High-frequency rTMS as a first-line treatment for gambling disorder - A case report

Gambling Disorder is a chronic and debilitating condition, often associated with impulsivity, mood disturbances, and significant social and financial consequences. Despite various pharmacological and psychotherapeutic approaches, standardized treatment is lacking. Repetitive transcranial magnetic stimulation (rTMS) has recently emerged as a potential neuromodulatory intervention for addictions. We report the case of a male patient in his sixties with severe Gambling Disorder who underwent TMS treatment with high-frequency rTMS targeting the left dorsolateral prefrontal cortex as a first-line therapy. The patient completed a six-week protocol. Clinical assessment was conducted at baseline, after six weeks, and after three months using multiple validated scales, including the South Oaks Gambling Screen, the Visual Analog Scale for craving, the Barratt Impulsiveness Scale, the Hamilton Anxiety and Depression Scales and the Canadian Problem Gambling Index. The patient's South Oaks Gambling Screen score decreased from 20.5 to 2.0, and craving assessed via Visual Analog Scale reduced from 85 to 15 over three months. Reductions in anxiety, depression, and impulsivity were also observed, along with improvements in emotional stability and extroversion. Cognitive performance remained stable, and no adverse effects were reported throughout the treatment. This case highlights the potential of rTMS as a safe and effective intervention for Gambling Disorder, particularly in patients who are not willing to undergo a psychotherapy or pharmacological treatment. The progressive reduction in craving highlights the role of high rTMS in regulating compulsive behaviour and impulsive control.