Decreasing Cocaine Use with Repetitive Transcranial Magnetic Stimulation

Background: Dependence on cocaine causes significant functional impairment and morbidity in users and is extremely prevalent in the U.S. Unlike other abused substances, there is currently no effective standard of treatment to decrease cocaine cravings and prevent relapse. This systematic review assesses whether recent research shows that repetitive transcranial magnetic stimulation (rTMS) is an effective treatment to decrease cocaine use. Methods: An exhaustive search of the medical literature databases was performed using Medline-Ovid, CINAHL, and Web of Science with the search words “cocaine” and “transcranial magnetic stimulation”. The studies reviewed were chosen based on inclusion and exclusion criteria and were assessed for quality using the GRADE criteria. Results: There have only been two studies performed on rTMS’s effects on cocaine use specifically, which were both included in this review. Both studies showed evidence that rTMS decreases cocaine use. One study showed a significant increase in abstinence during, and up to 6 months after rTMS treatment and a significant decrease in cravings as a secondary outcome. The second study did not show a significant decrease in cocaine use for the rTMS group until an exploratory analysis was done. The quality of both studies was low to moderate based on the GRADE criteria. Conclusion: Despite the small number of studies assessing rTMS’s effectiveness on decreasing cocaine use and their low to moderate quality of evidence based on the GRADE criteria, the 2 studies reviewed here show promising evidence that rTMS can successfully decrease cocaine use. Trials with a larger sample size and higher attrition rate are required to more clearly show whether rTMS has a positive effect on decreasing cocaine use. Despite these limitations, since effective treatments are not currently available, the risk of rTMS treatment is low, and the cost of continued cocaine dependence is extremely high, rTMS treatment should be considered for patients trying to abstain from cocaine use