Effect of Repetitive Transcranial Magnetic Stimulation (rTMS) on Nicotine Use Disorder in Patients with Schizophrenia: A Randomized Double-Blind Clinical Trial

Background: Schizophrenia is a chronic mental disorder with high nicotine use rates. Despite available interventions, smoking cessation remains challenging due to unique neurobiological and behavioral factors. This study evaluates the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) using Theta Burst Stimulation (TBS) in reducing nicotine cravings and consumption in schizophrenia. Methods: A randomized, double-blind controlled trial was conducted with 44 patients with schizophrenia and nicotine use disorder between summer 2022 and summer 2023. The main objective was to assess rTMS effectiveness in reducing cravings and consumption. Secondary objectives included evaluating changes in cravings via the Visual Analog Scale (VAS), comparing cigarette use before, immediately after, and one month post-intervention, and assessing effects on positive and negative symptoms (PANSS scale). Participants were randomized to rTMS or sham. Inclusion criteria were DSM-5 schizophrenia and nicotine use disorder. The rTMS group received 10 sessions using the TBS protocol (20 Hz, 90% RMT, 20 trains, 30 pulses/train, 1.5 s on, 30 s off, 750 pulses/hemisphere) over two weeks, targeting the left Dorsolateral Prefrontal Cortex (DLPFC). Key outcomes were measured pre- and post-intervention. Results: Nicotine cravings and cigarette consumption decreased significantly in the rTMS group versus sham. No significant differences in schizophrenia symptom severity were observed. The intervention was well tolerated with minimal side effects. Conclusion: rTMS with TBS effectively reduces nicotine cravings and consumption in schizophrenia, representing a promising adjunctive therapy for smoking cessation.