Targeted brain stimulation increases cigarette cravings, a new study in Biological Psychiatry has found, which may ultimately lead to new treatments that reverse these effects. Cues associated with cigarette smoking, such as watching someone else smoke, elicit craving and may provoke relapse when smokers are attempting to quit. There are many methods that smokers use in an attempt to reduce their craving for cigarettes, including efficacious pharmacologic treatments such as nicotine patches, and alternative approaches such as hypnosis and acupuncture. Scientists have long suspected that these diverse approaches might work through a common mechanism - the reduction of activity in a brain circuit that is responsible for cigarette craving.

This hypothesis is supported by human functional brain imaging studies, which consistently report the activation of several brain regions during craving that involve regions in the cerebral cortex as well as the limbic system, a brain circuit involved in emotion.

Building on these brain imaging studies, scientists at the Center for Nicotine and Smoking Cessation Research at Duke University Medical Center manipulated this ‘craving circuit’ activity using transcranial magnetic stimulation (TMS), a non-invasive technique that uses electromagnetic currents to target specific or general areas of the brain. Depending upon the frequency used, it can either stimulate or depress brain activity.

The researchers found that the delivery of repeated TMS to the superior frontal gyrus at high frequency (10 Hz) increased craving for cigarettes.

“We directly stimulated a frontal brain region using magnetic fields and showed that it exaggerated smokers’ craving for cigarettes when they viewed smoking related cues. By gaining a better understanding of how the brain influences craving responses, strategies for blocking these responses can be devised and ultimately more effective smoking cessation treatments may be developed,” explained Dr. Jed Rose, one of the study authors.

However, they did not find that low frequency (1 Hz) stimulation reduced craving. Thus, a potential intervention that may have reduced the activation within this circuit did not produce the opposite effect.

Nonetheless, the high frequency stimulation reduced craving when participants were viewing nonsmoking cues. Moreover, the ability of smoking to satisfy craving, a rewarding effect that helps keep smokers “hooked,” was partially blocked by high frequency stimulation. These effects need to be explored for potential therapeutic applications.

“This elegant study implicates the superior frontal gyrus in controlling the activity of the craving circuit,” commented Dr. John Krystal, Editor of Biological Psychiatry. “Additional research will be needed to determine the potential value of repetitive TMS as a treatment for smoking.”

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Notes to Editors:
The article is “Repetitive Transcranial Magnetic Stimulation of the Superior Frontal Gyrus Modulates Craving for Cigarettes” (DOI 10.1016/j.biopsych.2011.05.031) by Jed E. Rose, F. Joseph McClernon, Brett Froeliger, Fre’de’rique M. Behm, Xavier Preud’homme, and Andrew D. Krystal. The authors are affiliated with Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina. McClernon is also with Durham Veterans Affairs Medical Center and Veterans Integrated Service Network Number 6 Mental Illness Research, Education, and Clinical Center, Durham, North Carolina. The article appears in Biological Psychiatry, Volume 70, Number 8 (October 15, 2011), published by Elsevier. The authors’ disclosures of financial and conflicts of interests are available in the article.  John H. Krystal, M.D., is Chairman of the Department of Psychiatry at the Yale University School of Medicine and a research psychiatrist at the VA Connecticut Healthcare System.

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About Biological Psychiatry
  Biological Psychiatry is the official journal of the   Society of Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal publishes both basic and clinical contributions from all disciplines and research areas relevant to the pathophysiology and treatment of major psychiatric disorders.

The journal publishes novel results of original research which represent an important new lead or significant impact on the field, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Reviews and commentaries that focus on topics of current research and interest are also encouraged.

Biological Psychiatry is one of the most selective and highly cited journals in the field of psychiatric neuroscience. It is ranked 4th out of 128 Psychiatry titles and 15th out of 239 Neurosciences titles in the 2010 ISI Journal Citations Reports® published by Thomson Reuters. The 2010 Impact Factor score for Biological Psychiatry is 8.674.

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