Safety and feasibility of accelerated deep transcranial magnetic stimulation for stimulant use disorder: A pilot...

Stimulant use disorder (StUD) remains a major public health concern with limited treatment options and high attrition. Deep transcranial magnetic stimulation (dTMS) targeting the medial prefrontal and anterior cingulate cortices may modulate circuits involved in craving and control. This pilot study evaluated the safety, tolerability, and feasibility of accelerated dTMS (adTMS) using the H7 coil in individuals with moderate to severe StUD.

In this open-label, single-arm feasibility trial, participants received 30 sessions of high-frequency (20 Hz) adTMS using the H7 coil (three daily sessions delivered over 10 days). Primary outcomes were feasibility and safety. Secondary outcomes included craving (SCQ-B; daily visual analog scale), and stimulant use (Timeline Follow-Back, urine toxicology). Exploratory outcomes, including changes in depression (PHQ-9), anxiety (GAD-7), withdrawal (SSSA), and rumination (RRS) were analyzed with linear mixed-effects models.

19 participants enrolled, 16 initiated treatment, and 12 (75% of those who initiated treatment) completed ≥80% of sessions. Among these 12 treatment completers, retention was 67% at 2 and 4 weeks and 58% at 12 weeks. No serious adverse events occurred; the most frequent side effects were mild headache (75%) and fatigue (69%). Depressive symptoms (p=.020) and withdrawal severity (p=.033) improved significantly, while changes in anxiety, rumination, craving, and stimulant use did not (p>.05).

Our adTMS protocol was safe and well tolerated in individuals with StUD. Retention was similar to what has been observed in other trials in this population, but refining retention strategies may help decrease attrition. Depression and withdrawal scores decreased over time, but not craving or stimulant use. Larger, sham-controlled studies with optimized retention strategies are warranted to determine efficacy.