The effect of repetitive transcranial magnetic stimulation (RTMS) therapy on the smoking behaviors of patients with depression or ocd: A retrospective study

Aim and Introduction: Smoking addiction is an important health problem affecting one third of the population according to the studies of the World Health Organization. Repetitive transcranial magnetic stimulation (rTMS) is thought to reduce cigarette consumption in nicotine addicts and may have a therapeutic effect on nicotine craving. In this study, it was aimed to retrospectively analyze the sociodemographics and clinical characteristics of patients who have received and completed rTMS treatment with diagnoses of major depressive disorder (MDD) or obsessive compulsive disorder (OCD), as well as their response to the treatment and side effects of the treatment, the urge and frequency of smoking. It was planned to examine the effects of this treatment on smoking behavior and addiction level in active smokers who receive rTMS treatment with other diagnoses. Method: Thirty-two patients between the ages of 18-70 who were diagnosed with OCD or MDD according to DSM-5 criterias, in the TMS outpatient clinic of Akdeniz University Faculty of Medicine Psychiatry Department, between June 2019 and March 2020, and who completed the 6-week rTMS treatment were included in the study. Fagerstrom Test for Nicotine Dependence, Heaviness of Smoking Index, Visual Analog Scale Measurements of Craving for a Cigarette, and the Test to Assess the Psychological Dependence on Tobacco Smoking were applied to patients at regular intervals (at 0.3, 6 and 18 weeks) before and after treatment; and Hamilton Depression Scale, Beck Anxiety Inventory, Y-BOCS, PHQ-9 Patient Health Questionnaire scores were measured retrospectively. Results: After 6 weeks of treatment, a significant decrease was observed in all scales evaluating smoking behavior and addiction level. This decrease continued at a significant level in the 18th-week control, but a slight increase was found between weeks 6 and 18. After 6 weeks of rTMS application, a significant decrease was observed in MDD, OCD and anxiety symptoms and it was found that this effect was persistent 12 weeks after the end of the treatment. Logistic regression analysis was used to determine whether there was a relationship between the changes in psychiatric symptoms and decrease in smoking addiction, and no significant relationship was found. Conclusion: This study shows that rTMS treatment not only has a clinical improvement on people with smoking addiction who are followed and treated with a psychiatric diagnosis, but also has a significant effect on smoking addiction itself, and it was shown that this effect continues for at least 12 weeks after the end of the treatment. In order to observe the effectiveness of rTMS, randomized and placebo (sham) controlled studies are required with larger samples consisting of participants without psychiatric comorbidity.