A double-blind randomized clinical trial of high frequency rTMS over the DLPFC on nicotine dependence, anxiety and depression

Abstract

High frequency repetitive transcranial magnetic stimulation (HF-rTMS) over the left dorsolateral prefrontal cortex (L-DLPFC) is a widely applied treatment protocol for chronic smoking and major depressive disorder. However, no previous study has measured the effects of rTMS on both nicotine consumption and anxiety/depression in the same volunteers despite the relationship between them. The aim of this work was to evaluate the efficacy of 10 daily sessions of HF-rTMS over the L-DLPFC in chronic cigarette smokers’ addiction and investigate the possible beneficial effects of this treatment procedure on symptoms of depression and anxiety in the same subjects. The study included 40 treatment-seeking nicotine-dependent cigarette smokers. Onset/duration of smoking, number of cigarettes/day, Fagerstrom Test of Nicotine Dependence (FTND), Tobacco Craving Questionnaire-Short Form (TCQ-SF), Hamilton depression and anxiety scales (HAM-D and HAM-A) were recorded. Participants were randomly assigned to the active or the sham treatment group. Those in the active group received 10 trains of 20 Hz stimulation, at 80% of the resting motor threshold (rMT) for 10 consecutive working days over L-DLPFC. Participants were reassessed immediately after treatment, and then 3 months later using all rating scales. There were no differences between active and sham groups at baseline. The cigarette consumption/day, and scores on FTND, and TCQ decreased significantly in both groups (p = 0.0001 for each) immediately after treatment. However, improvement persisted to 3 months in the active group but not in the sham group. Moreover, there was a significant reduction in HAM-D and HAM-A scores immediately after treatment in the active but not the sham group. Subjects with a longer history of smoking had a lower percent improvement in FTND (p = 0.005). Our findings revealed that HF-rTMS over L-DLPCF for 10 days reduced cigarette consumption, craving, dependence, and improved associated symptoms of anxiety and depression.ClinicalTrials.gov Identifier: NCT03264755 registered at 29/08/2017.

Sex Differences in the Association of Cigarette Craving With Insula Structure

“…Future studies to validate and clarify this sex difference are necessary. Brain-based smoking cessation interventions, such as transcranial magnetic stimulation, have been evaluated for smoking cessation ( Li et al, 2017 ) and reduced cigarette consumption and nicotine dependence after stimulation of the insula ( Dinur-Klein et al, 2014 ) or the left dorsolateral prefrontal cortex ( Li et al, 2020 ; Abdelrahman et al, 2021 ). Such interventions may improve their efficacy by targeting different brain regions, and perhaps different subregions of the insula, in men vs women.…”

Predictors of Nutritional Status, Depression, Internet Addiction, Facebook Addiction, and Tobacco Smoking Among Women With Eating Disorders in Spain

“…In fact, the literature associates internet addiction with tobacco smoking, heavy drinking, substance abuse, and sexual promiscuity in both genders, although at varying degrees (26)(27)(28)(29). Negative emotions seem to be a core common effector in dysfunctional eating, internet addiction, and smoking (5,17,26,30,31).…”

“…The dynamics underlying the relationship between smoking and dysfunctional eating may be more complex than they seem to be. Imaging studies report abnormal activity of brain regions associated with self-referencing and emotional processing (e.g., medial prefrontal cortex and other brain regions) among smokers, AN and BN patients, and obese individuals who eat in response to aversive states (5,30,31,38,39). Psychopathological features closely linked to dysfunctional emotional processing are documented core correlates of internet addiction, smoking, binge drinking, substance abuse, problematic gambling, and maladaptive patterns of physical activity (26).…”

Predictive Role of Executive Function in the Efficacy of Intermittent Theta Burst Transcranial Magnetic Stimulation Modalities for Treating Methamphetamine Use Disorder—A Randomized Clinical Trial

“…Currently, researchers have conducted therapeutic explorations using rTMS for psychoneurological disorders and SUD. Previous studies have made continuous attempts for treatment modalities, from low frequency ( 28 , 29 ) to high frequency ( 18 , 30 ), and from rTMS to TBS or from the original stimulation site (e.g., L-DLPFC) to other sites (e.g., mPFC) ( 11 ). Current research suggested that the stimulation of the DLFPC region (area within the executive control network) by modalities such as high-frequency rTMS or iTBS effectively reduced craving, which might be associated with enhanced executive function ( 12 , 31 , 32 ).…”

“…Executive function, as an important part of cognitive function, has gained increasing attention in studies on SUD, which has found that long-term drug abuse would cause widespread impairment of executive function ( 16 , 17 ). Lower executive function has been reported to be associated with relapse ( 18 ), and improving executive function reduces relapse and improves treatment outcomes for SUD ( 19 ). Executive function may therefore be an effective novel therapeutic target for improving drug addiction and relapse and a valid predictor of treatment efficacy for SUD.…”