Transcranial Magnetic Stimulation for Smoking Cessation

Abraham Zangen, Hagar Moshe, Diana Martinez, Noam Barnea-Ygael, Tanya Vapnik, Alexander Bystritsky, Walter Duffy, Doron Toder, Leah Casuto, Moran Lipkinsky Grosz, Edward V. Nunes, Herbert Ward, Aron Tendler, David Feifel, Oscar Morales, Yiftach Roth, Dan V. Iosifescu, Jaron Winston, Theodore Wirecki, Ahava SteinFrederic Deutsch, Xingbao Li, Mark S. George

Research output: Contribution to journalArticle


BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation method that is increasingly used to treat psychiatric disorders, primarily depression. Initial studies suggest that rTMS may help treat addictions, but evaluation is required in a multicenter randomized controlled trial (RCT).

METHODS: Here, we tested in chronic smokers whether repeated bilateral rTMS of the lateral prefrontal and insular cortices reduces cigarette craving and consumption and increases quit rates. This multicenter RCT included 14 sites and 262 chronic smokers who received Active or Sham rTMS. Participants received three weeks of daily rTMS sessions following cue-induced craving and were monitored up to four months. The primary outcome was the four-week continuous quit rate (CQR) measured by daily smoking diaries and verified by urine cotinine measures. Secondary outcome measures included changes in cigarette consumption and craving. This trail is registered at, number NCT02126124.

RESULTS: In the intent to treat analysis set, CQR was 19·4% following Active and 8·7% following Sham rTMS (χ 2 = 5·655, p=0·017). Among completers (N=169), CQR was 28·0% and 11·7%, respectively (χ 2 = 7·219, p=0·007). CQR within the first six weeks was 25·3% (Active) and 6·4% (Sham) (χ 2 = 11·885, p=0·0006), of which 63% (Active) and 50% (Sham) remained abstinent for at least four months (χ 2 =8·46, p=0·003). Significant between-group differences in cigarette consumption and craving emerged as early as two weeks into treatment.

CONCLUSIONS: This study establishes a safe treatment protocol that promotes smoking cessation by stimulating the relevant brain circuits. It represents the first large multicenter RCT of brain stimulation for addiction medicine.
Original languageEnglish GB
JournalSSRN Electronic Journal
StatePublished - 13 Feb 2021


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