Addiction is a mental disorder with limited available treatment options. The therapeutic potential of repetitive transcranial magnetic stimulation (rTMS) on it, by targeting craving in particular, has been explored with heterogenous results. This meta-analysis uses updated evidence to assess overall rTMS efficacy on craving, differential effects between addiction types clustered into three groups (depressant (alcohol, cannabis, opiate), stimulant (nicotine, cocaine, methamphetamine), and behavioral addiction (gambling, eating disorder)), and stimulation settings. Studies on substance use, gambling, and eating disorders are included, with unrestricted stimulation settings, by searching the PubMed, Embase, PsycINFO, and Cochrane databases up to 30 April 2020. A total of 34 eligible studies (42 units of analysis) were identified. Because of highly significant heterogeneity in primary results, a sensitivity analysis was performed on a remaining sample of 26 studies (30 units of analysis). Analyses performed using random effects model revealed a small effect size favoring active rTMS over shamTMS stimulation in the reduction in craving. We found a significant difference between addiction types, with a persistent small effect only for stimulant and behavioral groups. In these groups we found no difference between the different combinations of target and frequency of stimulation, but a significant correlation between number of sessions and craving reduction. In conclusion, efficacy of rTMS on craving in stimulant and behavioral addiction was highlighted, but recommendations on optimal stimulation settings and its clinical application await further research.

Attempted suicide is a major public health problem, and the efficacies of current postvention protocols vary. We evaluated the effectiveness of telephone follow-up of patients referred to an emergency psychiatric unit for attempted suicide on any further attempt/s over the following year. In a single-center, controlled study with intent to treat, we evaluated the efficacy of a protocol of telephone follow-up of 436 patients at 8, 30, and 60 days after they were treated for attempted suicide. As controls for comparison, we evaluated patients with similar social and demographic characteristics referred to our emergency psychiatric unit in the year prior to the study who did not receive telephone follow-up after their initial hospitalization. Data were analyzed using logistic regression. Very early telephone follow-up of our patients effectively reduced recidivism and seemed to be the only protective factor against repeated suicide attempt. Implementing a protocol of early telephone follow-up after attempted suicide could help prevent repeated attempt/s. More controlled studies are needed to assess optimal techniques to prevent such repetition.

Background: Gambling disorder (GD) is common and disabling addictive disorder. In patients with substance use disorders, the application of repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) offers promise to alleviate craving. We hypothesized that applying real compared to sham rTMS over the left DLPFC would reduce gambling craving in patients with GD.Methods: In a randomized sham-controlled crossover design, 22 treatment-seeking patients with GD received real or sham treatment with high frequency rTMS over the left DLPFC followed a week later by the other type of treatment. Before and after each rTMS session, participants rated their gambling craving (from 0 to 100) before and after viewing a gambling video used as a cue. We used the Yale-Brown Obsessive Compulsive Scale adapted for Pathological Gambling to assess gambling behavior before and 7 days after each rTMS session.Results: As compared to sham (mean +0.74; standard deviation ± 3.03), real rTMS significantly decreased cue-induced craving (−2.12 ± 3.39;F_(1,19)= 4.87;P= 0.04; partialη²= 0.05; 95% CI: 0.00–0.21). No significant effect of rTMS was observed on gambling behavior.Conclusions: Patients with GD reported decreased cue-induced craving following a single session of high frequency rTMS applied over the left DLPFC. Further large randomized controlled studies are needed to determine the usefulness of rTMS in GD.

Food craving is a main pathological issue in Eating Disorders (ED), associated with binge eating such as bulimia nervosa and binge eating disorder. Common therapies are currently based on Cognitive and Behavioral Therapies (CBT). However, a significant number of patients are not receptive to conventional CBTs. Virtual Reality (VR) is now used as a variant of CBTs, especially VR based cue exposure therapy, but only food triggers are generally considered in this form of therapy. In this context, we developed the ReVBED environment: a semi-directed VR exposure scenario allowing the induction of food craving by including multimodal stimuli. The proposed paper presents the REVBED environment and scenario, and the planned clinical study of which aim is to evaluate its effectiveness for inducing food cravings in bulimia nervosa and binge eating disorder patients, with subjective and objective measurements.