Laia Miquel, Daniel Folch-Sanchez, Pilar Lusilla-Palacios, Antoni Gual
rTMS was associated with reduced craving and improved clinical outcomes. Baseline abstinence and younger age were associated with lower relapse rate and increased retention. rTMS may be a safe and promising adjunctive treatment for CUD.
BACKGROUND: Cocaine use disorder (CUD) presents high relapse rates and limited treatment options. Repetitive transcranial magnetic stimulation (rTMS) has shown promise, but evidence in clinical practice is scarce.
METHODS: We conducted a naturalistic retrospective study using medical records of patients with CUD (n = 93) who received rTMS treatment in a private clinic between October 2018 and 2021. Thirty-two (rTMS) sessions were administered: 2 daily sessions in the first week and 2 sessions per week at a high-frequency (10 Hz) stimulation at 120% motor threshold to the left dorsolateral prefrontal cortex. Sociodemographic data, cocaine use, and treatment dropout were recorded, along with psychopathological assessments at 5 time points.
RESULTS: Baseline abstinence predicted lower relapse risk at days 5, 30, and 90 (OR range = 1.42-1.95, all P < .05). At study end, abstinence probability was 58.6% for baseline abstinent versus 33.6% for active users. Intensive treatment (day 5) increased abstinence by 18.8%. Treatment completion was 44.6%, higher among baseline abstinent (70.3% vs 25.0%; P < .001). Age predicted relapse (OR = 1.06, P = .003), while sex and baseline craving did not. Craving decreased significantly over time (F = 56.4, P < .001), with higher scores in active users and a significant time × consumption interaction (P < .05). Sleep quality, depressive symptoms, and anxiety also improved (all P < .001). No side effects were described.
CONCLUSIONS: rTMS was associated with reduced craving and improved clinical outcomes. Baseline abstinence and younger age were associated with lower relapse rate and increased retention. rTMS may be a safe and promising adjunctive treatment for CUD.