Off-Label Medications and Non-Invasive Brain Stimulation (NIBS) in the Treatment of Internet Gaming Disorder: A Systematic Review and Meta-Analysis.

Internet gaming disorder (IGD) has become a worldwide concern, but there are still no approved medications or treatments for IGD. The present study systematically meta-analyzed the available research regarding off-label medications and non-invasive brain stimulation (NIBS) as neurobiological treatments for IGD. A total of 18 studies met the inclusion criteria (n = 687; age range = 9 to 26 years) following PRISMA guidelines, and data from 15 studies were included in the meta-analysis. In some of the studies, IGD was a comorbid condition with major depression, alcohol use disorder, attention deficits, and/or hyperactivity disorder. The findings indicated that: (i) treatment using non-invasive neuromodulation (tDCS targeting dorsolateral prefrontal cortex [DLPFC]), bupropion, selective serotonin reuptake inhibitors (SSRIs), and methylphenidate were significant in reducing IGD; (ii) pharmacotherapy was much more effective than tDCS; (iii) there were no significant differences between tDCS, SSRIs, and methylphenidate, and all except SSRIs were outperformed by bupropion; (iv) the effect of tDCS, bupropion, and SSRIs were independent of IGD severity; (v) the effect of bupropion was independent of treatment duration, gaming level, or comorbidity with depression; (vi) the effect of bupropion remained stable after 12 weeks follow-up; (vii) the effect of methylphenidate was independent of treatment duration; and (viii) the effect of SSRIs was independent of IGD severity and treatment duration. However, this initial evidence is limited in its generalizability due to high risk of bias, overrepresentation of males, small sample sizes, lack of clinical interviews, lack of consideration of comorbidities, lack of monitoring for side effects, and insufficient details for exact replication.