A Drug-Free Treatment Uses Magnetic Pulses to Help Smokers Quit

FDA-approved magnetic brain stimulation targets craving-related brain circuits involved in smoking addiction.

Photo by Andres Siimon on Unsplash

Approximately 11 percent of the American population, or 29 million individuals, are regular cigarette smokers. This habit remains the primary cause of preventable illness, resulting in nearly 500,000 deaths each year and incurring healthcare costs totaling roughly $240 billion.

Given these severe health and financial consequences, it is understandable that surveys indicate nearly 70 percent of smokers desire to quit. However, the highly addictive nature of nicotine makes cessation a significant challenge.

The FDA has been actively seeking effective treatments to support smoking cessation. One particularly successful non-drug, non-invasive approach reached a major milestone in 2020, when the FDA officially approved it as a therapeutic aid for those trying to stop smoking.

Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique that uses rapidly changing magnetic fields to alter activity within specific regions of the brain.

During treatment, an electromagnetic coil is placed against the scalp, where it delivers brief magnetic pulses that pass painlessly through the skull and induce small electrical currents in the underlying cortical tissue.

These currents can either increase or decrease neuronal excitability depending on the stimulation parameters used, including pulse frequency, intensity, and treatment duration.

Unlike medications, which affect neurotransmitter systems throughout the entire body, TMS targets discrete neural circuits implicated in disease while producing few systemic side effects.

The technology is based on the principles of electromagnetic induction, first described by physicist Michael Faraday in the nineteenth century.

Modern TMS was developed in 1985 by researchers led by Anthony Barker at the University of Sheffield, who demonstrated that magnetic stimulation could safely activate neurons in the human brain without the need for surgery.

Initially, TMS was used primarily as a research tool to study brain function and map the relationships between specific cortical regions and behavior. Researchers employed the technique to investigate motor control, language processing, memory, and attention by temporarily modulating activity within targeted brain areas.

Over time, evidence accumulated that repeated TMS sessions, known as repetitive TMS (rTMS), could produce lasting changes in neural activity through mechanisms resembling synaptic plasticity.

In 2008, the U.S. Food and Drug Administration granted the first approval for TMS as a treatment for major depressive disorder in patients who had not responded adequately to antidepressant medications.

Since then, additional approvals have expanded its clinical use, as well as some off-label uses, which include obsessive-compulsive disorder, migraine with aura, smoking cessation, and anxious depression.

TMS for Smoking

TMS for smoking cessation appears effective for some adults and is generally well tolerated, but benefits vary by protocol.

The strongest support comes from randomized trials of repeated TMS, especially high-frequency protocols targeting prefrontal and insular circuits, which improved quit rates, reduced craving, and lowered cigarette consumption compared with sham treatment.

TMS tries to help people quit smoking by nudging the brain circuits involved in craving, habit, and self-control.

In the largest multicenter randomized trial, deep rTMS targeting the lateral prefrontal cortex and insula achieved a 19.4% quit rate, compared with 8.7% with sham at 18 weeks. Also, they reduced craving and cigarette consumption, which helped drive FDA clearance of one protocol as a short-term aid for smoking cessation.

Smaller controlled studies of figure-8 or left DLPFC stimulation point in the same direction: one trial found more quitting on the target quit date after 10 sessions, while another found a 62.9% reduction in cigarettes per day by the end of treatment.

Importantly, not only is the treatment effective, but it is also very safe. For otherwise healthy adults, the side effects are very mild. Headaches and scalp tingling may occur during treatment, but are generally short-lived.

The one potential serious complication is seizures; however, this risk is exceedingly low, with an estimated seizure occurrence of one in thirty thousand to one in 60 thousand.

Take Home

Quitting smoking remains one of the most difficult health challenges because nicotine alters the brain circuits that drive reward, craving, and habit formation. Transcranial magnetic stimulation offers a new approach by directly targeting these neural pathways rather than relying solely on medications or nicotine replacement.