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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00621

rTMS reduces psychopathological burden and cocaine consumption in treatment-seeking subjects with Cocaine Use Disorder: an open label, feasibility study

  • 1Associazione "La Promessa" Onlus, Italy
  • 2Department of Neuroscience, Imaging, Clinical Sciences, Università degli Studi G. d'Annunzio Chieti e Pescara, Italy
  • 3University of Hertfordshire, United Kingdom

Introduction: Cocaine use disorder (CUD) currently represents a notable public health concern, linked with significant disability, high chances of chronicity, and lack of effective pharmacological or psychological treatments. Repetitive transcranial magnetic stimulation (rTMS) is supposed to be a potential therapeutic option for addictive disorders. Aim of this study was to evaluate the feasibility of rTMS on (1) cocaine craving and consumption and (2) other comorbid psychiatric symptoms.
Methods: Twenty treatment seeking CUD subjects underwent 2 weeks of intensive rTMS treatment (15Hz; 5 days per week, twice a day for a total of 20 stimulation sessions) of the left dorsolateral prefrontal cortex, followed by 2 weeks of maintenance treatment (15Hz, 1 day per week, twice a day). Sixteen patients completed the study. Patients were evaluated at baseline (T0), after 2 weeks of treatment (T1), and at the end of the study (T2; 4 weeks), with the following scales: Cocaine Selective Severity Assessment (CSSA), Zung Self-Rating Anxiety Scale, Beck Depression Inventory (BDI), Symptom Checklist-90 (SCL-90), and the Insomnia Severity Index.
Results: After four weeks of rTMS treatment, 9 out of 16 subjects (56.25%) had a negative urinalysis test, with a significant conversion rate with respect to baseline (Z = -3.00; p = 0.003). Craving scores significantly improved only at T2 (p = 0.020). The overall psychopathological burden, as measured by the SCL-90 Global Severity Index (GSI), significantly decreased during the study period (Z = -2.689; p = 0.007), with a relevant improvement with regards to depressive symptoms, anhedonia, and anxiety. Subjects exhibiting lower baseline scores on the SCL-90 were more likely to be in the positive outcome group at the end of the study (Z = -3.334; p = 0.001).
Discussion: Findings from this study are consistent with previous contributions on rTMS use in subjects with cocaine use disorder. We evidenced a specific action on some psychopathological areas and a consequent indirect effect in terms of relapse prevention and craving reduction. A double-blind, sham-controlled, neuro-navigated rTMS study design is needed, in order to confirm the potential benefits of this technique, opening new scenarios in substance use disorders treatment.

Keywords: Transcranial Magnetic Stimulation, Cocaine, Depression, Addiction, Anhedonia, Anxiety, dorso lateral prefrontal cortex

Received: 02 Nov 2018; Accepted: 02 Aug 2019.

Edited by:

CARLOS RONCERO, University of Salamanca Health Care Complex, Spain

Reviewed by:

Carla Cannizzaro, University of Palermo, Italy
Colleen A. Hanlon, Medical University of South Carolina, United States  

Copyright: © 2019 Pettorruso, Martinotti, Santacroce, Montemitro, Fanella and Di Giannantonio. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Giovanni Martinotti, Università degli Studi G. d'Annunzio Chieti e Pescara, Department of Neuroscience, Imaging, Clinical Sciences, Chieti, 00135, Please Select, Italy,