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.