title: Efficacy of add-on deep transcranial magnetic stimulation in comorbid alcohol dependence and dysthymic disorder: three case reports.
abstract: BACKGROUND
  Craving for alcohol is associated with abnormal activation in the dorsolateral prefrontal cortex. Deep transcranial magnetic stimulation (dTMS) has shown promise in the treatment of depression. There are few treatment options for treatment-resistant dysthymic disorder comorbid with alcohol use disorder.
  
  
  OBJECTIVE
  To investigate the possible anticraving efficacy of bilateral dorsolateral prefrontal cortex high-frequency dTMS in 3 patients with comorbid long-term DSM-IV-TR dysthymic disorder and alcohol use disorder.
  
  
  METHODS
  Three patients with alcohol use disorder with dysthymic disorder in their detoxification phase (abstaining for > 1 month) underwent twenty 20-minute sessions of 20 Hz dTMS over the dorsolateral prefrontal cortex over 28 days between 2011 and 2012. Alcohol craving was rated with the Obsessive Compulsive Drinking Scale and depressive symptoms with the Hamilton Depression Rating Scale.
  
  
  RESULTS
  All 3 patients responded unsatisfactorily to initial intravenous antidepressant and antianxiety combinations but responded after 10 dTMS sessions, improving on both anxiety-depressive symptoms and craving. This improvement enabled us to reduce antidepressant dosages after dTMS cycle completion.
  
  
  CONCLUSIONS
  High-frequency bilateral dorsolateral prefrontal cortex dTMS with left prevalence was found to produce significant anticraving effects in alcohol use disorder comorbid with dysthymic disorder. The potential of dTMS for reducing craving in patients with substance use disorder deserves to be further investigated.
authors.affiliation: Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Chiara
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authors.forename: Daniele
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authors.lastname: Digiacomantonio
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authors.forename: Claudio
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authors.lastname: Fensore
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authors.lastname: Tatarelli
authors.forename: Gloria
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authors.lastname: Angeletti
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authors.lastname: Girardi