title: Add-on deep transcranial magnetic stimulation (dTMS) in patients with dysthymic disorder comorbid with alcohol use disorder: a comparison with standard treatment.
abstract: OBJECTIVE
  Dorsolateral prefrontal cortex (DLPFC) is dysfunctional in mood and substance use disorders. We predicted higher efficacy for add-on bilateral prefrontal high-frequency deep transcranial magnetic stimulation (dTMS), compared with standard drug treatment (SDT) in patients with dysthymic disorder (DD)/alcohol use disorder (AUD) comorbidity.
  
  
  METHODS
  We carried-out a 6-month open-label study involving 20 abstinent patients with DSM-IV-TR AUD comorbid with previously developed DD. Ten patients received SDT for AUD with add-on bilateral dTMS (dTMS-AO) over the DLPFC, while another 10 received SDT alone. We rated alcohol craving with the Obsessive Compulsive Drinking Scale (OCDS), depression with the Hamilton Depression Rating Scale (HDRS), clinical status with the Clinical Global Impressions scale (CGI), and global functioning with the Global Assessment of Functioning (GAF).
  
  
  RESULTS
  At the end of the 20-session dTMS period (or an equivalent period in the SDT group), craving scores and depressive symptoms in the dTMS-AO group dropped significantly more than in the SDT group (P < 0.001 and P < 0.02, respectively).
  
  
  CONCLUSIONS
  High frequency bilateral DLPFC dTMS with left preference was well tolerated and found to be effective as add-on in AUD. The potential of dTMS for reducing craving in substance use disorder patients deserves to be further investigated.
authors.affiliation: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital , Rome , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
authors.forename: Chiara
authors.initials: C
authors.lastname: Rapinesi
authors.forename: Flavia
authors.initials: F
authors.lastname: Chiarotti
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Kotzalidis
authors.forename: Daria
authors.initials: D
authors.lastname: Piacentino
authors.forename: Daniele
authors.initials: D
authors.lastname: Serata
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Casale
authors.forename: Paola
authors.initials: P
authors.lastname: Scatena
authors.forename: Flavia
authors.initials: F
authors.lastname: Mascioli
authors.forename: Ruggero N
authors.initials: RN
authors.lastname: Raccah
authors.forename: Roberto
authors.initials: R
authors.lastname: Brugnoli
authors.forename: Vittorio
authors.initials: V
authors.lastname: Digiacomantonio
authors.forename: Vittoria Rachele
authors.initials: VR
authors.lastname: Ferri
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferracuti
authors.forename: Abraham
authors.initials: A
authors.lastname: Zangen
authors.forename: Gloria
authors.initials: G
authors.lastname: Angeletti
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D019973:Alcohol-Related Disorders / Q000188:drug therapy / Q000628:therapy*; D015897:Comorbidity; D066249:Craving; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D019263:Dysthymic Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: alcohol; deep Transcranial magnetic stimulation (dTMS); depression; dorsolateral pre-frontal cortex (DLPFC); dysthymia