Sleep quality improves during treatment with repetitive transcranial magnetic stimulation (rTMS) in patients with cocaine use disorder: a retrospective observational study

Luis J Gómez Pérez, Stefano Cardullo, Nicola Cellini, Michela Sarlo, Tommaso Monteanni, Antonello Bonci, Alberto Terraneo, Luigi Gallimberti, Graziella Madeo, Luis J Gómez Pérez, Stefano Cardullo, Nicola Cellini, Michela Sarlo, Tommaso Monteanni, Antonello Bonci, Alberto Terraneo, Luigi Gallimberti, Graziella Madeo

Abstract

Background: Sleep disturbance is a prominent and common complaint in people with cocaine use disorder (CUD), either during intake or withdrawal. Repetitive transcranial magnetic stimulation (rTMS) has shown promise as a treatment for CUD. Thus, we evaluated the relationship between self-perceived sleep quality and cocaine use pattern variables in outpatients with CUD undergoing an rTMS protocol targeted at the left dorsolateral prefrontal cortex.

Methods: This is a retrospective observational study including 87 patients diagnosed with CUD according to the DSM-5 criteria. Scores in Pittsburgh Sleep Quality Index (PSQI), Cocaine Craving Questionnaire (CCQ), Beck Depression Inventory-II (BDI-II), Self-rating Anxiety Scale (SAS), and Symptoms checklist 90-Revised (outcome used: Global Severity Index, GSI) were recorded at baseline, and after 5, 30, 60, and 90 days of rTMS treatment. Cocaine use was assessed by self-report and regular urine screens.

Results: Sleep disturbances (PSQI scores > 5) were common in patients at baseline (mean ± SD; PSQI score baseline: 9.24 ± 3.89; PSQI > 5 in 88.5% of patients). PSQI scores significantly improved after rTMS treatment (PSQI score Day 90: 6.12 ± 3.32). Significant and consistent improvements were also seen in craving and in negative-affect symptoms compared to baseline. Considering the lack of a control group, in order to help the conceptualization of the outcomes, we compared the results to a wait-list group (n = 10). No significant improvements were observed in the wait-list group in any of the outcome measures.

Conclusions: The present findings support the therapeutic role of rTMS interventions for reducing cocaine use and accompanying symptoms such as sleep disturbance and negative-affect symptoms.

Trial registration: ClinicalTrials.gov.NCT03733821.

Keywords: Cocaine use disorder (CUD); Craving; Dorsolateral prefrontal cortex (DLPFC); Pittsburgh sleep quality index (PSQI); Repetitive Transcranial magnetic stimulation (rTMS); Sleep.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Consort 2010 Flow Diagram of the study
Fig. 2
Fig. 2
PSQI score changes at each timepoint of observation. Plots of the means and confidence intervals show a significant decrease of the PSQI score at each timepoint of observation compared to baseline
Fig. 3
Fig. 3
Dose-dependent effect of rTMS on PSQI and BDI scores
Fig. 4
Fig. 4
Comparison of PSQI scores change between rTMS and wait-list group of patients in a 30-day-window of observation. “Baseline” and “Day 30” assessment for active group compared to “Day − 30” and “Baseline” for wait-list patients; ns non-significant; * p < 0.05

References

    1. Grant BF, Saha TD, Ruan WJ, Goldstein RB, Chou SP, Jung J, et al. Epidemiology of DSM-5 drug use disorder: results from the National Epidemiologic Survey on alcohol and related conditions–III. JAMA psychiatry. 2016;73:39–47. doi: 10.1001/jamapsychiatry.2015.2132.
    1. (EMCDDA) EMC for D and DA . European Drug Report 2019: trends and developments. 2019.
    1. Angarita GA, Canavan SV, Forselius E, Bessette A, Pittman B, Morgan PT. Abstinence-related changes in sleep during treatment for cocaine dependence. Drug Alcohol Depend. 2014;134:342–347. doi: 10.1016/j.drugalcdep.2013.11.007.
    1. Schierenbeck T, Riemann D, Berger M, Hornyak M. Effect of illicit recreational drugs upon sleep: cocaine, ecstasy and marijuana. Sleep Med Rev. 2008;12:381–389. doi: 10.1016/j.smrv.2007.12.004.
    1. Mahoney JJ, De La Garza R, Jackson BJ, Verrico CD, Ho A, Iqbal T, et al. The relationship between sleep and drug use characteristics in participants with cocaine or methamphetamine use disorders. Psychiatry Res. 2014;219:367–371. doi: 10.1016/j.psychres.2014.05.026.
    1. Hodges SE, Pittman B, Morgan PT. Sleep perception and misperception in chronic cocaine users during abstinence. Sleep. 2017;40. 10.1093/sleep/zsw069.
    1. Johanson CE, Roehrs T, Schuh K, Warbasse L. The effects of cocaine on mood and sleep in cocaine-dependent males. Exp Clin Psychopharmacol. 1999;7:338–346. doi: 10.1037/1064-1297.7.4.338.
    1. Morgan PT, Pace-Schott EF, Sahul ZH, Coric V, Stickgold R, Malison RT. Sleep, sleep-dependent procedural learning and vigilance in chronic cocaine users: evidence for occult insomnia. Drug Alcohol Depend. 2006;82:238–249. doi: 10.1016/j.drugalcdep.2005.09.014.
    1. Thompson PM, Gillin JC, Golshan S, Irwin M. Polygraphic sleep measures differentiate alcoholics and stimulant abusers during short-term abstinence. Biol Psychiatry. 1995;38:831–836. doi: 10.1016/0006-3223(95)00070-4.
    1. Angarita GA, Canavan SV, Forselius E, Bessette A, Morgan PT. Correlates of polysomnographic sleep changes in cocaine dependence: self-administration and clinical outcomes. Drug Alcohol Depend. 2014;143:173–180. doi: 10.1016/j.drugalcdep.2014.07.025.
    1. Berro LF, Frussa-Filho R, Tufik S, Andersen ML. Relationships between sleep and addiction: the role of drug-environment conditioning. Med Hypotheses. 2014;82:374–376. doi: 10.1016/j.mehy.2013.12.026.
    1. Demontis MG, Fadda P, Devoto P, Martellotta MC, Fratta W. Sleep deprivation increases dopamine D1 receptor antagonist [3H] SCH 23390 binding and dopamine-stimulated adenylate cyclase in the rat limbic system. Neurosci Lett. 1990;117:224–227. doi: 10.1016/0304-3940(90)90148-3.
    1. Fadda P, Martellotta MC, Gessa GL, Fratta W. Dopamine and opioids interactions in sleep deprivation. Prog Neuro-Psychopharmacol Biol Psychiatry. 1993;17:269–278. doi: 10.1016/0278-5846(93)90047-V.
    1. Nunes Júnior GP, Tufik S, Nobrega JN. Autoradiographic analysis of D1 and D2 dopaminergic receptors in rat brain after paradoxical sleep deprivation. Brain Res Bull. 1994;34:453–456. doi: 10.1016/0361-9230(94)90018-3.
    1. Gujar N, Yoo S-S, Hu P, Walker MP. Sleep deprivation amplifies reactivity of brain reward networks, biasing the appraisal of positive emotional experiences. J Neurosci. 2011;31:4466–4474. doi: 10.1523/JNEUROSCI.3220-10.2011.
    1. Koob GF, Volkow ND. Neurobiology of addiction: a neurocircuitry analysis. Lancet Psychiatry. 2016;3:760–773. doi: 10.1016/S2215-0366(16)00104-8.
    1. Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet. 1985;325:1106–1107. doi: 10.1016/S0140-6736(85)92413-4.
    1. Leuchter AF, Cook IA, Jin Y, Phillips B. The relationship between brain oscillatory activity and therapeutic effectiveness of transcranial magnetic stimulation in the treatment of major depressive disorder. Front Hum Neurosci. 2013;7:37. doi: 10.3389/fnhum.2013.00037.
    1. Diana M, Raij T, Melis M, Nummenmaa A, Leggio L, Bonci A. Rehabilitating the addicted brain with transcranial magnetic stimulation. Nat Rev Neurosci. 2017;18:685–693. doi: 10.1038/nrn.2017.113.
    1. Terraneo A, Leggio L, Saladini M, Ermani M, Bonci A, Gallimberti L. Transcranial magnetic stimulation of dorsolateral prefrontal cortex reduces cocaine use: a pilot study. Eur Neuropsychopharmacol. 2016;26:37–44. doi: 10.1016/j.euroneuro.2015.11.011.
    1. Rapinesi C, Del Casale A, Di Pietro S, Ferri VR, Piacentino D, Sani G, et al. Add-on high frequency deep transcranial magnetic stimulation (dTMS) to bilateral prefrontal cortex reduces cocaine craving in patients with cocaine use disorder. Neurosci Lett. 2016;629:43–47. doi: 10.1016/j.neulet.2016.06.049.
    1. Politi E, Fauci E, Santoro A, Smeraldi E. Daily sessions of transcranial magnetic stimulation to the left prefrontal cortex gradually reduce cocaine craving. Am J Addict. 2008;17:345–346. doi: 10.1080/10550490802139283.
    1. Cardullo S, Gomez Perez JL, Marconi L, Terraneo A, Gallimberti L, Bonci A, et al. Clinical improvements in comorbid gambling/cocaine use disorder (GD/CUD) patients undergoing repetitive Transcranial magnetic stimulation (rTMS) J Clin Med. 2019;8:768. doi: 10.3390/jcm8060768.
    1. Bolloni C, Panella R, Pedetti M, Frascella AG, Gambelunghe C, Piccoli T, et al. Bilateral transcranial magnetic stimulation of the prefrontal cortex reduces cocaine intake: a pilot study. Front Psychiatry. 2016;7:133. doi: 10.3389/fpsyt.2016.00133.
    1. Cohrs S, Tergau F, Riech S, Kastner S, Paulus W, Ziemann U, et al. High-frequency repetitive transcranial magnetic stimulation delays rapid eye movement sleep. Neuroreport. 1998;9:3439–3443. doi: 10.1097/00001756-199810260-00019.
    1. Huber R, Esser SK, Ferrarelli F, Massimini M, Peterson MJ, Tononi G. TMS-induced cortical potentiation during wakefulness locally increases slow wave activity during sleep. PLoS One. 2007;2:e276. doi: 10.1371/journal.pone.0000276.
    1. Nardone R, Höller Y, Brigo F, Tezzon F, Golaszewski S, Trinka E. Transcranial magnetic stimulation and sleep disorders: pathophysiologic insights. Sleep Med. 2013;14:1047–1058. doi: 10.1016/j.sleep.2013.04.025.
    1. Gang JC, Zhang T, Guo YF, Ling YM, Gao D. Efficacy of repetitive Transcranial magnetic stimulation in the treatment of patients with chronic primary insomnia. Cell Biochem Biophys. 2013;67:169–173. doi: 10.1007/s12013-013-9529-4.
    1. Lin J, Liu X, Li H, Yu L, Shen M, Lou Y, et al. Chronic repetitive transcranial magnetic stimulation (rTMS) on sleeping quality and mood status in drug dependent male inpatients during abstinence. Sleep Med. 2019;58:7–12. doi: 10.1016/j.sleep.2019.01.052.
    1. Pettorruso M, Martinotti G, Santacroce R, Montemitro C, Fanella F, Di Giannantonio M. rTMS reduces psychopathological burden and cocaine consumption in treatment-seeking subjects with cocaine use disorder: an open label, feasibility study. Front psychiatry. 2019;10:621. doi: 10.3389/fpsyt.2019.00621.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 2013.
    1. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev. 2016;25:52–73. doi: 10.1016/j.smrv.2015.01.009.
    1. Weiss RD, Griffin ML, Hufford C, Muenz LR, Najavits LM, Jansson SB, et al. Early prediction of initiation of abstinence from cocaine. Am J Addict. 1997;6:224–231. doi: 10.1111/j.1521-0391.1997.tb00401.x.
    1. Beck A, Steer R, Brown G. Beck depression inventory-II. San Antonio: Psychological Corporation; 1996.
    1. Zung WWK. A rating instrument for anxiety disorders. Psychosomatics. 1971;12:371–379. doi: 10.1016/S0033-3182(71)71479-0.
    1. Derogatis LR. Symptom Checklist-90-R (SCL-90-R): administration, scoring, and procedures manual. 3. Minneapolis: MN NCS Pearson; 1994.
    1. RStudio Team . RStudio: integrated development for R. Boston, MA: RStudio Inc; 2016.
    1. R Core Team. R . A language and environment for statistical computing. Vienna: R Found Stat Comput; 2018.
    1. Bates D, Mächler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015.
    1. Kuznetsova A, Brockhoff PB, Christensen RHB. lmerTest package: Tests in linear mixed effects models. J Stat Softw. 2017;82:13. doi: 10.18637/jss.v082.i13.
    1. Fox J. Effect displays in R for generalised linear models. J Stat Softw. 2003;8:1–27. doi: 10.18637/jss.v008.i15.
    1. Rosnow RL, Rosenthal R, Rubin DB. Contrasts and correlations in effect-size estimation. Psychol Sci. 2000;11:446–453. doi: 10.1111/1467-9280.00287.
    1. Brower KJ, Perron BE. Sleep disturbance as a universal risk factor for relapse in addictions to psychoactive substances. Med Hypotheses. 2010;74:928–933. doi: 10.1016/j.mehy.2009.10.020.
    1. Angarita GA, Emadi N, Hodges S, Morgan PT. Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review. Addict Sci Clin Pract. 2016;11:9. doi: 10.1186/s13722-016-0056-7.
    1. Brower KJ, Maddahian E, Blow FC, Beresford TP. A comparison of self-reported symptoms and DSM-III-R criteria for cocaine withdrawal. Am J Drug Alcohol Abuse. 1988;14:347–356. doi: 10.3109/00952998809001556.
    1. Morgan PT, Angarita GA, Canavan S, Pittman B, Oberleitner L, Malison RT, et al. Modafinil and sleep architecture in an inpatient-outpatient treatment study of cocaine dependence. Drug Alcohol Depend. 2016;160:49–56. doi: 10.1016/j.drugalcdep.2015.12.004.
    1. Dackis CA, Kampman KM, Lynch KG, Pettinati HM, O’brien CP. A double-blind, placebo-controlled trial of modafinil for cocaine dependence. Neuropsychopharmacology. 2005;30:205–211. doi: 10.1038/sj.npp.1300600.
    1. Kampman KM, Lynch KG, Pettinati HM, Spratt K, Wierzbicki MR, Dackis C, et al. A double blind, placebo controlled trial of modafinil for the treatment of cocaine dependence without co-morbid alcohol dependence. Drug Alcohol Depend. 2015;155:105–110. doi: 10.1016/j.drugalcdep.2015.08.005.
    1. Anderson AL, Reid MS, Li S-H, Holmes T, Shemanski L, Slee A, et al. Modafinil for the treatment of cocaine dependence. Drug Alcohol Depend. 2009;104:133–139. doi: 10.1016/j.drugalcdep.2009.04.015.
    1. Dackis CA, Kampman KM, Lynch KG, Plebani JG, Pettinati HM, Sparkman T, et al. A double-blind, placebo-controlled trial of modafinil for cocaine dependence. J Subst Abus Treat. 2012;43:303–312. doi: 10.1016/j.jsat.2011.12.014.
    1. Schmitz JM, Rathnayaka N, Green C, Moeller FG, Dougherty AE, Grabowski J. Combination of modafinil and d-amphetamine for the treatment of cocaine dependence: a preliminary investigation. Front psychiatry. 2012;3:77. doi: 10.3389/fpsyt.2012.00077.
    1. Schmitz JM, Green CE, Stotts AL, Lindsay JA, Rathnayaka NS, Grabowski J, et al. A two-phased screening paradigm for evaluating candidate medications for cocaine cessation or relapse prevention: Modafinil, levodopa–carbidopa, naltrexone. Drug Alcohol Depend. 2014;136:100–107. doi: 10.1016/j.drugalcdep.2013.12.015.
    1. Liang Y, Wang L, Yuan T-FF. Targeting withdrawal symptoms in men addicted to methamphetamine with Transcranial magnetic stimulation: a randomized clinical trial. JAMA Psychiatry. 2018;75:1199–1201. doi: 10.1001/jamapsychiatry.2018.2383.
    1. Su H, Zhong N, Gan H, Wang J, Han H, Chen T, et al. High frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex for methamphetamine use disorders: a randomised clinical trial. Drug Alcohol Depend. 2017;175:84–91. doi: 10.1016/j.drugalcdep.2017.01.037.
    1. Gershon AA, Dannon PN, Grunhaus L. Transcranial magnetic stimulation in the treatment of depression. Am J Psychiatry. 2003;160:835–845. doi: 10.1176/appi.ajp.160.5.835.
    1. Donse L, Sack AT, Fitzgerald PB, Arns M. Sleep disturbances in obsessive-compulsive disorder: association with non-response to repetitive transcranial magnetic stimulation (rTMS) J Anxiety Disord. 2017;49:31–39. doi: 10.1016/j.janxdis.2017.03.006.
    1. Sánchez-Escandón O, Arana-Lechuga Y, Terán-Pérez G, Ruiz-Chow A, González-Robles R, Shkurovich-Bialik P, et al. Effect of low-frequency repetitive transcranial magnetic stimulation on sleep pattern and quality of life in patients with focal epilepsy. Sleep Med. 2016;20:37–40. doi: 10.1016/j.sleep.2015.11.022.
    1. Pellicciari MC, Cordone S, Marzano C, Bignotti S, Gazzoli A, Miniussi C, et al. Dorsolateral prefrontal transcranial magnetic stimulation in patients with major depression locally affects alpha power of REM sleep. Front Hum Neurosci. 2013;7:433. doi: 10.3389/fnhum.2013.00433.
    1. Zhang C, Liu J. Effects of Transcranial magnetic stimulation on Polysomnography in patients with insomnia. Chinese J Rehabil Theory Pract 2013;0:568–571.
    1. Oishi Y, Lazarus M. The control of sleep and wakefulness by mesolimbic dopamine systems. Neurosci Res. 2017;118:66–73. doi: 10.1016/j.neures.2017.04.008.
    1. Eban-Rothschild A, Rothschild G, Giardino WJ, Jones JR, De Lecea L. VTA dopaminergic neurons regulate ethologically relevant sleep-wake behaviors. Nat Neurosci. 2016;19:1356–1366. doi: 10.1038/nn.4377.
    1. Pereira AC, Mao X, Jiang CS, Kang G, Milrad S, McEwen BS, et al. Dorsolateral prefrontal cortex GABA deficit in older adults with sleep-disordered breathing. Proc Natl Acad Sci. 2017;114:10250–10255. doi: 10.1073/pnas.1700177114.
    1. Liu Z, Wang Y, Cai L, Li Y, Chen B, Dong Y, et al. Prefrontal cortex to Accumbens projections in sleep regulation of reward. J Neurosci. 2016;36:7897–7910. doi: 10.1523/JNEUROSCI.0347-16.2016.
    1. Berro LF, Santos R, Hollais AW, Wuo-Silva R, Fukushiro DF, Mári-Kawamoto E, et al. Acute total sleep deprivation potentiates cocaine-induced hyperlocomotion in mice. Neurosci Lett. 2014;579:130–133. doi: 10.1016/j.neulet.2014.07.028.
    1. Drevets WC, Gautier C, Price JC, Kupfer DJ, Kinahan PE, Grace AA, et al. Amphetamine-induced dopamine release in human ventral striatum correlates with euphoria. Biol Psychiatry. 2001;49:81–96. doi: 10.1016/S0006-3223(00)01038-6.
    1. Volkow ND, Wang G, Telang F, Fowler J, Logan J, Wong C, et al. Sleep deprivation decreases binding of [11C] raclopride to dopamine D2/D3 receptors in the human brain. J Neurosci. 2008;28:8454–8461. doi: 10.1523/JNEUROSCI.1443-08.2008.
    1. Volkow ND, Wang GJ, Fowler JS, Gatley SJ, Ding YS, Logan J, et al. Relationship between psychostimulant-induced “high” and dopamine transporter occupancy. Proc Natl Acad Sci. 1996;93:10388–10392. doi: 10.1073/pnas.93.19.10388.
    1. Chen BT, Yau HJ, Hatch C, Kusumoto-Yoshida I, Cho SL, Hopf FW, et al. Rescuing cocaine-induced prefrontal cortex hypoactivity prevents compulsive cocaine seeking. Nature. 2013;496:359–362. doi: 10.1038/nature12024.
    1. Goldstein RZ, Volkow ND. Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. Am J Psychiatry. 2002;159:1642–1652. doi: 10.1176/appi.ajp.159.10.1642.
    1. Castelluccio BC, Meda SA, Muska CE, Stevens MC, Pearlson GD. Error processing in current and former cocaine users. Brain Imaging Behav. 2014;8:87–96. doi: 10.1007/s11682-013-9247-y.
    1. Tononi G, Cirelli C. Sleep and the Price of plasticity: from synaptic and cellular homeostasis to memory consolidation and integration. Neuron. 2014;81:12–34. doi: 10.1016/j.neuron.2013.12.025.
    1. Wiers CE, Shumay E, Cabrera E, Shokri-Kojori E, Gladwin TE, Skarda E, et al. Reduced sleep duration mediates decreases in striatal D2/D3 receptor availability in cocaine abusers. Transl Psychiatry. 2017;6:e752. doi: 10.1038/tp.2016.14.
    1. Everitt BJ. Neural and psychological mechanisms underlying compulsive drug seeking habits and drug memories - indications for novel treatments of addiction. Eur J Neurosci. 2014;40:2163–2182. doi: 10.1111/ejn.12644.
    1. Jentsch JD, Ashenhurst JR, Cervantes MC, Groman SM, James AS, Pennington ZT. Dissecting impulsivity and its relationships to drug addictions. Ann N Y Acad Sci. 2014;1327:1–26.
    1. Strafella AP, Paus T, Barrett J, Dagher A. Repetitive transcranial magnetic stimulation of the human prefrontal cortex induces dopamine release in the caudate nucleus. J Neurosci. 2001;21:1–4. doi: 10.1523/JNEUROSCI.21-15-j0003.2001.
    1. Modirrousta M, Meek BP, Wikstrom SL. Efficacy of twice-daily vs once-daily sessions of repetitive transcranial magnetic stimulation in the treatment of major depressive disorder: a retrospective study. Neuropsychiatr Dis Treat. 2018;14:309–316. doi: 10.2147/NDT.S151841.
    1. Donse L, Padberg F, Sack AT, Rush AJ, Arns M. Simultaneous rTMS and psychotherapy in major depressive disorder: clinical outcomes and predictors from a large naturalistic study. Brain Stimul. 2018;11:337–345. doi: 10.1016/j.brs.2017.11.004.
    1. Wagner FA, Anthony JC. From first drug use to drug dependence: developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Neuropsychopharmacology. 2002;26:479–488. doi: 10.1016/S0893-133X(01)00367-0.
    1. Kessler RC, Aguilar-Gaxiola S, Berglund PA, Caraveo-Anduaga JJ, DeWit DJ, Greenfield SF, et al. Patterns and predictors of treatment seeking after onset of a substance use disorder. Arch Gen Psychiatry. 2001;58:1065–1071. doi: 10.1001/archpsyc.58.11.1065.
    1. Madeo G, Terraneo A, Cardullo S, Gómez Pérez LJ, Cellini N, Sarlo M, et al. Long-term outcome of repetitive transcranial magnetic stimulation in a large cohort of patients with cocaine-use disorder: an observational study. Front Psychiatry. 2020;11:158. doi: 10.3389/fpsyt.2020.00158.
    1. Pace-Schott EF, Stickgold R, Muzur A, Wigren PE, Ward AS, Hart CL, et al. Sleep quality deteriorates over a binge-abstinence cycle in chronic smoked cocaine users. Psychopharmacology (Berl) 2005;179:873–883. doi: 10.1007/s00213-004-2088-z.
    1. Pettorruso M, Spagnolo PA, Leggio L, Janiri L, Di Giannantonio M, Gallimberti L, et al. Repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex may improve symptoms of anhedonia in individuals with cocaine use disorder: a pilot study. Brain Stimul. 2018;11:1195–1197. doi: 10.1016/j.brs.2018.06.001.

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