2026 ECNP Congress

PS01-1005

Deep transcranial magnetic stimulation in cocaine use disorder: the impact on craving and psychopathological burden

Ilaria Marcelli — M. Massetti, F. Grisoni, M. Pepe, M.B. Anesini, O. Di Giacomi, L. Farsakh, G. Sani, M. Di Nicola · Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Department of Psychiatry, Rome, Italy

2026 ECNP Congress

Background

Cocaine use disorder (CUD) is a highly prevalent condition associated with substantial clinical burden [1]. Core withdrawal symptoms, including craving and negative affect, are key therapeutic targets. Deep transcranial magnetic stimulation (dTMS) has recently emerged as a promising non-invasive neuromodulation technique for treating addictive disorders [2], enabling stimulation of deeper cortical and subcortical regions compared to conventional repetitive TMS (rTMS) [3]. The H1-coil primarily targets the dorsolateral prefrontal cortex (DLPFC), a region involved in motivation, decision-making and emotional regulation – domains frequently impaired in CUD and associated with relapse vulnerability [4]. This study aims to investigate the effects of dTMS on craving and global psychopathological burden in patients with CUD, to explore their longitudinal association and to preliminary assess changes in cocaine use patterns.

Methods

Twenty-two patients (90.9% males; mean age 43 ± 10.8 years) with CUD underwent 29 dTMS sessions (H1 coil) in addition to pharmacotherapy and group psychotherapy. Assessments were conducted at baseline (T0), mid-treatment (T1), and end of treatment (T2). Craving, global clinical severity, and overall psychopathological burden were measured using the Cocaine Craving Questionnaire (CCQ), Clinical Global Impression-Severity (CGI-S), and the Symptom Checklist-90-Global Severity index (SCL-90 GSI), respectively. Depressive and anxiety symptoms were also evaluated using the SCL-90 subscales. Cocaine use was monitored via the Timeline Follow-Back (TLFB) method and confirmed by urine toxicological screenings. Statistical analyses included repeated-measures ANOVA, and Pearson correlations; significance was set at p < 0.05.

Results

A significant reduction in craving (CCQ; p < 0.001) was observed over time, with post-hoc analyses confirming decreases between T0–T2 and T1–T2 (both p < 0.001). Global psychopathological burden significantly improved, as reflected by reductions in SCL-90 GSI and CGI-S scores (both p < 0.001). Depressive symptoms decreased significantly (p = 0.015), while anxiety symptoms showed significant improvement between T1 and T2 (p = 0.035). Craving was positively associated with global psychopathological burden at T1 (r = 0.75, p = 0.001) and T2 (r = 0.78, p < 0.001), and was also significantly correlated with depressive and anxiety symptoms at both time points. Descriptive analyses of TLFB and toxicological data suggested a reduction in cocaine use frequency and increased rates of abstinence over the treatment period. By the end of treatment, 40.9% of patients reduced cocaine use and 40.9% achieved abstinence.

Conclusions

These findings support dTMS as a promising adjunctive intervention in CUD, potentially enhancing outcomes when integrated with pharmacological treatment and psychotherapy. The strong association between craving and psychopathology highlights their dynamic interplay during treatment. Notably, more pronounced clinical improvements emerged in the later phases, suggesting a cumulative effect of dTMS. This pattern underscores the potential importance of implementing more intensive interventions in the early phase of treatment to optimize subsequent outcomes. Preliminary data on cocaine use patterns further suggest a favorable impact on consumption and abstinence. Overall, these findings extend evidence from rTMS studies [5], indicating that dTMS may exert broader modulatory effects across clinical dimensions relevant to relapse in CUD.

References

  1. United Nations, G.A. World Drug Report 2020. Report 2. Drug Use and Health Consequences. 2020.
  2. Del Mauro L, Vergallito A, Devoto F, Locatelli G, Hassan G, Romero Lauro LJ. Beyond the Surface: Deep Transcranial Magnetic Stimulation Efficacy in Reducing Craving in Addictive Disorders: A Systematic Review and Meta-Analysis. Biol Psychiatry Cogn Neurosci Neuroimaging. 2025 Oct;10(10):1005-1014. doi: 10.1016/j.bpsc.2025.03.012. Epub 2025 Apr 7. PMID: 40204236.
  3. Cheng JL, Tan C, Liu HY, Han DM, Liu ZC. Past, present, and future of deep transcranial magnetic stimulation: A review in psychiatric and neurological disorders. World J Psychiatry. 2023 Sep 19;13(9):607-619. doi: 10.5498/wjp.v13.i9.607. PMID: 37771645; PMCID: PMC10523198.
  4. Rapinesi C, Del Casale A, Di Pietro S, Ferri VR, Piacentino D, Sani G, Raccah RN, Zangen A, Ferracuti S, Vento AE, Angeletti G, Brugnoli R, Kotzalidis GD, Girardi P. Add-on high frequency deep transcranial magnetic stimulation (dTMS) to bilateral prefrontal cortex reduces cocaine craving in patients with cocaine use disorder. Neurosci Lett. 2016 Aug 26;629:43-47. doi: 10.1016/j.neulet.2016.06.049. Epub 2016 Jun 27. PMID: 27365134.
  5. Amerio A, Baccino C, Breda GS, Cortesi D, Spiezio V, Magnani L, De Berardis D, Conio B, Costanza A, De Paola G, Rocca G, Arduino G, Aguglia A, Amore M, Serafini G. Effects of transcranial magnetic stimulation on cocaine addiction: A systematic review of randomized controlled trials. Psychiatry Res. 2023 Nov;329:115491. doi: 10.1016/j.psychres.2023.115491. Epub 2023 Sep 22. PMID: 37783092.