Repetitive Transcranial Magnetic Stimulation in Addiction

Although in the last two decades important advances have been made in understanding the neurobiological underpinnings of addictive disorders (ADs), this knowledge has not yet been translated into effective treatments, especially on the long term. Recent findings report that repetitive transcranial magnetic stimulation (rTMS), including theta burst stimulation (TBS) and deep TMS (dTMS), has emerged as a potential treatment for ADs due to its promising results in terms of craving reduction, and given its ability to induce neuroplasticity and modulate brain activity. Based on this rationale and the current evidence, rTMS can be classified as probably effective in the treatment of addiction, with promising effect size for high-frequency rTMS stimulation protocol of the DLPFC, mainly in nicotine and cocaine/stimulant-use disorders, and with some noteworthy pilot data in the area of gambling disorder. However, double-blind, sham-controlled studies are mostly needed in order to confirm these potential benefits. Interestingly, most of the efforts for rTMS in addiction have been focused on increasing activity in the DLPFC. However, decreasing activity in the MPFC and ventral striatum may also be a feasible and fruitful target to consider. Future research should identify potential parameters (i.e., duration, number of stimulation treatments, stimulation frequency, intensity, brain region of target) of stimulation in rTMS studies for the most effective and safe treatment of drug addiction. The personalization of rTMS treatments, as well as the optimization of stimulation protocols, is the main issue that will involve future research in this area.