Repetitive Transcranial Magnetic Stimulation (rTMS) as a Promising Treatment for Craving in Stimulant Drugs and Behavioral Addiction: A Meta-Analysis

Abstract

Addiction is a mental disorder with limited available treatment options. The therapeutic potential of repetitive transcranial magnetic stimulation (rTMS) on it, by targeting craving in particular, has been explored with heterogenous results. This meta-analysis uses updated evidence to assess overall rTMS efficacy on craving, differential effects between addiction types clustered into three groups (depressant (alcohol, cannabis, opiate), stimulant (nicotine, cocaine, methamphetamine), and behavioral addiction (gambling, eating disorder)), and stimulation settings. Studies on substance use, gambling, and eating disorders are included, with unrestricted stimulation settings, by searching the PubMed, Embase, PsycINFO, and Cochrane databases up to 30 April 2020. A total of 34 eligible studies (42 units of analysis) were identified. Because of highly significant heterogeneity in primary results, a sensitivity analysis was performed on a remaining sample of 26 studies (30 units of analysis). Analyses performed using random effects model revealed a small effect size favoring active rTMS over shamTMS stimulation in the reduction in craving. We found a significant difference between addiction types, with a persistent small effect only for stimulant and behavioral groups. In these groups we found no difference between the different combinations of target and frequency of stimulation, but a significant correlation between number of sessions and craving reduction. In conclusion, efficacy of rTMS on craving in stimulant and behavioral addiction was highlighted, but recommendations on optimal stimulation settings and its clinical application await further research.

Efficacy of Repetitive Transcranial Magnetic Stimulation in Patients With Methamphetamine Use Disorder: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials

“…Our findings are consistent with those of three meta-analyses ( 23 – 25 ). We included seven DBRCTs in our study, whereas other studies had four ( 25 ), five ( 24 ) and six ( 23 ). Zhang et al included 26 trials, with four ( 20 , 28 , 31 , 32 ) focusing on MUD.…”

“…Our study has several strengths compared with the three other meta-analyses ( 23 – 25 ). First, we included seven trials, whereas other studies included four, five, and six ( 23 – 25 ).…”

“…Our study has several strengths compared with the three other meta-analyses ( 23 – 25 ). First, we included seven trials, whereas other studies included four, five, and six ( 23 – 25 ). Second, we conducted a subgroup analysis on conventional rTMS and TBS, revealing that TBS had a higher positive effect on cravings than 10-Hz rTMS.…”

“…In this study, two well-trained authors (C-HC and M-FL) independently performed a systematic literature search from the study’s inception until March 5, 2022. The search terms were (methamphetamine OR methylamphetamine) AND (repetitive transcranial magnetic stimulation OR rTMS OR brain stimulation OR theta-burst) ( 23 – 25 ). We searched the PubMed, Cochrane Collaboration Central Register of Controlled Clinical Trials, and Cochrane Systematic Reviews databases for studies on rTMS for MUD.…”

Cortical and subcortical connections change after repetitive transcranial magnetic stimulation therapy in cocaine use disorder and predict clinical outcome

“…These results may suggest firstly, a recovery of the integrity of prefrontal connections neurites due to active rTMS, and secondly, a close-relationship between the fronto-striatal circuits and the dependency behavior. The main mechanism of action proposed for rTMS in SUD treatment is to activate dopamine function in meso-cortico-limbic system and a reinstaining of extracellular glutamate and dopamine concentrations, which could trigger changes of dendritic spine density, neurotransmitter receptor expression, neuronal degeneration, and microglial activation which could explain the microstructural reversive results in basal ganglia and PFC (8,51,52). A previous study has found that rTMS can reach deep subcortical structures such as the amygdala through stimulation of cortical to subcortical connections (53).…”