Efficacy of Continuous Theta Burst Stimulation to the Pre-supplementary Motor Area in Gambling Disorder: a Randomized Double-Blind Controlled Trial

Gambling disorder (GD) is a condition constituting a public health concern due to its impactful detrimental consequences for affected individuals and its very high social costs. Given the lack of FDA-approved treatments, novel non-pharmacological interventions are warranted. In this double-blind randomized controlled trial, we aimed to investigate the effects of continuous Theta Burst Stimulation (cTBS) in patients with GD. Twenty-nine patients with a diagnosis of GD were included and randomly assigned to active or sham condition. In the active condition, participants received 10 sessions of cTBS over pre-SMA bilaterally. Patients were evaluated at baseline and at the end of treatment with the Pathological Gambling version of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS) as primary outcome measure, and with the following secondary measures: Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), Gambling Urges Scale (GUS), Barratt Impulsiveness Scale (BIS-11), Sheehan Disability Scale (SDS), Fagerstrom Test for Nicotine Dependence (FTND). A two-way repeated measures ANOVA revealed a significant "group" x "time" interaction for PG-YBOCS and GUS measures. Within group comparisons revealed that PG-YBOCS scores (p<.001) and GUS scores (p<.001) improved significantly in the group receiving the active stimulation, and positively correlated with a reduction of gambling-related disability, as measured with the SDS. This study shows that cTBS could be an effective treatment for GD, since it reduces one of its main dimensions: craving. Trial registration: Identifier: NCT03669315