Effects of transcranial magnetic stimulation on cocaine addiction: A systematic review of randomized controlled trials

A Amerio; C Baccino; G S Breda; D Cortesi; V Spiezio; L Magnani; D De Berardis; B Conio; A Costanza; G De Paola; G Rocca; G Arduino; A Aguglia; M Amore; G Serafini

doi:10.1016/j.psychres.2023.115491

Effects of transcranial magnetic stimulation on cocaine addiction: A systematic review of randomized controlled trials

Psychiatry Res. 2023 Nov:329:115491. doi: 10.1016/j.psychres.2023.115491. Epub 2023 Sep 22.

Authors

A Amerio¹, C Baccino², G S Breda², D Cortesi³, V Spiezio², L Magnani⁴, D De Berardis⁵, B Conio⁶, A Costanza⁷, G De Paola⁸, G Rocca⁹, G Arduino¹⁰, A Aguglia¹¹, M Amore¹², G Serafini¹³

Affiliations

¹ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy. Electronic address: andrea.amerio@unige.it.
² Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
³ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy. Electronic address: cortesidavide96@libero.it.
⁴ Department of Psychiatry, San Maurizio Hospital, Bolzano, Italy.
⁵ NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy. Electronic address: domenico.deberardis@aslteramo.it.
⁶ IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁷ Department of Psychiatry, Faculty of Medicine, Geneva University (UNIGE), Geneva, Switzerland; Department of Psychiatry, Adult Psychiatry Service (SPA), University Hospitals of Geneva (HUG), Geneva, Switzerland; Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), Lugano, Switzerland. Electronic address: alessandra.costanza@unige.ch.
⁸ Ospedale Maria Luigia, Monticelli Terme, Italy.
⁹ R&R Neuromodulation Lab, Piacenza, Italy.
¹⁰ Department of Mental Health and Pathological Addictions, Piacenza Local Health Authority, Piacenza, Italy.
¹¹ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy. Electronic address: andrea.aguglia@unige.it.
¹² Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy. Electronic address: mario.amore@unige.it.
¹³ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy. Electronic address: gianluca.serafini@unige.it.

PMID: 37783092
DOI: 10.1016/j.psychres.2023.115491

Abstract

Objective: While pharmacological strategies appear to be ineffective in treating long-term addiction, repetitive transcranial magnetic stimulation (rTMS) is emerging as a promising new tool for the attenuation of craving among multiple substance dependent populations.

Method: A systematic review of randomized controlled trials (RCTs) was conducted on the efficacy and tolerability of rTMS in treating cocaine use disorder (CUD). Relevant papers published in English through November 30^th 2022 were identified, searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library.

Results: Eight studies matched inclusion criteria. The best findings were reported by the RCTs conducted at high-frequency (≥5 Hz) multiple sessions of rTMS delivered over the left dorsolateral prefrontal cortex (DLPFC): a significant decrease in self-reported cue-induced cocaine craving and lower cocaine craving scores and a considerable amelioration in the tendency to act rashly under extreme negative emotions (impulsivity) were found in the active group compared to controls.

Conclusion: Although still scant and heterogeneous, the strongest evidence so far on the use of rTMS on individuals with CUD support the high frequency stimulation over the left DLPFC as a well tolerated treatment of cocaine craving and impulsivity.

Keywords: Cocaine addiction; Cocaine craving; TMS; Transcranial magnetic stimulation.

Publication types

Systematic Review
Review

MeSH terms

Cocaine*
Cocaine-Related Disorders* / therapy
Craving / physiology
Humans
Prefrontal Cortex / physiology
Randomized Controlled Trials as Topic
Substance-Related Disorders* / etiology
Transcranial Magnetic Stimulation
Treatment Outcome

Substances

Cocaine