealing with addiction, anxiety, depression, or dual diagnosis, this approach is particularly important, as there is rarely a single symptom that explains the entire clinical picture.

Request a specialized assessment

Not all patients require neuromodulation, and not everyone needs the same protocol.
The initial decision must always be clinical.
If you would like to know whether TMS or tDCS treatment might be indicated for your case, our team can conduct an assessment and explore the various therapeutic options.