Repetitive Transcranial Magnetic Stimulation for Cocaine Use Disorder: An Observational Study

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.

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.

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.

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.