Background: An imbalance between prefrontal cortex (PFC) and the mesolimbic reward system has been suggested to contribute to GD. GD patients showed increased functional connectivity between regions of the PFC and mesolimbic reward system, as well as reduced connectivity in the area of the PFC. The altered interaction between prefrontal structures and the mesolimbic reward system in GD shares similarity with functional organization reported in Substances Use Disorders (SUDs), suggesting a more general pathophysiology for addictive disorders Objectives: To test if rTMS can reduce craving and playing in Gambling Disorder, and also affect several mood, behavioral and cognitive alterations associated with prolonged Gambling Disorder. Eligibility: Healthy, right-handed adults ages 18-65 who do have Gambling Disorder. Design: This is a non-randomized, open label study. The study includes three phases: 1) a rTMS continued treatment phase; 2) a rTMS follow-up; and 3) a no rTMS follow-up. Prior to participating, participants will be screened with: * Questionnaires * Cognitive tests * Medical history * Physical exam After being enrolled, baseline behavioral and imaging data will be collected. In particular, participants will undergo: * Questionnaires * Cognitive tests During the continued rTMS phase, participants with Gambling Disorder will receive real rTMS. Repetitive TMS will be delivered during 10 outpatient treatment days, over 2 weeks (5 days/week). Following this phase, subjects will have 12 follow-up visits (once/weekly), during which they will receive rTMS, and behavioral assessments will be performed. At the end of the rTMS follow up period, participants will further receive 3 follow up visits (once a month), during which rTMS will not be performed, but behavioral data will be collected. Treatment includes: * rTMS: A coil is placed on the head. Brief electrical current passes through the coil. At each visit, participants will receive two rTMS sessions, with a 1hr interval between sessions. At the beginning of each rTMS session, they view gambling-related images for few minutes. * Repeat of screening tests and questionnaires
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Changes in the Visual Analogue Scale for Craving (VAS-craving)
Timeframe: Baseline, after rTMS treatment: 2 weeks, 3 months, 6 months
Changes in the Pathological Gambling Adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS)
Timeframe: Baseline, after rTMS treatment: 2 weeks, 3 months, 6 months
Changes in Gambling Disorder Severity as assessed by Timeline Follow Back (TLFB)
Timeframe: Baseline, after rTMS treatment: 2 weeks, 3 months, 6 months, 12 months
Changes in Gambling Behavior as assessed by Gambling Symptom Assessment Scale (G-SAS) Total Score
Timeframe: Baseline, after rTMS treatment: 2 weeks, 3 months, 6 months, 12 months