Beyond the Surface: Deep Transcranial Magnetic Stimulation Efficacy in Reducing Craving in Addictive Disorders: A Systematic Review and Meta-Analysis

BACKGROUND: Substance use disorders (SUDs) and gambling disorder (GD) are addictive diseases with a chronic course. Due to the limited efficacy of conventional treatments, there is growing interest in alternative approaches that target the altered neural circuits underlying these disorders. Deep transcranial magnetic stimulation (dTMS) has emerged as a promising neuromodulation technique capable of reaching deep and bilateral brain regions. However, no definite recommendation for its use in addiction treatment exists. In this study, we systematically reviewed and quantitatively analyzed dTMS effects in SUDs and GD. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we screened 4 electronic databases up to February 2024 and selected relevant original English-language research articles. Seventeen articles were included in the systematic review and 12 in the meta-analysis. Because only a minority of studies used a sham-controlled design, we ran a main analysis computing the standardized mean change (SMCC) from pre to post real stimulation as the effect size, with self-reported craving scores as the outcome measure. RESULTS: The results showed a significant and large effect of real dTMS in reducing craving scores (SMCC = -1.26; 95% CI, -1.67 to -0.86; p < .001). High heterogeneity across studies was found at both quantitative and qualitative levels. CONCLUSIONS: Results provide preliminary evidence supporting the effectiveness of dTMS for the treatment of SUDs. Current limitations and future directions are critically discussed, highlighting the need for further rigorous research to refine the therapeutic potential and develop consensus-based guidelines for dTMS clinical application.