Peer reviewed: Yes
Type of study: Review
Subject of study: People
A new systematic review of randomised controlled trials has found evidence that non-invasive brain stimulation may reduce smoking frequency (number of cigarettes per day) in nicotine-dependent smokers.
Because nicotine can produce neuroadaptations in the brain that make it hard to quit smoking, researchers have sought ways to treat nicotine dependence with non-invasive brain stimulation (NIBS) techniques that counteract abnormal brain activity associated with chronic nicotine exposure.
This review, published by the scientific journal Addiction, looked at twelve randomised controlled trials of NIBS methods on a combined total of 710 participants with nicotine dependence. It used a network meta-analysis technique to compare the benefits and safety of various types of NIBS. Several NIBS techniques showed promising results, but the best results came from high-frequency repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC), which was associated with the greatest reduction in smoking frequency.
Interestingly, none of the investigated NIBS appeared to reduce the severity of either craving or nicotine dependence, compared with the control groups. It may be that enhancement of DLPFC activity increases dopamine release, counterbalances the reward system, and helps patients cope with unaffected craving and withdrawal symptoms.
None of the investigated NIBS was associated with dropout rates significantly different from those of the control groups, suggesting that these kinds of treatments are well-tolerated.
Nicotine affects the release of neurotransmitters in the brain, increasing brain activity and the release of dopamine. Higher levels of dopamine bring pleasure to the smoker. Over time, chronic nicotine exposure causes the brain to produce more receptors to handle the increased brain activity. When nicotine levels drop, such as when a smoker tries to quit, activity in the brain’s reward system decreases, causing withdrawal symptoms that encourage continued smoking.
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This paper is free to download for one month from the Wiley Online Library: https://onlinelibrary.wiley.com/doi/abs/10.1111/add.15624 or by contacting Jean O’Reilly, Editorial Manager, Addiction, firstname.lastname@example.org.
To speak with co-author Dr. Cheng-Ta Li: contact him at Taipei Veterans General Hospital, Taiwan by email (email@example.com) or telephone (+886-2-28712121).
Full citation for article: Tseng P-T, Jeng J-S, Zenge B-S, Stubbs B, Carhalho AF, Brunoni AR, Su K-P, Tu Y-K, Wu Y-C, Chen T-Y, Lin P-Y, Liang C-S, Hsu C-W, Chen Y-W, and Li C-T (2021) Efficacy of Noninvasive Brain Stimulation Interventions in Reducing Smoking Frequency in Patients With Nicotine Dependence: a Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Addiction 116: doi:10.1111/add.15624
Funding: Partial support from the Higher Education Sprout Project, Ministry of Education, Taiwan. Authors have reported their individual support in the acknowledgment section of the paper.
Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884.