Brain stimulation techniques, including repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS) and deep brain stimulation (DBS), have been under recent investigation as novel, effective treatments for mental disorders. These procedures utilize magnets, electricity or impulses to activate and make long-term changes to specific areas of the brain. Historically, brain stimulation techniques have been utilized for patients affected by severe and treatment-resistant depressive disorders as well as other mental illnesses including psychosis, schizophrenia and bipolar disorder.
According to a recently published article in the journal European Neuropsychopharmacology, rTMS may be an effective treatment for reducing cravings and use of cocaine among patients with cocaine addiction. The pilot study, conducted by Antonello Bonci, M.D., from the National Institute on Drug Abuse (NIDA) Intramural Research Program and Johns Hopkins University School of Medicine, and his colleagues, investigated the effectiveness of rTMS for treating patients with cocaine addiction.
Thirty-two patients with cocaine addiction were randomly assigned to either the experimental group (i.e., rTMS) or the control group (i.e., pharmacological agents). Patients in the experimental group received rTMS directed at stimulating the dorsolateral prefrontal cortex, an area of the brain that plays a role in addiction (e.g., cravings, inhibitory control, reinforcement learning, etc.), to determine whether targeting this area could prevent the use of cocaine among patients with cocaine addiction.
Importantly, chronic cocaine use damages the dorsolateral prefrontal cortex and leads to significant reductions in brain volume, brain activity, executive functioning and regulation of neurotransmitters (i.e., brain chemicals). rTMS is a type of noninvasive brain stimulation therapy that uses insulated coils to generate brief magnetic pulses in rapid succession into specific areas of the brain, and is thought to produce long lasting changes in neuronal activity in areas of the brain, especially in areas responsible for regulating mood (e.g., prefrontal cortex) and that play a role in the addictive cycle.
Although the patients in the control group did not receive rTMS therapy, they were treated with pharmacological treatments (i.e., pramipexole, bupropione, oxazepam, triazolam and gamma hydroxybutyrate), which aimed at improving comorbid symptoms of depression, anxiety and sleep-related disorders, because these disorders often co-occur among patients with cocaine addiction.
After 29 days, patients in the rTMS group reported having no significant adverse effects due to treatment with rTMS, although a few participants reported mild discomfort at the beginning of rTMS, especially during the initial session. Importantly, the researchers found that patients in the rTMS group had significantly lower cravings for cocaine and significantly more positive outcomes (i.e., negative urine drug screens, no relapse during treatment) compared to the control group. Patients with cocaine addiction in both the experimental and control groups also reported improvements in depressive symptomology.
What this means
This study provides preliminary evidence for the safety and effectiveness of rTMS for treating patients with cocaine addiction. The researchers found that rTMS led to significant reductions in the use of cocaine and cravings among patients with cocaine addiction. These preliminary results are promising, but further empirical investigation is warranted to determine the safety and effectiveness of using rTMS to treat patients with different mental disorders.
The Sovereign Health Group provides evidence-based treatments for mental health disorders, substance abuse and co-occurring conditions. For more information about addiction or about the treatment programs offered at Sovereign Health, please contact our 24/7 helpline.
Written by Amanda Habermann, M.S. clinical psychology, Sovereign Health Group writer