Accelerated rTMS for the Reduction of Nicotine Craving

Accelerated Repetitive Transcranial Magnetic Stimulation (rTMS) of the Dorsolateral Prefrontal Cortex for the Reduction of Craving in Nicotine Dependent Individuals

The purpose if this study is to determine if five treatments of repetitive transcranial magnetic stimulation (rTMS) can reduce craving for cigarettes in smokers. rTMS uses magnetic pulses to stimulate the brain and is currently approved for the treatment of major depressive disorder.

Inclusion Criteria:

• Outpatient Adults aged 18-70
• Cigarette Smokers smoking at least 1 pack (20 cigarettes a day) with current smoking status confirmed by exhaled CO reading of >10ppm day of visit.
• Ability to provide informed consent

Exclusion Criteria

• Current treatment with varenicline or bupropion
• Currently making a smoking quit attempt (not currently smoking).
• Current treatment with an antidepressant, anti-convulsant, anxiolytic, antipsychotic or mood stabilizer.
• Current episode of major depression determined by MINI interview.
• Current or past history of schizophrenia, schizoaffective disorder, anorexia nervosa, bulimia or bipolar disorder as determined by MINI.
• Current daily consumption of alcohol or current alcohol use disorder.
• Current substance use disorder except for nicotine or cannabis use disorder.
• Currently pregnant or lactating.
• Contraindications to rTMS including history of seizure, metal implanted above the neck, pacemaker or any brain lesion.
• Unstable medical conditions
• Suicidal ideation or history of suicide attempt within the last six months.
• Inability or unwillingness of subject or legal guardian/representative to give informed consent