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Herman RJ, Schmidt HD. Targeting GLP-1 receptors to reduce nicotine use disorder: Preclinical and clinical evidence. Physiol Behav 2024; 281:114565. [PMID: 38663460 PMCID: PMC11128349 DOI: 10.1016/j.physbeh.2024.114565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 04/30/2024]
Abstract
Nicotine use disorder (NUD) remains a leading cause of preventable death in the U.S. Unfortunately, current FDA-approved pharmacotherapies for smoking cessation have limited efficacy and are associated with high rates of relapse. One major barrier to long-term smoking abstinence is body weight gain during withdrawal. Nicotine withdrawal-induced body weight gain can also lead to development of chronic disease states like obesity and type II diabetes mellitus. Therefore, it is critical to identify novel pharmacotherapies for NUD that decrease relapse and nicotine withdrawal symptoms including body weight gain. Recent studies demonstrate that glucagon-like peptide-1 receptor (GLP-1R) agonists attenuate voluntary nicotine taking and seeking and prevent withdrawal-induced hyperphagia and body weight gain. Emerging evidence also suggests that GLP-1R agonists improve cognitive deficits, as well as depressive- and anxiety-like behaviors, which contribute to smoking relapse during withdrawal. While further studies are necessary to fully characterize the effects of GLP-1R agonists on NUD and understand the mechanisms by which GLP-1R agonists decrease nicotine withdrawal-mediated behaviors, the current literature supports GLP-1R-based approaches to treating NUD.
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Affiliation(s)
- Rae J Herman
- Neuroscience Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Heath D Schmidt
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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Salling MC, Pleil KE. A Little "Re-Cognition" Goes a Long Way for Pro-Cognitive Therapeutics in Alcohol Studies. J Pharmacol Exp Ther 2024; 389:254-257. [PMID: 38772715 DOI: 10.1124/jpet.123.002058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/02/2024] [Indexed: 05/23/2024] Open
Affiliation(s)
- Michael C Salling
- Department of Cell Biology and Anatomy, Louisiana State University Health Sciences Center, New Orleans, Louisiana (M.C.S.); and Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, New York (K.E.P.)
| | - Kristen E Pleil
- Department of Cell Biology and Anatomy, Louisiana State University Health Sciences Center, New Orleans, Louisiana (M.C.S.); and Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, New York (K.E.P.)
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Kady A, Grodin EN, Ray LA. Characterizing reward and relief/habit drinking profiles in a study of naltrexone, varenicline, and placebo. Alcohol Alcohol 2024; 59:agae044. [PMID: 38953743 PMCID: PMC11217986 DOI: 10.1093/alcalc/agae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION This study aims to clarify differences in mood, craving, and treatment response between reward and relief/habit individuals in a study of naltrexone, varenicline, and placebo. We hypothesized that relief/habit individuals would have a poorer mood during early abstinence and higher levels of alcohol craving than reward individuals. We hypothesized that reward individuals would demonstrate better drinking outcomes on naltrexone versus placebo. METHODS Data were culled from a randomized, double-blind, placebo-controlled human trial of 53 individuals (18F/16M) with alcohol use disorder randomized to varenicline (n = 19), naltrexone (n = 15), or matched placebo (n = 19). In this 6-day practice quit trial, participants attempted to abstain from drinking and completed daily diaries. Participants were classified into reward or relief/habit subgroups based on self-reported motivation for drinking. Multilinear models tested differences in mood and alcohol craving between reward and relief/habit individuals. General linear models tested differences between reward and relief/habit individuals' drinking outcomes on each medication versus placebo. RESULTS Relief/habit individuals showed decreases in positive mood and increases in negative mood over the quit attempt across medications, compared to reward individuals (P's < .05). Reward individuals' tension decreased on naltrexone, while relief/habit individuals' tension remained stable (F = 3.64, P = .03). Reward individuals in the placebo group had higher percent days abstinent than relief individuals in the placebo group (P < .001). DISCUSSION This study suggests relief/habit individuals' mood worsens during early abstinence. Our finding that reward individuals' tension decreased on naltrexone and increased on placebo may suggest a clinical response to the medication.
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Affiliation(s)
- Annabel Kady
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 51563, Los Angeles, CA 90095-1563, United States
| | - Erica N Grodin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 757 Westwood Plaza #4, Los Angeles, CA 90095, United States
- Brain Research Institute, University of California, Los Angeles, 695 Charles E Young Dr. S, Los Angeles, CA 90095, United States
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 51563, Los Angeles, CA 90095-1563, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 757 Westwood Plaza #4, Los Angeles, CA 90095, United States
- Brain Research Institute, University of California, Los Angeles, 695 Charles E Young Dr. S, Los Angeles, CA 90095, United States
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Panagopoulos VN, Bailey A, Kostopoulos GK, Ioannides AA. Changes in distinct brain systems identified with fMRI during smoking cessation treatment with varenicline: a review. Psychopharmacology (Berl) 2024; 241:653-685. [PMID: 38430396 DOI: 10.1007/s00213-024-06556-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 02/15/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Varenicline is considered one of the most effective treatment options for smoking cessation. Nonetheless, it is only modestly effective. A deeper comprehension of the effects of varenicline by means of the in-depth review of relevant fMRI studies may assist in paving the development of more targeted and effective treatments. METHODOLOGY A search of PubMed and Google Scholar databases was conducted with the keywords "functional magnetic resonance imaging" or "fMRI", and "varenicline". All peer-reviewed articles regarding the assessment of smokers with fMRI while undergoing treatment with varenicline and meeting the predefined criteria were included. RESULTS Several studies utilizing different methodologies and targeting different aspects of brain function were identified. During nicotine withdrawal, decreased mesocorticolimbic activity and increased amygdala activity, as well as elevated amygdala-insula and insula-default-mode-network functional connectivity are alleviated by varenicline under specific testing conditions. However, other nicotine withdrawal-induced changes, including the decreased reward responsivity of the ventral striatum, the bilateral dorsal striatum and the anterior cingulate cortex are not influenced by varenicline suggesting a task-dependent divergence in neurocircuitry activation. Under satiety, varenicline treatment is associated with diminished cue-induced activation of the ventral striatum and medial orbitofrontal cortex concomitant with reduced cravings; during the resting state, varenicline induces activation of the lateral orbitofrontal cortex and suppression of the right amygdala. CONCLUSIONS The current review provides important clues with regard to the neurobiological mechanism of action of varenicline and highlights promising research opportunities regarding the development of more selective and effective treatments and predictive biomarkers for treatment efficacy.
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Affiliation(s)
- Vassilis N Panagopoulos
- Laboratory for Human Brain Dynamics, AAI Scientific Cultural Services Ltd., Nicosia, Cyprus.
- Department of Physiology, Medical School, University of Patras, Patras, Greece.
| | - Alexis Bailey
- Pharmacology Section, St. George's University of London, London, UK
| | | | - Andreas A Ioannides
- Laboratory for Human Brain Dynamics, AAI Scientific Cultural Services Ltd., Nicosia, Cyprus
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Dodd S, Harper J, Berk M. Current Pharmacotherapies for Smoking Cessation and Promising Emerging Drugs. Curr Rev Clin Exp Pharmacol 2024; 19:259-268. [PMID: 38708918 DOI: 10.2174/0127724328274939231121114142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Pharmacotherapy is commonly used during quit attempts and has shown an increase in the likelihood of achieving abstinence. However, with established pharmacotherapies, abstinence rates following a quit attempt remain low, and relapse is common. This review aims to investigate the efficacy and harm profiles of current and emerging pharmacotherapies. METHODS Literature review of current and emerging pharmacotherapies for smoking cessation and tobacco use disorder. RESULTS Emerging pharmacotherapies include new formulations of existing therapies, drug repurposing and some new treatments. New treatments are welcome and may incorporate different mechanisms of action or different safety and tolerability profiles compared to existing treatments. However, emerging pharmacotherapies have yet to demonstrate greater efficacy compared to existing treatments. The emergence of Electronic Nicotine Delivery Systems (ENDS) or 'vaping' is a feature of the current debate around tobacco use disorder. ENDS appear to facilitate switching but not quitting and are controversial as a harm minimisation strategy. LIMITATIONS Studies included a broad range of therapies and trial designs that should be compared with their differences taken into consideration. CONCLUSION Strategies to successfully quit smoking vary between individuals and may extend beyond pharmacotherapy and involve complex psychosocial factors and pathways.
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Affiliation(s)
- Seetal Dodd
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Barwon Health, P.O. Box 281, Geelong, 3220, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Jodie Harper
- School of Medicine, Deakin University, Geelong, Australia
| | - Michael Berk
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Barwon Health, P.O. Box 281, Geelong, 3220, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry, The University of Melbourne, Parkville, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
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Esaki H, Deyama S, Izumi S, Katsura A, Nishikawa K, Nishitani N, Kaneda K. Varenicline enhances recognition memory via α7 nicotinic acetylcholine receptors in the medial prefrontal cortex in male mice. Neuropharmacology 2023; 239:109672. [PMID: 37506875 DOI: 10.1016/j.neuropharm.2023.109672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Previous studies postulated that chronic administration of varenicline, a partial and full agonist at α4β2 and α7 nicotinic acetylcholine receptors (nAChRs), respectively, enhances recognition memory. However, whether its acute administration is effective, on which brain region(s) it acts, and in what signaling it is involved, remain unknown. To address these issues, we conducted a novel object recognition test using male C57BL/6J mice, focusing on the medial prefrontal cortex (mPFC), a brain region associated with nicotine-induced enhancement of recognition memory. Systemic administration of varenicline before the training dose-dependently enhanced recognition memory. Intra-mPFC varenicline infusion also enhanced recognition memory, and this enhancement was blocked by intra-mPFC co-infusion of a selective α7, but not α4β2, nAChR antagonist. Consistent with this, intra-mPFC infusion of a selective α7 nAChR agonist augmented object recognition memory. Furthermore, intra-mPFC co-infusion of U-73122, a phospholipase C (PLC) inhibitor, or 2-aminoethoxydiphenylborane (2-APB), an inositol trisphosphate (IP3) receptor inhibitor, suppressed the varenicline-induced memory enhancement, suggesting that α7 nAChRs may also act as Gq-coupled metabotropic receptors. Additionally, whole-cell recordings from mPFC layer V pyramidal neurons in vitro revealed that varenicline significantly increased the summation of evoked excitatory postsynaptic potentials, and this effect was suppressed by U-73122 or 2-APB. These findings suggest that varenicline might acutely enhance recognition memory via mPFC α7 nAChR stimulation, followed by mPFC neuronal excitation, which is mediated by the activation of PLC and IP3 receptor signaling. Our study provides evidence supporting the potential repositioning of varenicline as a treatment for cognitive impairment.
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Affiliation(s)
- Hirohito Esaki
- Laboratory of Molecular Pharmacology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Satoshi Deyama
- Laboratory of Molecular Pharmacology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Shoma Izumi
- Laboratory of Molecular Pharmacology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Ayano Katsura
- Laboratory of Molecular Pharmacology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Keisuke Nishikawa
- Laboratory of Molecular Pharmacology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Naoya Nishitani
- Laboratory of Molecular Pharmacology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Katsuyuki Kaneda
- Laboratory of Molecular Pharmacology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, 920-1192, Japan.
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Hitsman B, Papandonatos GD, Gollan JK, Huffman MD, Niaura R, Mohr DC, Veluz-Wilkins AK, Lubitz SF, Hole A, Leone FT, Khan SS, Fox EN, Bauer AM, Wileyto EP, Bastian J, Schnoll RA. Efficacy and safety of combination behavioral activation for smoking cessation and varenicline for treating tobacco dependence among individuals with current or past major depressive disorder: A 2 × 2 factorial, randomized, placebo-controlled trial. Addiction 2023; 118:1710-1725. [PMID: 37069490 DOI: 10.1111/add.16209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/28/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND AND AIMS Treatment of depression-related psychological factors related to smoking behavior may improve rates of cessation among adults with major depressive disorder (MDD). This study measured the efficacy and safety of 12 weeks of behavioral activation for smoking cessation (BASC), varenicline and their combination. DESIGN, SETTING, PARTICIPANTS This study used a randomized, placebo-controlled, 2 × 2 factorial design comparing BASC versus standard behavioral treatment (ST) and varenicline versus placebo, taking place in research clinics at two urban universities in the United States. Participants comprised 300 hundred adult smokers with current or past MDD. INTERVENTIONS BASC integrated behavioral activation therapy and ST to increase engagement in rewarding activities by reducing avoidance, withdrawal and inactivity associated with depression. ST was based on the 2008 PHS Clinical Practice Guideline. Both treatments consisted of eight 45-min sessions delivered between weeks 1 and 12. Varenicline and placebo were administered for 12 weeks between weeks 2 and 14. MEASUREMENTS Primary outcomes were bioverified intent-to-treat (ITT) 7-day point-prevalence abstinence at 27 weeks and adverse events (AEs). FINDINGS No significant interaction was detected between behavioral treatment and pharmacotherapy at 27 weeks (χ2 (1) = 0.19, P = 0.67). BASC and ST did not differ (χ2 (1) = 0.43, P = 0.51). Significant differences in ITT abstinence rates (χ2 (1) = 4.84, P = 0.03) emerged among pharmacotherapy arms (16.2% for varenicline, 7.5% for placebo), with results favoring varenicline over placebo (rate ratio = 2.16, 95% confidence interval = 1.08, 4.30). All significant differences in AE rates after start of medication were higher for placebo than varenicline. CONCLUSION A randomized trial in smokers with major depressive disorder found that varenicline improved smoking abstinence versus placebo at 27 weeks without elevating rates of adverse events. Behavioral activation for smoking cessation did not outperform standard behavioral treatment, with or without adjunctive varenicline therapy.
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Affiliation(s)
- Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States
| | - George D Papandonatos
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, United States
| | - Jacqueline K Gollan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States
- Asher Center for the Study and Treatment of Depressive Disorders, Chicago, Illinois, United States
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States
- Cardiovascular Program, The George Institute for Global Health, University of South Wales, Newtown, New South Wales, Australia
| | - Raymond Niaura
- Department of Epidemiology, School of Global Public Health, New York University, New York, New York, United States
| | - David C Mohr
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States
| | - Anna K Veluz-Wilkins
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Su Fen Lubitz
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Anita Hole
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Frank T Leone
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, United States
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Erica N Fox
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Anna-Marika Bauer
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - E Paul Wileyto
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Joseph Bastian
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Robert A Schnoll
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
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Abstract
Background Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). This is an update of a Cochrane Review first published in 2007. Objectives To assess the effectiveness of nicotine receptor partial agonists, including varenicline and cytisine, for smoking cessation. Search methods We searched the Cochrane Tobacco Addiction Group's Specialised Register in April 2022 for trials, using relevant terms in the title or abstract, or as keywords. The register is compiled from searches of CENTRAL, MEDLINE, Embase, and PsycINFO. Selection criteria We included randomised controlled trials that compared the treatment drug with placebo, another smoking cessation drug, e‐cigarettes, or no medication. We excluded trials that did not report a minimum follow‐up period of six months from baseline. Data collection and analysis We followed standard Cochrane methods. Our main outcome was abstinence from smoking at longest follow‐up using the most rigorous definition of abstinence, preferring biochemically validated rates where reported. We pooled risk ratios (RRs), using the Mantel‐Haenszel fixed‐effect model. We also reported the number of people reporting serious adverse events (SAEs). Main results We included 75 trials of 45,049 people; 45 were new for this update. We rated 22 at low risk of bias, 18 at high risk, and 35 at unclear risk. We found moderate‐certainty evidence (limited by heterogeneity) that cytisine helps more people to quit smoking than placebo (RR 1.30, 95% confidence interval (CI) 1.15 to 1.47; I2 = 83%; 4 studies, 4623 participants), and no evidence of a difference in the number reporting SAEs (RR 1.04, 95% CI 0.78 to 1.37; I2 = 0%; 3 studies, 3781 participants; low‐certainty evidence). SAE evidence was limited by imprecision. We found no data on neuropsychiatric or cardiac SAEs. We found high‐certainty evidence that varenicline helps more people to quit than placebo (RR 2.32, 95% CI 2.15 to 2.51; I2 = 60%, 41 studies, 17,395 participants), and moderate‐certainty evidence that people taking varenicline are more likely to report SAEs than those not taking it (RR 1.23, 95% CI 1.01 to 1.48; I2 = 0%; 26 studies, 14,356 participants). While point estimates suggested increased risk of cardiac SAEs (RR 1.20, 95% CI 0.79 to 1.84; I2 = 0%; 18 studies, 7151 participants; low‐certainty evidence), and decreased risk of neuropsychiatric SAEs (RR 0.89, 95% CI 0.61 to 1.29; I2 = 0%; 22 studies, 7846 participants; low‐certainty evidence), in both cases evidence was limited by imprecision, and confidence intervals were compatible with both benefit and harm. Pooled results from studies that randomised people to receive cytisine or varenicline found no clear evidence of difference in quit rates (RR 1.00, 95% CI 0.79 to 1.26; I2 = 65%; 2 studies, 2131 participants; low‐certainty evidence) and reported SAEs (RR 0.67, 95% CI 0.44 to 1.03; I2 = 45%; 2 studies, 2017 participants; low‐certainty evidence). However, the evidence was limited by imprecision, and confidence intervals incorporated the potential for benefit from either cytisine or varenicline. We found no data on neuropsychiatric or cardiac SAEs. We found high‐certainty evidence that varenicline helps more people to quit than bupropion (RR 1.36, 95% CI 1.25 to 1.49; I2 = 0%; 9 studies, 7560 participants), and no clear evidence of difference in rates of SAEs (RR 0.89, 95% CI 0.61 to 1.31; I2 = 0%; 5 studies, 5317 participants), neuropsychiatric SAEs (RR 1.05, 95% CI 0.16 to 7.04; I2 = 10%; 2 studies, 866 participants), or cardiac SAEs (RR 3.17, 95% CI 0.33 to 30.18; I2 = 0%; 2 studies, 866 participants). Evidence of harms was of low certainty, limited by imprecision. We found high‐certainty evidence that varenicline helps more people to quit than a single form of nicotine replacement therapy (NRT) (RR 1.25, 95% CI 1.14 to 1.37; I2 = 28%; 11 studies, 7572 participants), and low‐certainty evidence, limited by imprecision, of fewer reported SAEs (RR 0.70, 95% CI 0.50 to 0.99; I2 = 24%; 6 studies, 6535 participants). We found no data on neuropsychiatric or cardiac SAEs. We found no clear evidence of a difference in quit rates between varenicline and dual‐form NRT (RR 1.02, 95% CI 0.87 to 1.20; I2 = 0%; 5 studies, 2344 participants; low‐certainty evidence, downgraded because of imprecision). While pooled point estimates suggested increased risk of SAEs (RR 2.15, 95% CI 0.49 to 9.46; I2 = 0%; 4 studies, 1852 participants) and neuropsychiatric SAEs (RR 4.69, 95% CI 0.23 to 96.50; I2 not estimable as events only in 1 study; 2 studies, 764 participants), and reduced risk of cardiac SAEs (RR 0.32, 95% CI 0.01 to 7.88; I2 not estimable as events only in 1 study; 2 studies, 819 participants), in all three cases evidence was of low certainty and confidence intervals were very wide, encompassing both substantial harm and benefit. Authors' conclusions Cytisine and varenicline both help more people to quit smoking than placebo or no medication. Varenicline is more effective at helping people to quit smoking than bupropion, or a single form of NRT, and may be as or more effective than dual‐form NRT. People taking varenicline are probably more likely to experience SAEs than those not taking it, and while there may be increased risk of cardiac SAEs and decreased risk of neuropsychiatric SAEs, evidence was compatible with both benefit and harm. Cytisine may lead to fewer people reporting SAEs than varenicline. Based on studies that directly compared cytisine and varenicline, there may be no difference or a benefit from either medication for quitting smoking. Future trials should test the effectiveness and safety of cytisine compared with varenicline and other pharmacotherapies, and should also test variations in dose and duration. There is limited benefit to be gained from more trials testing the effect of standard‐dose varenicline compared with placebo for smoking cessation. Further trials on varenicline should test variations in dose and duration, and compare varenicline with e‐cigarettes for smoking cessation. Can medications like varenicline and cytisine (nicotine receptor partial agonists) help people to stop smoking and do they cause unwanted effects? Key messages · Varenicline can help people to stop smoking for at least 6 months. Evidence shows it works better than bupropion and using only one type of nicotine replacement therapy (e.g. only patches). Quit rates might be similar to using more than one type of nicotine replacement therapy at the same time (e.g. patches and gum together). · Cytisine can help people to stop smoking for at least 6 months. It may work as well as varenicline, but future evidence may show that while it helps, it is not quite as helpful as varenicline. · Future studies should test the effectiveness and safety of cytisine compared with varenicline and other stop‐smoking medications, and should also investigate giving cytisine or varenicline at different doses and for different lengths of time. What are 'nicotine receptor partial agonists'? Smoking tobacco is extremely bad for people’s health. For people who smoke, quitting is the best thing they can do to improve their health. Many people find it difficult to quit smoking. Nicotine receptor partial agonists (NRPAs) are a type of medication used to help people to stop smoking. They help to reduce the withdrawal symptoms people experience when they stop smoking, like cravings and unpleasant mood changes. They also reduce the pleasure people usually experience when they smoke. The most widely‐available treatment in this drug type is varenicline. Cytisine is another, similar medication. They may cause unwanted effects such as feeling sick (nausea) and other stomach problems, difficulties sleeping, abnormal dreams, and headache. They may also lead to potentially serious unwanted effects, such as suicidal thoughts, heart problems and raised blood pressure. What did we want to find out? We wanted to find out if using NRPAs can help people to quit smoking, and if they cause unwanted effects. We wanted to know: · how many people stopped smoking for at least 6 months; and · how many people had unwanted effects. What did we do? We searched for studies that investigated NRPAs used to help people quit smoking. People in the studies had to be chosen at random to receive an NRPA, or another NRPA, placebo (medication like the NRPA but with no active ingredients) or no treatment. They had to be adult tobacco smokers who wanted to stop smoking. What did we find? We found 75 studies that compared NRPAs with: · placebo or no medicine; · nicotine replacement therapy, such as patches or gum; · bupropion (another medicine to help people stop smoking); · another NRPA; · e‐cigarettes. The USA hosted the most studies (28 studies). Other studies took place in a range of countries across the world, some in several countries. Main results People are more likely to stop smoking for at least six months using varenicline than using placebo (41 studies, 17,395 people), bupropion (9 studies, 7560 people), or just one type of nicotine replacement therapy, like patches alone (11 studies, 7572 people). They may be just as likely to quit as people using two or more kinds of nicotine replacement therapy, like patches and gum together (5 studies, 2344 people). Cytisine probably helps more people to stop smoking than placebo (4 studies, 4623 people) and may be just as effective as varenicline (2 studies, 2131 people). For every 100 people using varenicline to stop smoking, 21 to 25 might successfully stop, compared with only 18 of 100 people using bupropion, 18 of 100 people using a single form of nicotine‐replacement therapy, and 20 of 100 using two or more kinds of nicotine‐replacement therapy. For every 100 people using cytisine to stop smoking, 18 to 23 might successfully stop. The most common unwanted effect of varenicline is nausea, but this is mostly at mild or moderate levels and usually clears over time. People taking varenicline likely have an increased chance of a more serious unwanted effect that could result in going to hospital, however these are still rare (2.7% to 4% of people on varenicline, compared with 2.7% of people without) and may include many that are unrelated to varenicline. People taking cytisine may also have a slightly increased chance of serious unwanted effects compared with people not taking it, but this may be less likely compared with varenicline. What are the limitations of the evidence? The evidence for some of our results is very reliable. We’re very confident that varenicline helps people to quit smoking better than many alternatives. We’re less sure of some other results because fewer or smaller studies provided evidence. Several results suggest one treatment is better or less harmful than another, but the opposite could still be true. How up to date is the evidence? The evidence is up to date to 29 April 2022.
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Gournay LR, Petry J, Bilsky S, Hill MA, Feldner M, Peters E, Bonn-Miller M, Leen-Feldner E. Cannabidiol Reduces Nicotine Withdrawal Severity and State Anxiety During an Acute E-cigarette Abstinence Period: A Novel, Open-Label Study. Cannabis Cannabinoid Res 2023. [PMID: 37167367 DOI: 10.1089/can.2022.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Introduction: Despite efforts to curb nicotine use, 8.1 million adults in the United States use e-cigarettes. Notably, the majority of nicotine-containing e-cigarette users report wanting to quit in the near future, yet there is a dearth of research surrounding intervention efforts. Cannabidiol (CBD) has potential to facilitate e-cigarette quit attempts by decreasing withdrawal symptom intensity and anxiety during nicotine e-cigarette abstinence. Methods: This study employed an open-label, crossover design (n=20) to test the hypothesis that among daily nicotine-containing e-cigarette users, oral administration of 320 mg CBD would reduce self-reported nicotine withdrawal severity and state anxiety following a 4-h e-cigarette abstinence period compared to withdrawal and anxiety reported after abstinence in the absence of CBD. Results: After controlling for participants' positive CBD expectancies, results were consistent with hypotheses, suggesting CBD reduced both nicotine withdrawal symptom severity and state anxiety during e-cigarette abstinence. Conclusion: These preliminary findings suggest testing the impact of CBD on e-cigarette cessation attempts is warranted.
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Affiliation(s)
- L Riley Gournay
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas, USA
| | - Jordan Petry
- University of Texas at Dallas, Richardson, Texas, USA
- Steven A. Cohen Military and Family Clinic, Addison, Texas, USA
| | - Sarah Bilsky
- Department of Psychology, University of Mississippi, University, Mississippi, USA
| | - Morgan A Hill
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas, USA
| | | | - Erica Peters
- Canopy Growth Corporation, Smiths Falls, Ontario, Canada
| | | | - Ellen Leen-Feldner
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas, USA
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Livingstone-Banks J, Fanshawe TR, Thomas KH, Theodoulou A, Hajizadeh A, Hartman L, Lindson N. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2023; 5:CD006103. [PMID: 37142273 PMCID: PMC10169257 DOI: 10.1002/14651858.cd006103.pub8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). This is an update of a Cochrane Review first published in 2007. OBJECTIVES To assess the effectiveness of nicotine receptor partial agonists, including varenicline and cytisine, for smoking cessation. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register in April 2022 for trials, using relevant terms in the title or abstract, or as keywords. The register is compiled from searches of CENTRAL, MEDLINE, Embase, and PsycINFO. SELECTION CRITERIA: We included randomised controlled trials that compared the treatment drug with placebo, another smoking cessation drug, e-cigarettes, or no medication. We excluded trials that did not report a minimum follow-up period of six months from baseline. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Our main outcome was abstinence from smoking at longest follow-up using the most rigorous definition of abstinence, preferring biochemically validated rates where reported. We pooled risk ratios (RRs), using the Mantel-Haenszel fixed-effect model. We also reported the number of people reporting serious adverse events (SAEs). MAIN RESULTS We included 75 trials of 45,049 people; 45 were new for this update. We rated 22 at low risk of bias, 18 at high risk, and 35 at unclear risk. We found moderate-certainty evidence (limited by heterogeneity) that cytisine helps more people to quit smoking than placebo (RR 1.30, 95% confidence interval (CI) 1.15 to 1.47; I2 = 83%; 4 studies, 4623 participants), and no evidence of a difference in the number reporting SAEs (RR 1.04, 95% CI 0.78 to 1.37; I2 = 0%; 3 studies, 3781 participants; low-certainty evidence). SAE evidence was limited by imprecision. We found no data on neuropsychiatric or cardiac SAEs. We found high-certainty evidence that varenicline helps more people to quit than placebo (RR 2.32, 95% CI 2.15 to 2.51; I2 = 60%, 41 studies, 17,395 participants), and moderate-certainty evidence that people taking varenicline are more likely to report SAEs than those not taking it (RR 1.23, 95% CI 1.01 to 1.48; I2 = 0%; 26 studies, 14,356 participants). While point estimates suggested increased risk of cardiac SAEs (RR 1.20, 95% CI 0.79 to 1.84; I2 = 0%; 18 studies, 7151 participants; low-certainty evidence), and decreased risk of neuropsychiatric SAEs (RR 0.89, 95% CI 0.61 to 1.29; I2 = 0%; 22 studies, 7846 participants; low-certainty evidence), in both cases evidence was limited by imprecision, and confidence intervals were compatible with both benefit and harm. Pooled results from studies that randomised people to receive cytisine or varenicline showed that more people in the varenicline arm quit smoking (RR 0.83, 95% CI 0.66 to 1.05; I2 = 0%; 2 studies, 2131 participants; moderate-certainty evidence) and reported SAEs (RR 0.67, 95% CI 0.44 to 1.03; I2 = 45%; 2 studies, 2017 participants; low-certainty evidence). However, the evidence was limited by imprecision, and confidence intervals incorporated the potential for benefit from either cytisine or varenicline. We found no data on neuropsychiatric or cardiac SAEs. We found high-certainty evidence that varenicline helps more people to quit than bupropion (RR 1.36, 95% CI 1.25 to 1.49; I2 = 0%; 9 studies, 7560 participants), and no clear evidence of difference in rates of SAEs (RR 0.89, 95% CI 0.61 to 1.31; I2 = 0%; 5 studies, 5317 participants), neuropsychiatric SAEs (RR 1.05, 95% CI 0.16 to 7.04; I2 = 10%; 2 studies, 866 participants), or cardiac SAEs (RR 3.17, 95% CI 0.33 to 30.18; I2 = 0%; 2 studies, 866 participants). Evidence of harms was of low certainty, limited by imprecision. We found high-certainty evidence that varenicline helps more people to quit than a single form of nicotine replacement therapy (NRT) (RR 1.25, 95% CI 1.14 to 1.37; I2 = 28%; 11 studies, 7572 participants), and low-certainty evidence, limited by imprecision, of fewer reported SAEs (RR 0.70, 95% CI 0.50 to 0.99; I2 = 24%; 6 studies, 6535 participants). We found no data on neuropsychiatric or cardiac SAEs. We found no clear evidence of a difference in quit rates between varenicline and dual-form NRT (RR 1.02, 95% CI 0.87 to 1.20; I2 = 0%; 5 studies, 2344 participants; low-certainty evidence, downgraded because of imprecision). While pooled point estimates suggested increased risk of SAEs (RR 2.15, 95% CI 0.49 to 9.46; I2 = 0%; 4 studies, 1852 participants) and neuropsychiatric SAEs (RR 4.69, 95% CI 0.23 to 96.50; I2 not estimable as events only in 1 study; 2 studies, 764 participants), and reduced risk of cardiac SAEs (RR 0.32, 95% CI 0.01 to 7.88; I2 not estimable as events only in 1 study; 2 studies, 819 participants), in all three cases evidence was of low certainty and confidence intervals were very wide, encompassing both substantial harm and benefit. AUTHORS' CONCLUSIONS Cytisine and varenicline both help more people to quit smoking than placebo or no medication. Varenicline is more effective at helping people to quit smoking than bupropion, or a single form of NRT, and may be as or more effective than dual-form NRT. People taking varenicline are probably more likely to experience SAEs than those not taking it, and while there may be increased risk of cardiac SAEs and decreased risk of neuropsychiatric SAEs, evidence was compatible with both benefit and harm. Cytisine may lead to fewer people reporting SAEs than varenicline. Based on studies that directly compared cytisine and varenicline, there may be a benefit from varenicline for quitting smoking, however further evidence could strengthen this finding or demonstrate a benefit from cytisine. Future trials should test the effectiveness and safety of cytisine compared with varenicline and other pharmacotherapies, and should also test variations in dose and duration. There is limited benefit to be gained from more trials testing the effect of standard-dose varenicline compared with placebo for smoking cessation. Further trials on varenicline should test variations in dose and duration, and compare varenicline with e-cigarettes for smoking cessation.
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Affiliation(s)
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kyla H Thomas
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lilian Hartman
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Truong VTT, Green C, Pedroza C, Hwang LY, Rajan SS, Suchting R, Cinciripini P, Tyndale RF, Lerman C. Bayesian regularization to predict neuropsychiatric adverse events in smoking cessation with pharmacotherapy. BMC Med Res Methodol 2023; 23:107. [PMID: 37118656 PMCID: PMC10148544 DOI: 10.1186/s12874-023-01931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 04/25/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Research on risk factors for neuropsychiatric adverse events (NAEs) in smoking cessation with pharmacotherapy is scarce. We aimed to identify predictors and develop a prediction model for risk of NAEs in smoking cessation with medications using Bayesian regularization. METHODS Bayesian regularization was implemented by applying two shrinkage priors, Horseshoe and Laplace, to generalized linear mixed models on data from 1203 patients treated with nicotine patch, varenicline or placebo. Two predictor models were considered to separate summary scores and item scores in the psychosocial instruments. The summary score model had 19 predictors or 26 dummy variables and the item score model 51 predictors or 58 dummy variables. A total of 18 models were investigated. RESULTS An item score model with Horseshoe prior and 7 degrees of freedom was selected as the final model upon model comparison and assessment. At baseline, smokers reporting more abnormal dreams or nightmares had 16% greater odds of experiencing NAEs during treatment (regularized odds ratio (rOR) = 1.16, 95% credible interval (CrI) = 0.95 - 1.56, posterior probability P(rOR > 1) = 0.90) while those with more severe sleep problems had 9% greater odds (rOR = 1.09, 95% CrI = 0.95 - 1.37, P(rOR > 1) = 0.85). The prouder a person felt one week before baseline resulted in 13% smaller odds of having NAEs (rOR = 0.87, 95% CrI = 0.71 - 1.02, P(rOR < 1) = 0.94). Odds of NAEs were comparable across treatment groups. The final model did not perform well in the test set. CONCLUSIONS Worse sleep-related symptoms reported at baseline resulted in 85%-90% probability of being more likely to experience NAEs during smoking cessation with pharmacotherapy. Treatment for sleep disturbance should be incorporated in smoking cessation program for smokers with sleep disturbance at baseline. Bayesian regularization with Horseshoe prior permits including more predictors in a regression model when there is a low number of events per variable.
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Affiliation(s)
- Van Thi Thanh Truong
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 2850, Houston, TX, 77030, USA.
| | - Charles Green
- Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lu-Yu Hwang
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Suja S Rajan
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paul Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rachel F Tyndale
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Caryn Lerman
- Keck School of Medicine, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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12
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Calakos KC, Hillmer AT, Anderson JM, LeVasseur B, Baldassarri SR, Angarita GA, Matuskey D, Kapinos M, Zheng MQ, Huang Y, Cosgrove KP. Cholinergic system adaptations are associated with cognitive function in people recently abstinent from smoking: a (-)-[ 18F]flubatine PET study. Neuropsychopharmacology 2023; 48:683-689. [PMID: 36681758 PMCID: PMC9938267 DOI: 10.1038/s41386-023-01535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Abstract
The cholinergic system is a critical mediator of cognition in animals. People who smoke cigarettes exhibit cognitive deficits, especially during quit attempts. Few studies jointly examine the cholinergic system and cognition in people while trying to quit smoking. We used positron emission tomography (PET) brain imaging with the β2-subunit containing nicotinic acetylcholine receptor (β2*-nAChR) partial agonist radioligand (-)-[18F]flubatine and the acetylcholinesterase inhibitor physostigmine to jointly examine the cholinergic system, smoking status, and cognition. (-)-[18F]Flubatine scans and cognitive data were acquired from twenty people who recently stopped smoking cigarettes (aged 38 ± 11 years; 6 female, 14 male; abstinent 7 ± 1 days) and 27 people who never smoked cigarettes (aged 29 ± 8 years; 11 female, 16 male). A subset of fifteen recently abstinent smokers and 21 never smokers received a mid-scan physostigmine challenge to increase acetylcholine levels. Regional volume of distribution (VT) was estimated with equilibrium analysis at "baseline" and post-physostigmine. Participants completed a cognitive battery prior to (-)-[18F]flubatine injection and physostigmine administration assessing executive function (Groton Maze Learning test), verbal learning (International Shopping List test), and working memory (One Back test). Physostigmine significantly decreased cortical (-)-[18F]flubatine VT, consistent with increased cortical acetylcholine levels reducing the number of β2*-nAChR sites available for (-)-[18F]flubatine binding, at comparable magnitudes across groups (p values < 0.05). A larger magnitude of physostigmine-induced decrease in (-)-[18F]flubatine VT was significantly associated with worse executive function in people who recently stopped smoking (p values < 0.05). These findings underscore the role of the cholinergic system in early smoking cessation and highlight the importance of neuroscience-informed treatment strategies.
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Affiliation(s)
- Katina C Calakos
- Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Ansel T Hillmer
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
- Yale PET Center, Yale University, New Haven, CT, USA
| | | | - Brittany LeVasseur
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Stephen R Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care Medicine, & Sleep Medicine, Yale University, New Haven, CT, USA
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - David Matuskey
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
- Yale PET Center, Yale University, New Haven, CT, USA
- Department of Neurology, Yale University, New Haven, CT, USA
| | | | - Ming-Qiang Zheng
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Yiyun Huang
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
- Yale PET Center, Yale University, New Haven, CT, USA
| | - Kelly P Cosgrove
- Department of Psychiatry, Yale University, New Haven, CT, USA.
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
- Department of Neuroscience, Yale University, New Haven, CT, USA.
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13
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Pandria N, Athanasiou A, Styliadis C, Terzopoulos N, Mitsopoulos K, Paraskevopoulos E, Karagianni M, Pataka A, Kourtidou-Papadeli C, Makedou K, Iliadis S, Lymperaki E, Nimatoudis I, Argyropoulou-Pataka P, Bamidis PD. Does combined training of biofeedback and neurofeedback affect smoking status, behavior, and longitudinal brain plasticity? Front Behav Neurosci 2023; 17:1096122. [PMID: 36778131 PMCID: PMC9911884 DOI: 10.3389/fnbeh.2023.1096122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
Introduction: Investigations of biofeedback (BF) and neurofeedback (NF) training for nicotine addiction have been long documented to lead to positive gains in smoking status, behavior and to changes in brain activity. We aimed to: (a) evaluate a multi-visit combined BF/NF intervention as an alternative smoking cessation approach, (b) validate training-induced feedback learning, and (c) document effects on resting-state functional connectivity networks (rsFCN); considering gender and degree of nicotine dependence in a longitudinal design. Methods: We analyzed clinical, behavioral, and electrophysiological data from 17 smokers who completed five BF and 20 NF sessions and three evaluation stages. Possible neuroplastic effects were explored comparing whole-brain rsFCN by phase-lag index (PLI) for different brain rhythms. PLI connections with significant change across time were investigated according to different resting-state networks (RSNs). Results: Improvements in smoking status were observed as exhaled carbon monoxide levels, Total Oxidative Stress, and Fageström scores decreased while Vitamin E levels increased across time. BF/NF promoted gains in anxiety, self-esteem, and several aspects of cognitive performance. BF learning in temperature enhancement was observed within sessions. NF learning in theta/alpha ratio increase was achieved across baselines and within sessions. PLI network connections significantly changed across time mainly between or within visual, default mode and frontoparietal networks in theta and alpha rhythms, while beta band RSNs mostly changed significantly after BF sessions. Discussion: Combined BF/NF training positively affects the clinical and behavioral status of smokers, displays benefit in smoking harm reduction, plays a neuroprotective role, leads to learning effects and to positive reorganization of RSNs across time. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02991781.
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Affiliation(s)
- Niki Pandria
- Laboratory of Medical Physics and Digital Innovation, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Alkinoos Athanasiou
- Laboratory of Medical Physics and Digital Innovation, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Charis Styliadis
- Laboratory of Medical Physics and Digital Innovation, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Nikos Terzopoulos
- Laboratory of Medical Physics and Digital Innovation, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Konstantinos Mitsopoulos
- Laboratory of Medical Physics and Digital Innovation, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Evangelos Paraskevopoulos
- Laboratory of Medical Physics and Digital Innovation, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece,Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Maria Karagianni
- Laboratory of Medical Physics and Digital Innovation, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Athanasia Pataka
- Pulmonary Department-Oncology Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Kali Makedou
- Laboratory of Biochemistry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Iliadis
- Laboratory of Biochemistry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evgenia Lymperaki
- Department of Biomedical Sciences, International Hellenic University, Thessaloniki, Greece
| | - Ioannis Nimatoudis
- Third Department of Psychiatry, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Panagiotis D. Bamidis
- Laboratory of Medical Physics and Digital Innovation, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece,*Correspondence: Panagiotis D. Bamidis
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14
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Neurobiology and Mechanisms of Nicotine Addiction. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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15
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Newman AH, Xi ZX, Heidbreder C. Current Perspectives on Selective Dopamine D 3 Receptor Antagonists/Partial Agonists as Pharmacotherapeutics for Opioid and Psychostimulant Use Disorders. Curr Top Behav Neurosci 2023; 60:157-201. [PMID: 35543868 PMCID: PMC9652482 DOI: 10.1007/7854_2022_347] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Over three decades of evidence indicate that dopamine (DA) D3 receptors (D3R) are involved in the control of drug-seeking behavior and may play an important role in the pathophysiology of substance use disorders (SUD). The expectation that a selective D3R antagonist/partial agonist would be efficacious for the treatment of SUD is based on the following key observations. First, D3R are distributed in strategic areas belonging to the mesolimbic DA system such as the ventral striatum, midbrain, and ventral pallidum, which have been associated with behaviors controlled by the presentation of drug-associated cues. Second, repeated exposure to drugs of abuse produces neuroadaptations in the D3R system. Third, the synthesis and characterization of highly potent and selective D3R antagonists/partial agonists have further strengthened the role of the D3R in SUD. Based on extensive preclinical and preliminary clinical evidence, the D3R shows promise as a target for the development of pharmacotherapies for SUD as reflected by their potential to (1) regulate the motivation to self-administer drugs and (2) disrupt the responsiveness to drug-associated stimuli that play a key role in reinstatement of drug-seeking behavior triggered by re-exposure to the drug itself, drug-associated environmental cues, or stress. The availability of PET ligands to assess clinically relevant receptor occupancy by selective D3R antagonists/partial agonists, the definition of reliable dosing, and the prospect of using human laboratory models may further guide the design of clinical proof of concept studies. Pivotal clinical trials for more rapid progression of this target toward regulatory approval are urgently required. Finally, the discovery that highly selective D3R antagonists, such as R-VK4-116 and R-VK4-40, do not adversely affect peripheral biometrics or cardiovascular effects alone or in the presence of oxycodone or cocaine suggests that this class of drugs has great potential in safely treating psychostimulant and/or opioid use disorders.
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Affiliation(s)
- Amy Hauck Newman
- Medicinal Chemistry Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, Baltimore, MD, USA.
| | - Zheng-Xiong Xi
- Medicinal Chemistry Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, Baltimore, MD, USA
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Novick AM, Duffy KA, Johnson RL, Sammel MD, Cao W, Strasser AA, Sofuoglu M, Kuzma A, Loughead J, Morrow AL, Epperson CN. Effect of progesterone administration in male and female smokers on nicotine withdrawal and neural response to smoking cues: role of progesterone conversion to allopregnanolone. Biol Sex Differ 2022; 13:60. [PMID: 36274158 PMCID: PMC9590190 DOI: 10.1186/s13293-022-00472-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Progesterone administration has therapeutic effects in tobacco use disorder (TUD), with females benefiting more than males. Conversion of progesterone to the neurosteroid allopregnanolone is hypothesized to partly underlie the therapeutic effects of progesterone; however, this has not been investigated clinically. METHODS Smokers (n = 18 males, n = 21 females) participated in a randomized, double-blind, placebo-controlled crossover study of 200 mg progesterone daily across 4 days of abstinence. The ratio of allopregnanolone:progesterone was analyzed in relationship to nicotine withdrawal, smoking urges, mood states, subjective nicotine effects, and neural response to smoking cues. RESULTS Allopregnanolone:progesterone ratio interacted with sex to predict withdrawal symptoms (p = 0.047), such that females with higher allopregnanolone:progesterone ratios reported lower withdrawal severity (b = - 0.98 [- 1.95, - 0.01]; p = 0.048). In addition, allopregnanolone:progesterone ratio interacted with sex to predict confusion (p = 0.014) and fatigue (p = 0.034), such that females with higher allopregnanolone:progesterone ratios reported less confusion (b = - 0.45 [- 0.78, - 0.12]; p = 0.008) and marginally lower fatigue (b = - 0.50 [- 1.03, 0.02]; p = 0.062. Irrespective of sex, higher ratios of allopregnanolone:progesterone were associated with stronger "good effects" of nicotine (b = 8.39 [2.58, 14.20]); p = 0.005) and weaker "bad effects" of nicotine (b = - 7.13 [- 13.53, - 0.73]; p = 0.029). CONCLUSIONS Conversion of progesterone to allopregnanolone correlated with smoking-related outcomes in both sex-dependent and sex-independent ways. Sex-dependent effects suggest that conversion of progesterone to allopregnanolone may contribute to greater therapeutic benefits in females but not males with TUD. Trial registration Clinicaltrials.gov registration, retrospectively registered: NCT01954966; https://clinicaltrials.gov/ct2/show/NCT01954966 \.
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Affiliation(s)
- Andrew M Novick
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA.
| | - Korrina A Duffy
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of CO-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Mary D Sammel
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of CO-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Wen Cao
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, 06511, USA
| | - Alexandra Kuzma
- Larner College of Medicine, University of Vermont, Burlington, VM, 05405, USA
| | - James Loughead
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - A Leslie Morrow
- Departments of Psychiatry and Pharmacology and the Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, Chapel Hill, NC, 27514, USA
| | - C Neill Epperson
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Family Medicine, School of Medicine, University of CO-Anschutz Medical Campus, Aurora, CO, 80045, USA
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Zaso MJ, Hendershot CS. Effects of varenicline and bupropion on laboratory smoking outcomes: Meta-analysis of randomized, placebo-controlled human laboratory studies. Addict Biol 2022; 27:e13218. [PMID: 36001439 PMCID: PMC9413474 DOI: 10.1111/adb.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022]
Abstract
Human laboratory studies are widely used to evaluate behavioural mechanisms of pharmacotherapy effects. Results from human laboratory studies examining smoking cessation pharmacotherapies have not been examined in aggregate. The current meta-analysis aimed to synthesize data from randomized, placebo-controlled human laboratory studies on the effects of non-nicotine pharmacotherapies on outcomes relevant for smoking cessation. Literature searches identified 15 human laboratory studies of varenicline (n = 697) and 9 studies of bupropion (n = 313) with sufficient data for inclusion. Studies involved acute or subacute pharmacotherapy treatment with administration durations ranging from a single dose to 8 weeks. Primary outcomes examined were craving, withdrawal and behavioural indices of smoking. Varenicline significantly reduced craving (Hedge's g = -0.36[-0.54,-0.17], p < 0.001), withdrawal (g = -0.25[-0.41,-0.09], p = 0.003) and behavioural indices of smoking (g = -0.36[-0.63,-0.08], p = 0.01) relative to placebo. In contrast, results were inconclusive regarding bupropion's effects on craving (g = -0.13[-0.32,0.05], p = 0.15), withdrawal (g = -0.15[-0.44,0.14], p = 0.31) and behavioural indices of smoking (g = -0.05[-0.35,0.24], p = 0.73) relative to placebo. Findings provide meta-analytic support that short-term varenicline treatment decreases craving, withdrawal symptoms and smoking behaviour under controlled laboratory conditions. However, findings also suggest the ability of human laboratory paradigms to detect pharmacotherapy effects may differ by treatment type. Pharmacotherapy discovery and evaluation efforts utilizing human laboratory methods should aim to align study designs and laboratory procedures with presumed therapeutic mechanisms when possible.
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Affiliation(s)
- Michelle J. Zaso
- Clinical and Research Institute on Addictions, University at Buffalo – The State University of New York, Buffalo, NY USA
| | - Christian S. Hendershot
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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18
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Lee MD, Mistry PK, Menon V. A Multinomial Processing Tree Model of the 2-back Working Memory Task. COMPUTATIONAL BRAIN & BEHAVIOR 2022; 5:261-278. [PMID: 37873549 PMCID: PMC10593202 DOI: 10.1007/s42113-022-00138-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 10/25/2023]
Abstract
The n -back task is a widely used behavioral task for measuring working memory and the ability to inhibit interfering information. We develop a novel model of the commonly used 2-back task using the cognitive psychometric framework provided by Multinomial Processing Trees. Our model involves three parameters: a memory parameter, corresponding to how well an individual encodes and updates sequence information about presented stimuli; a decision parameter corresponding to how well participants execute choices based on information stored in memory; and a base-rate parameter corresponding to bias for responding "yes" or "no". We test the parameter recovery properties of the model using existing 2-back experimental designs, and demonstrate the application of the model to two previous data sets: one from social psychology involving faces corresponding to different races (Stelter and Degner, British Journal of Psychology 109:777-798, 2018), and one from cognitive neuroscience involving more than 1000 participants from the Human Connectome Project (Van Essen et al., Neuroimage 80:62-79, 2013). We demonstrate that the model can be used to infer interpretable individual-level parameters. We develop a hierarchical extension of the model to test differences between stimulus conditions, comparing faces of different races, and comparing face to non-face stimuli. We also develop a multivariate regression extension to examine the relationship between the model parameters and individual performance on standardized cognitive measures including the List Sorting and Flanker tasks. We conclude by discussing how our model can be used to dissociate underlying cognitive processes such as encoding failures, inhibition failures, and binding failures.
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Affiliation(s)
- Michael D. Lee
- Department of Cognitive Sciences, University of California Irvine, Irvine, CA 92697, USA
| | - Percy K. Mistry
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, USA, CA 94305
| | - Vinod Menon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, USA, CA 94305
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, USA, CA 94305
- Wu Tsai Stanford Neuroscience Institute, Stanford University School of Medicine, Stanford, USA, CA 94305
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19
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Deshpande HU, Fedota JR, Castillo J, Salmeron BJ, Ross TJ, Stein EA. Not all smokers are alike: the hidden cost of sustained attention during nicotine abstinence. Neuropsychopharmacology 2022; 47:1633-1642. [PMID: 35091674 PMCID: PMC9283548 DOI: 10.1038/s41386-022-01275-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022]
Abstract
Nicotine Withdrawal Syndrome (NWS)-associated cognitive deficits are notably heterogeneous, suggesting underlying endophenotypic variance. However, parsing this variance in smokers has remained challenging. In this study, we identified smoker subgroups based on response accuracy during a Parametric Flanker Task (PFT) and then characterized distinct neuroimaging endophenotypes using a nicotine state manipulation. Smokers completed the PFT in two fMRI sessions (nicotine sated, abstinent). Based on response accuracy in the stressful, high cognitive demand PFT condition, smokers split into high (HTP, n = 21) and low task performer (LTP, n = 24) subgroups. Behaviorally, HTPs showed greater response accuracy (88.68% ± 5.19 SD) vs. LTPs (51.04% ± 4.72 SD), independent of nicotine state, and greater vulnerability to abstinence-induced errors of omission (EOm, p = 0.01). Neurobiologically, HTPs showed greater BOLD responses in attentional control brain regions, including bilateral insula, dorsal ACC, and frontoparietal Cx for the [correct responses (-) errors of commission] PFT contrast in both states. A whole-brain functional connectivity (FC) analysis with these subgroup-derived regions as seeds identified two circuits: Precentral Cx↔Insula and Insula↔Occipital Cx, with abstinence-induced FC strength increases seen only in HTPs. Finally, abstinence-induced FC and behavior (EOm) differences were positively correlated for HTPs in a Precentral Cx↔Orbitofrontal cortical circuit. In sum, only the HTP subgroup demonstrated sustained attention deficits following 48-hr nicotine abstinence, a stressor in dependent smokers. Unpacking underlying smoker heterogeneity with this 'dual (task and abstinence) stressor' approach revealed discrete smoker subgroups with differential attentional deficits to withdrawal that could be novel pharmacological/behavioral targets for therapeutic interventions to improve cessation outcomes.
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Affiliation(s)
- Harshawardhan U. Deshpande
- grid.420090.f0000 0004 0533 7147Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, MD USA
| | - John R. Fedota
- grid.420090.f0000 0004 0533 7147Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, MD USA ,grid.420090.f0000 0004 0533 7147Present Address: Behavioral and Cognitive Neuroscience Branch, Division of Neuroscience Behavior, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD USA
| | - Juan Castillo
- grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, Cambridge, MA USA
| | - Betty Jo Salmeron
- grid.420090.f0000 0004 0533 7147Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, MD USA
| | - Thomas J. Ross
- grid.420090.f0000 0004 0533 7147Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, MD USA
| | - Elliot A. Stein
- grid.420090.f0000 0004 0533 7147Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, MD USA
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20
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Johnstone S, Sorkhou M, Rabin RA, George TP. Dose-dependent effects of Varenicline on tobacco craving and withdrawal in tobacco smokers with and without schizophrenia. Drug Alcohol Depend 2022; 234:109412. [PMID: 35395548 DOI: 10.1016/j.drugalcdep.2022.109412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND People with schizophrenia (SCZ) have significantly higher tobacco smoking rates and lower quit rates than the general population. Varenicline, a partial agonist at α4β2 nicotinic acetylcholine receptors (nAChRs) is an effective smoking cessation pharmacotherapy, however, investigation into its effects in SCZ are less well-studied and mechanisms may differ from non-psychiatric controls due to dysregulation in nAChR neurotransmission associated with SCZ. Here, we investigate whether Varenicline attenuates acute abstinence-induced increases in craving and withdrawal in participants with and without SCZ. METHODS Following biochemically-verified overnight abstinence and subsequent smoking reinstatement, individuals with nicotine-dependence (n = 13 SCZ or schizoaffective; n = 12 controls) were assessed on the Minnesota Nicotine Withdrawal Scale (MNWS) and Tiffany Questionnaire for Smoking Urges (TQSU). Participants were pretreated in a double-blind, counterbalanced manner with Varenicline (0, 1 or 2 mg/day x 3 days) over three separate weeks. Data were analyzed using linear mixed-effects modelling and estimated marginal means. RESULTS Robust effects of smoking abstinence were observed on TQSU and MNWS scores in SCZ and control participants. Relative to 1 mg, 2 mg/day of Varenicline attenuated abstinence-induced increases in craving (TQSU Factor 1 d=-0.47, p = .006; TQSU Factor 2 d=-0.42, p = .008) and withdrawal (MNWS d=-0.35, p = .03) in both groups. CONCLUSION Our preliminary findings suggest that subacute Varenicline treatment reduces abstinence-induced craving and withdrawal in participants with and without SCZ. The efficacy of Varenicline on tobacco withdrawal and craving requires further study.
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Affiliation(s)
- Samantha Johnstone
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H4, Canada.
| | - Maryam Sorkhou
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H4, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5T 1R8, Canada.
| | - Rachel A Rabin
- Department of Psychiatry, McGill University and Douglas Hospital and Research Centre, Montreal, QC H4H 1R3 , Canada.
| | - Tony P George
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H4, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5T 1R8, Canada.
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21
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Danilov M, Issany A, Mercado P, Haghdel A, Muzayad JK, Wen X. Sleep quality and health among pregnant smokers. J Clin Sleep Med 2022; 18:1343-1353. [PMID: 34978278 PMCID: PMC9059582 DOI: 10.5664/jcsm.9868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES We aimed to examine 1) sleep quality trends of pregnant smokers and 2) their associations with health outcomes. METHODS A secondary analysis of 88 participants from the University at Buffalo Pregnancy and Smoking Cessation Study (non-randomized clinical study) was performed. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) (higher scores, worse quality) and sleep duration was self-reported repeatedly during pregnancy at pre-intervention, post-intervention, and end-of-pregnancy visits. Participants were divided into 3 groups (until pre-intervention, until post-intervention, until end-of-pregnancy). Maternal outcomes included gestational weight gain (GWG) and smoking cessation. Infant outcomes included birth weight, gestational age, and APGAR score. RESULTS There was a significant increase (P= 0.046) in PSQI score from post-intervention (mean, 5.5 [SD, 2.6]) to end-of-pregnancy (6.6 [SD, 2.8]). Mean GWG was significantly lower for participants with poor sleep quality than those with good sleep quality (19.0 kg [SD, 21.3] vs. 36.1 kg [SD, 22.8]; P=0.008). Newborns with poor maternal sleep quality had a significantly lower mean 5-minute APGAR score (8.1 [SD, 1.3] vs. 9.0 [SD, 0.0]; P=0.021) than newborns with good maternal sleep quality. Pre-intervention sleep quality was not associated with smoking cessation, birth weight, or gestational age. Smoking cessation was almost half as prevalent in participants with insufficient sleep (<7 hours/night) vs. sufficient sleep duration (47.4% vs. 92.3%, P=0.011). CONCLUSIONS Sleep quality worsened towards the end-of-pregnancy among smokers. Poor sleep might negatively influence GWG and APGAR score. Insufficient pre-intervention sleep might negatively influence smoking cessation.
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Affiliation(s)
- Michael Danilov
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Arsh Issany
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Paul Mercado
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Arsalan Haghdel
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Jamila Khlid Muzayad
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
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22
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Wang C, Huang P, Shen Z, Qian W, Wang S, Jiaerken Y, Luo X, Li K, Zeng Q, Zhou C, Yang Y, Zhang M. Increased striatal functional connectivity is associated with improved smoking cessation outcomes: A preliminary study. Addict Biol 2021; 26:e12919. [PMID: 32436626 DOI: 10.1111/adb.12919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022]
Abstract
The striatum is the critical area of reward processing and has been repeatedly linked to nicotine addiction. However, it remains unclear whether different smoking cessation outcomes (relapse or not) are associated with different functional connectivity changes of the striatum during smoking cessation treatment. A total of 30 treatment-seeking smokers were recruited in the study and underwent magnetic resonance imaging (MRI) scans immediately before and after a 12-week treatment with varenicline. After the 12-week treatment with varenicline, 14 subjects relapsed to smoking (relapsers), whereas 16 not relapsed (nonrelapsers). Changes in resting-state functional connectivity (rsFC) across groups and visits were assessed using repeated measures analysis of covariance (ANCOVA). Significant interaction effects were detected: (1) between left nucleus accumbens (NAc) and left orbitofrontal cortex (OFC), insula, inferior frontal gyrus (IFG), and bilateral precuneus; (2) between right NAc and left insula, IFG, and bilateral dorsolateral prefrontal cortex (DLPFC); and (3) between bilateral putamen and left precuneus. Post hoc region-of-interest analyses in brain areas showing interaction effects indicated significantly decreased rsFC after treatment compared with before treatment in relapsers but opposite longitudinal changes in nonrelapers. These novel findings suggest that increased striatal rsFC is associated with improved smoking cessation outcomes. These striatal functional circuits may serve as potential therapeutic targets for more efficacious treatment of nicotine addiction.
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Affiliation(s)
- Chao Wang
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Peiyu Huang
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Zhujing Shen
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Wei Qian
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Shuyue Wang
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Yeerfan Jiaerken
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Xiao Luo
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Kaicheng Li
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Qingze Zeng
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Cheng Zhou
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Yihong Yang
- Neuroimaging Research Branch National Institute on Drug Abuse, National Institutes of Health Baltimore MD USA
| | - Minming Zhang
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
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23
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Klemperer EM, Hughes JR, Peasley-Miklus CE, Callas PW, Cook JW, Streck JM, Morley NE. Possible New Symptoms of Tobacco Withdrawal III: Reduced Positive Affect-A Review and Meta-analysis. Nicotine Tob Res 2021; 23:259-266. [PMID: 32188995 DOI: 10.1093/ntr/ntaa044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/26/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Most descriptions of tobacco withdrawal have not changed in >30 years despite new research. This meta-analysis tested whether abstinence leads to decreased positive affect (PA) because abstinence-induced symptom changes are a core feature of the tobacco withdrawal syndrome. In addition, we examined whether reduced PA was due to withdrawal (ie, temporary decrease in a "U-shaped" curve) or offset (ie, return to baseline) effect. METHODS Our main inclusion criterion was a prospective within-participant test of change in PA during abstinence conditions among people who smoke cigarettes daily who were not using a cessation medication. Our search of PubMed, PsycINFO, and personal libraries yielded a total of 32 tests with 2054 participants. RESULTS There was a medium effect size indicating an overall decrease in PA following abstinence from cigarettes (Cohen's d = -0.40, 95% CI = -0.30 to -0.49). There was large heterogeneity (I2 = 70.7%). Most (79%) of the 24 trials that conducted significance tests reported that reduction in PA was significant. Seven tests were adequately designed to detect a withdrawal versus offset effect. Over half (57%) displayed a U-shaped curve for abstinence-induced change in PA indicative of a withdrawal symptom rather than offset effect. CONCLUSIONS Abstinence from cigarettes is associated with a decrease in PA. Whether low PA should be added to withdrawal measures and diagnostic criteria requires replication of the time-course of change in PA and tests of whether abstinence-induced changes in PA and negative affect occur independently. IMPLICATIONS Though there was substantial heterogeneity among trials, our findings suggest that (1) abstinence from cigarettes decreases positive affect and (2) this decrease may represent a withdrawal effect (vs. an offset effect). However, it is unclear whether abstinence-induced losses in positive affect are independent from increased negative affect.
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Affiliation(s)
- Elias M Klemperer
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT.,Department of Psychological Science, University of Vermont, Burlington, VT
| | - John R Hughes
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT.,Department of Psychological Science, University of Vermont, Burlington, VT
| | | | - Peter W Callas
- Department of Biostatistics, University of Vermont, Burlington, VT
| | - Jessica W Cook
- Department of Medicine, William S. Middleton Memorial Veterans Hospital, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Joanna M Streck
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT.,Department of Psychological Science, University of Vermont, Burlington, VT.,Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Nicolas E Morley
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT
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Muench C, Malloy EJ, Juliano LM. Lower self-efficacy and greater depressive symptoms predict greater failure to recover from a single lapse cigarette. J Consult Clin Psychol 2020; 88:965-970. [PMID: 33048572 DOI: 10.1037/ccp0000605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Smoking reexposure after a quit attempt (i.e., lapse) increases relapse risk, but lapse recovery is possible. Using a 6-day analogue model of smoking cessation and lapse, this study tested the effect of a single lapse cigarette on the risk of subsequent smoking. Abstinence self-efficacy (ASE) and depressive symptoms (using the Center for Epidemiological Studies Depression Scale, CES-D) were also examined as hypothesized moderators of lapse recovery. METHOD After receiving cessation counseling and achieving 2 days of incentivized abstinence, 54 daily smokers (mean age: 41 years, 61% African American, 63% male) were randomly assigned to smoke 1 cigarette or to a no-lapse control condition. Participants were then offered monetary incentives to abstain for 3 more days and smoking was monitored. RESULTS Compared to the control condition, participants who experienced a lapse had a 2.5 times greater risk of smoking in the first 24 hours Furthermore, a lapse resulted in much greater risk of subsequent smoking compared to the control condition among individuals with lower postquit ASE scores (p = .044) and greater CES-D scores (p = .040). CONCLUSIONS These findings provide preliminary evidence that a single lapse cigarette after quitting plays a causal role in subsequent smoking and suggest that individuals with lower postquit ASE and greater depressive symptoms are less likely to recover from a lapse. Future research should investigate factors associated with lapse recovery and failure so that effective lapse-responsive strategies can be developed. Laboratory models provide an efficient and controlled method to examine such processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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McCaul ME, Wand GS, Kuwabara H, Dannals RF, Wong D, Xu X. The Relationship of Varenicline Agonism of α4β2 Nicotinic Acetylcholine Receptors and Nicotine-Induced Dopamine Release in Nicotine-Dependent Humans. Nicotine Tob Res 2020; 22:892-899. [PMID: 31096265 PMCID: PMC7529151 DOI: 10.1093/ntr/ntz080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/15/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cigarette smoking continues to be one of the most important behavioral causes of morbidity and mortality in the world. Varenicline, an α4β2 nicotinic acetylcholine receptor (nAChR) partial agonist, has been shown to increase smoking quit rates compared with nicotine-based products. This human laboratory, double-blind, placebo-controlled study examined varenicline and placebo effects on α4β2-nAChRs occupancy, nicotine-induced change in [11C]raclopride non-displaceable binding potential (BPND), and behavioral measures of cigarette smoking, nicotine craving, and withdrawal. METHODS Current nicotine dependent daily smokers (N = 17) were randomized to varenicline 1 mg twice daily or placebo for 13 days. Using positron emission tomography), we characterized α4β2-nAChRs occupancy using [18F]AZAN and dopamine receptor binding using [11C]raclopride as well as behavioral measures of cigarettes smoked, craving, and nicotine withdrawal. RESULTS Varenicline compared with placebo resulted in significant reductions in [18F]AZAN BPND in multiple brain regions including thalamus, midbrain, putamen, and ventral striatum. Following administration of a controlled-dose nicotine cigarette, dopamine release was significantly suppressed in the ventral striatum in the varenicline-treated compared with the placebo group. There was a significant relationship between α4β2-nAChRs BPND measured in thalamus during the [18F]AZAN scan and nicotine-induced change in raclopride BPND in the ventral striatum. CONCLUSION This is the first human study to demonstrate a direct relationship between the extent of varenicline occupancy of α4β2-nAChRs and the magnitude of dopamine release following nicotine use. IMPLICATIONS It has remained unclear how nicotinic receptor blockade through partial agonist medications such as varenicline promotes smoking cessation. One hypothesized mechanism is downstream dampening of the mesolimbic reward dopamine system. For the first time in human smokers, we observed a direct relationship between the extent of varenicline blockade of α4β2-nACh nicotinic receptors and the magnitude of dopamine release following smoking. This has mechanistic and therapeutic implications for improving smoking cessation interventions.
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Affiliation(s)
- Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gary S Wand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hiroto Kuwabara
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert F Dannals
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dean Wong
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xiaoqiang Xu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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26
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Ponzoni L, Braida D, Carboni L, Moretti M, Viani P, Clementi F, Zoli M, Gotti C, Sala M. Persistent cognitive and affective alterations at late withdrawal stages after long-term intermittent exposure to tobacco smoke or electronic cigarette vapour: Behavioural changes and their neurochemical correlates. Pharmacol Res 2020; 158:104941. [PMID: 32450347 DOI: 10.1016/j.phrs.2020.104941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
Smoking cessation induces a withdrawal syndrome associated with anxiety, depression, and impaired neurocognitive functions, but much less is known about the withdrawal of e-cigarettes (e-CIG). We investigated in Balb/c mice the behavioural and neurochemical effects of withdrawal for up to 90 days after seven weeks' intermittent exposure to e-CIG vapour or cigarette smoke (CIG). The withdrawal of e-CIG and CIG induced early behavioural alterations such as spatial memory deficits (spatial object recognition task), increased anxiety (elevated plus maze test) and compulsive-like behaviour (marble burying test) that persisted for 60-90 days. Notably, attention-related (virtual object recognition task) and depression-like behaviours (tail suspension and sucrose preference tests) appeared only 15-30 days after withdrawal and persisted for as long as up to 90 days. At hippocampal level, the withdrawal-induced changes in the levels of AMPA receptor GluA1 and GluA2/3 subunits, PSD 95 protein, corticotropin-releasing factor (Crf) and Crf receptor 1 (CrfR1) mRNA were biphasic: AMPA receptor subunit and PSD95 protein levels initially remained unchanged and decreased after 60-90 days, whereas Crf/CrfR1 mRNA levels initially increased and then markedly decreased after 60 days. These late reductions correlated with the behavioural impairments, particularly the appearance of depression-like behaviours. Our findings show that major behavioural and neurochemical alterations persist or even first appear late after the withdrawal of chronic CIG smoke or e-CIG vapour exposure, and underline importance of conducting similar studies of humans, including e-CIG vapers.
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Affiliation(s)
- Luisa Ponzoni
- CNR, Institute of Neuroscience, Milan, Italy; Fondazione Zardi-Gori, Milan, Italy; Dept. of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Daniela Braida
- Dept. of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Lucia Carboni
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Milena Moretti
- CNR, Institute of Neuroscience, Milan, Italy; Dept. of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Paola Viani
- Dept. of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Francesco Clementi
- CNR, Institute of Neuroscience, Milan, Italy; Dept. of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Michele Zoli
- Department of Biomedical, Metabolic and Neural Sciences, Center for Neuroscience and Neurotechnology (CfNN), University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Cecilia Gotti
- CNR, Institute of Neuroscience, Milan, Italy; Dept. of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy.
| | - Mariaelvina Sala
- CNR, Institute of Neuroscience, Milan, Italy; Dept. of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
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Patterson F, Grandner MA, Malone SK, Rizzo A, Davey A, Edwards DG. Sleep as a Target for Optimized Response to Smoking Cessation Treatment. Nicotine Tob Res 2020; 21:139-148. [PMID: 29069464 DOI: 10.1093/ntr/ntx236] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 10/19/2017] [Indexed: 12/23/2022]
Abstract
Declining national rates of current tobacco use to an all-time low of 15.1% represents a public health victory. Undermining this progress, however, are smoking rates of up to 50% among high-risk, low-income populations. Current FDA-approved treatments for nicotine dependence are ineffective with between 70-95% of treatment-seekers relapsing within the first year of attempted abstinence. Thus, identification of novel intervention targets to optimize response to currently available treatments for nicotine dependence is a critical next step. One such target may be sleep insomnia. Insomnia is a clinically verified nicotine withdrawal symptom but, to date, addressing insomnia or other sleep disturbance symptoms as an adjunctive smoking cessation therapy has yet to be fully considered. To this end, this manuscript presents a narrative review of: (1) sleep continuity and architecture in smokers versus nonsmokers; (2) effects of nicotine abstinence on sleep; (3) possible mechanisms linking sleep with smoking cessation outcomes; (4) plausible adjunctive sleep therapies to promote smoking cessation; (5) possible treatments for unhealthy sleep in smokers; and (6) directions for future research. Taken together, this will provide conceptual support for sleep therapy as an adjunctive treatment for smoking cessation. Implications This narrative literature review presents a comprehensive discussion of the relationship between habitual sleep and cigarette smoking. The extent to which unhealthy sleep in smokers may be a viable intervention target for promoting response to smoking cessation treatment is considered. Ultimately, this review provides conceptual support for sleep therapy as an adjunctive treatment for smoking cessation.
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Affiliation(s)
- Freda Patterson
- College of Health Sciences, University of Delaware, Newark, DE
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ
| | - Susan K Malone
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Albert Rizzo
- Christiana Care Health System, Pulmonary and Critical Care Medicine, Newark, DE
| | - Adam Davey
- College of Health Sciences, University of Delaware, Newark, DE
| | - David G Edwards
- College of Health Sciences, University of Delaware, Newark, DE
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Laikowski MM, Reisdorfer F, Moura S. NAChR α4β2 Subtype and their Relation with Nicotine Addiction, Cognition, Depression and Hyperactivity Disorder. Curr Med Chem 2019; 26:3792-3811. [PMID: 29637850 DOI: 10.2174/0929867325666180410105135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/27/2017] [Accepted: 04/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neuronal α4β2 nAChRs are receptors involved in the role of neurotransmitters regulation and release, and this ionic channel participates in biological process of memory, learning and attention. This work aims to review the structure and functioning of the α4β2 nAChR emphasizing its role in the treatment of associated diseases like nicotine addiction and underlying pathologies such as cognition, depression and attention-deficit hyperactivity disorder. METHODS The authors realized extensive bibliographic research using the descriptors "Nicotine Receptor α4β2" and "cognition", "depression", "attention-deficit hyperactivity disorder", besides cross-references of the selected articles and after analysis of references in the specific literature. RESULTS As results, it was that found 179 relevant articles presenting the main molecules with affinity to nAChR α4β2 related to the cited diseases. The α4β2 nAChR subtype is a remarkable therapeutic target since this is the most abundant receptor in the central nervous system. CONCLUSION In summary, this review presents perspectives on the pharmacology and therapeutic targeting of α4β2 nAChRs for the treatment of cognition and diseases like nicotine dependence, depression and attention-deficit hyperactivity disorder.
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Affiliation(s)
- Manuela M Laikowski
- Laboratory of Natural and Synthetics Products, University of Caxias do Sul, Caxias do Sul, Brazil
| | - Fávero Reisdorfer
- Laboratory of Drug Development and Quality Control, University Federal of Pampa, Brazil
| | - Sidnei Moura
- Laboratory of Natural and Synthetics Products, University of Caxias do Sul, Caxias do Sul, Brazil
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Brandon TH, Unrod M, Drobes DJ, Sutton SK, Hawk LW, Simmons VN, Brandon KO, Roetzheim RG, Meltzer LR, Miller RR, Cahill SP. Facilitated Extinction Training to Improve Pharmacotherapy for Smoking Cessation: A Pilot Feasibility Trial. Nicotine Tob Res 2019; 20:1189-1197. [PMID: 29059409 DOI: 10.1093/ntr/ntx203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/11/2017] [Indexed: 11/13/2022]
Abstract
Introduction Varenicline reduces smoking satisfaction during the pre-cessation run-in period, which may contribute to extinction of cravings and smoking behavior. Research indicates that efficacy is enhanced when the run-in period is increased from 1 to 4 weeks, providing a longer extinction opportunity. We hypothesized that efficacy could be further enhanced by harnessing basic and applied research on extinction. We developed a pre-cessation extinction-facilitating intervention and tested its feasibility in a pilot trial. Methods The facilitated extinction (FE) intervention comprised brief counseling and workbook-recommending strategies to maximize extinction processes during the run-in, including instructions to smoke at a normal rate across contexts and cues, and use of an extinction cue to enhance generalization. Participants were randomly assigned to one of three varenicline interventions: standard (1-week run-in), extended (4-week run-in), and extended + FE. Interventions were delivered prior to the target quit date (TQD). Assessments were conducted in weeks 1 and 4 pre-TQD and 1 and 3 months post-TQD, with focus on feasibility indices. Results Recruitment and retention goals were met (N = 58). Treatment satisfaction was high across groups. The majority of FE participants adhered to instructions and maintained their usual smoking rate during the run-in period. Greater decreases in craving and smoking satisfaction were observed among participants in both extended groups versus the standard group (p < .005). Conclusions Feasibility was demonstrated. Participants adhered to the FE intervention, thereby optimizing the number and variety of extinction trials. Findings support testing the novel FE smoking cessation intervention in a fully powered trial. Implications This study expands the research on the clinical benefits of extending the pre-cessation run-in period of varenicline. It introduces the hypothesis that further benefit might be achieved by translating basic behavioral research, as well as cue-exposure research and therapy for other disorders, to improve the extinction and generalization processes thought to underlie much of varenicline's effect. A FE intervention was developed and found acceptable to smokers and feasible to implement in a research setting. The study sets the stage for a subsequent randomized controlled trial.
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Affiliation(s)
- Thomas H Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Psychology, University of South Florida, Tampa, FL
| | - Marina Unrod
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Psychology, University of South Florida, Tampa, FL
| | - David J Drobes
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Psychology, University of South Florida, Tampa, FL
| | - Steven K Sutton
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL
| | - Larry W Hawk
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Psychology, University of South Florida, Tampa, FL
| | - Karen O Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Richard G Roetzheim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Psychology, University of South Florida, Tampa, FL
| | - Lauren R Meltzer
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Ralph R Miller
- Department of Psychology, State University of New York at Binghamton, Binghamton, NY
| | - Shawn P Cahill
- Department of Psychology, University of Wisconsin, Milwaukee, WI
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Carroll AJ, Kim K, Miele A, Olonoff M, Leone FT, Schnoll RA, Hitsman B. Longitudinal associations between smoking and affect among cancer patients using varenicline to quit smoking. Addict Behav 2019; 95:206-210. [PMID: 30978583 PMCID: PMC6545135 DOI: 10.1016/j.addbeh.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 11/21/2022]
Abstract
During a quit attempt, high negative affect predicts relapse to smoking. In this study, we evaluated bidirectional longitudinal associations between smoking and negative affect among cancer patients treated with varenicline. Participants (N = 119, 50% female, Mage = 59 years) were smokers (≥5 cigarettes/week) who were diagnosed with cancer and were recruited for a 24-week trial of extended duration varenicline plus behavioral counseling; data for this secondary analyses were drawn from the 12-week open-label phase of the trial. Smoking was assessed via self-reported number of cigarettes in the past 24 h. Negative affect was assessed using the Positive and Negative Affect Scale (PANAS). Data were collected at pre-quit (week 0), target quit day (week 1), week 4, and week 12. We evaluated cross-lagged panel models for negative affect and smoking using PROC CALIS in SAS. Models were run separately for participants who were adherent (≥80% of medication taken) or nonadherent to varenicline. Among adherent participants (n = 96), smoking accounted for up to 22% of variance in subsequent negative affect throughout treatment. Cross-lagged associations were not observed between smoking and negative affect among non-adherent participants (n = 23). Negative affect did not predict subsequent smoking among either adherent or nonadherent participants. These results suggest that varenicline may attenuate abstinence-induced negative affect among cancer patients treated for nicotine dependence.
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Affiliation(s)
- Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Kristine Kim
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Andrew Miele
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Matthew Olonoff
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Frank T Leone
- Department of Medicine, Division of Pulmonary, Allergy, & Critical Care, University of Pennsylvania, PA, United States of America
| | - Robert A Schnoll
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
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Zaccarelli-Magalhães J, Sandini TM, de Abreu GR, Petrocelli BM, Moreira N, Reis-Silva TM, Lebrun I, Flório JC, Ricci EL, Fukushima AR, Faria Waziry PA, de Souza Spinosa H. Prolonged exposure of rats to varenicline increases anxiety and alters serotonergic system, but has no effect on memory. Pharmacol Biochem Behav 2019; 181:1-8. [PMID: 30946884 DOI: 10.1016/j.pbb.2019.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/26/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
Abstract
Varenicline is a drug used for smoking addiction cessation treatment and acts as a partial agonist of nicotinic cholinergic receptors. Recent clinical trial data support use of varenicline for treatment of conditions/addictions that are not related to smoking cessation. Considering the importance of this issue and the need for new studies on its effects, especially on behavior, more studies using animal models are necessary. Thus, the aim of this study was to evaluate the effects of prolonged exposure to varenicline in anxiety-like behavior and memory, as well as in cerebral neurochemistry of rats. Male rats received three different doses of varenicline: 0.03 (therapeutic dose for humans), 0.1 and 0.3 mg/kg orally (gavage) for 30 days. Animal behavior was analyzed through open field, elevated plus maze, light/dark box, social interaction, Barnes maze and novel object recognition tests. Neurotransmitter levels and their metabolites in different brain structures (hippocampus, striatum and frontal cortex) were measured. Results showed that prolonged exposure of rats to varenicline: 1) did not interfere in motor activity, but caused an anxiogenic effect on elevated plus maze, light/dark box and social interaction testes; 2) did not alter memory; and 3) promoted alterations on serotoninergic system in the striatum and frontal cortex. In conclusion, compilation of the data indicates that prolonged exposure of rats to varenicline promoted anxiogenic effects and alteration in serotonergic system, which corroborated behavioral findings.
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Affiliation(s)
- Julia Zaccarelli-Magalhães
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil.
| | - Thaisa Meira Sandini
- Graduate Program of Toxicology and Toxicological Analysis, School of Pharmaceutical Science, University of São Paulo, Av. Prof. Dr. Lineu Prestes, 580, 05508-000 São Paulo, Brazil.
| | - Gabriel Ramos de Abreu
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil; Health Science Institute, Presbiterian Mackenzie University, Rua da Consolação, 930, 01302-907 São Paulo, Brazil
| | - Bianca Maria Petrocelli
- Health Science Institute, Presbiterian Mackenzie University, Rua da Consolação, 930, 01302-907 São Paulo, Brazil
| | - Natalia Moreira
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil.
| | - Thiago Moirinho Reis-Silva
- Department of Neuroscience, Institute of Psychology, University of São Paulo, Av. Prof. Dr. Melo de Morais, 1721, 05508-030 São Paulo, Brazil.
| | - Ivo Lebrun
- Laboratory of Biochemistry and Biophysics, Butantan Institute, 05503-900 São Paulo, Brazil.
| | - Jorge Camilo Flório
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil.
| | - Esther Lopes Ricci
- Health Science Institute, Presbiterian Mackenzie University, Rua da Consolação, 930, 01302-907 São Paulo, Brazil
| | - André Rinaldi Fukushima
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil; São Bento's College, Largo de São Bento s/no, 01029-010 São Paulo, Brazil.
| | - Paula A Faria Waziry
- Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, 3200 S. University Drive, Fort Lauderdale, Florida 33328, United States of America.
| | - Helenice de Souza Spinosa
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil.
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Schnoll R, Leone F, Veluz-Wilkins A, Miele A, Hole A, Jao NC, Paul Wileyto E, Carroll AJ, Kalhan R, Patel J, Langer C, Lubitz SF, Hitsman B. A randomized controlled trial of 24 weeks of varenicline for tobacco use among cancer patients: Efficacy, safety, and adherence. Psychooncology 2019; 28:561-569. [PMID: 30680852 DOI: 10.1002/pon.4978] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/23/2018] [Accepted: 12/31/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Continuing to smoke after a cancer diagnosis undermines prognosis. Yet few trials have tested Food and Drug Administration (FDA)-approved tobacco use medications in this population. Extended use varenicline may represent an effective treatment for cancer patients who smoke given barriers to cessation including a prolonged time line for relapse. METHODS A placebo-controlled randomized trial tested 12 weeks of varenicline plus 12 weeks of placebo (standard [ST]) vs 24 weeks of varenicline (extended [ET]) with seven counseling sessions for treatment-seeking cancer patients who smoke (N = 207). Primary outcomes were 7-day biochemically confirmed abstinence at weeks 24 and 52. Treatment adherence and side effects, adverse and serious adverse events, and blood pressure were assessed. RESULTS Point prevalence and continuous abstinence quit rates at weeks 24 and 52 were not significantly different across treatment arms (P's > 0.05). Adherence (43% of sample) significantly interacted with treatment arm for week 24 point prevalence (odds ratio [OR] = 2.31; 95% confidence interval [CI], 1.15-4.63; P = 0.02) and continuous (OR = 5.82; 95% CI, 2.66-12.71; P < 0.001) abstinence. For both outcomes, adherent participants who received ET reported higher abstinence (60.5% and 44.2%) vs ST (44.7% and 27.7%), but differences in quit rates between arms were not significant for nonadherent participants (ET: 9.7% and 4.8%; ST: 12.7% and 10.9%). There were no significant differences between treatment arms on side effects, adverse and serious adverse events, and rates of high blood pressure (P's > 0.05). CONCLUSIONS Compared with ST, ET varenicline does not increase patient risk and increases smoking cessation rates among patients who adhere to treatment. Studies are needed to identify effective methods to increase medication adherence to treat patient tobacco use effectively.
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Affiliation(s)
- Robert Schnoll
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frank Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anna Veluz-Wilkins
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Andrew Miele
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anita Hole
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nancy C Jao
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - E Paul Wileyto
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allison J Carroll
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Ravi Kalhan
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois.,Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jyoti Patel
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Corey Langer
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Su Fen Lubitz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine, and Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
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Versace F, Stevens EM, Robinson JD, Cui Y, Deweese MM, Engelmann JM, Green CE, Karam-Hage M, Lam CY, Minnix JA, Wetter DW, Cinciripini PM. Brain Responses to Cigarette-Related and Emotional Images in Smokers During Smoking Cessation: No Effect of Varenicline or Bupropion on the Late Positive Potential. Nicotine Tob Res 2019; 21:234-240. [PMID: 29220524 PMCID: PMC6329398 DOI: 10.1093/ntr/ntx264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/29/2017] [Indexed: 11/13/2022]
Abstract
Introduction Varenicline and bupropion are two effective smoking cessation pharmacotherapies. Researchers have hypothesized that they might be effective, in part, because they reduce cue reactivity and cue-induced cravings. Here, we used event-related potentials (ERPs) to directly measure brain responses to cigarette-related and other motivationally relevant images during a pharmacologically aided quit attempt. Methods Smokers involved in a 12-week placebo-controlled double-blind clinical trial of smoking cessation medications (varenicline, bupropion, placebo) took part in the study. We assessed participants at two time points: 24 h (n = 140) and 4 weeks (n = 176) after the quit date. At both sessions, we measured the amplitude of the late positive potential (LPP), an ERP component reliably associated with motivational relevance, and self-reported tonic craving using the brief version of the Questionnaire of Smoking Urges (QSU-Brief). Results At both sessions, emotional and cigarette-related images evoked significantly larger LPPs than neutral images. Neither drug type nor smoking abstinence altered this effect at either session. At both sessions, varenicline and bupropion significantly reduced self-reported tonic craving relative to the placebo condition. Conclusions While both varenicline and bupropion reduced self-reported tonic craving, neither medication altered the amplitude of the LPP to cigarette-related or emotional pictures in smokers attempting to quit. These medications may influence abstinence by means other than by reducing neuroaffective responses to cigarette-related cues. Smokers should be prepared for the likelihood that even after several weeks of successful abstinence, once treatment ends, cigarette-related cues may remain motivationally relevant and trigger cravings that might lead to relapse. Implications Bupropion and varenicline do not alter electrophysiological responses, as measured by the LPP, to cigarette-related and emotional images. These findings help explain why cigarette-related cues can trigger relapse when smoking cessation medication treatments end.
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Affiliation(s)
- Francesco Versace
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elise M Stevens
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jason D Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yong Cui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Menton M Deweese
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey M Engelmann
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Charles E Green
- Department of Pediatrics, The University of Texas-Houston Medical School, Houston, TX
| | - Maher Karam-Hage
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cho Y Lam
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jennifer A Minnix
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David W Wetter
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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Doran N, Dubrava S, Anthenelli RM. Effects of Varenicline, Depressive Symptoms, and Region of Enrollment on Smoking Cessation in Depressed Smokers. Nicotine Tob Res 2019; 21:156-162. [PMID: 29471329 PMCID: PMC6329403 DOI: 10.1093/ntr/nty033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/14/2018] [Indexed: 11/12/2022]
Abstract
Introduction Despite effective treatments, relapse to smoking remains a vexing global health problem. One predictor of relapse is depressive symptoms. Medications such as varenicline reduce withdrawal-related symptoms of depression, reducing relapse. This study examined whether varenicline moderated the effect of depressive symptoms on relapse, and whether this varied by region of enrollment. Methods Adult smokers (n = 525; 37% male) with past or current, stable major depressive disorder recruited from United States (n = 255), and European (n = 270) sites participated in a randomized, double-blind cessation treatment trial including 12 weeks of varenicline or placebo, with 40-week nontreatment follow-up. Results Longitudinal and binary logistic regressions were used to model the probability of sustained abstinence by end of treatment and point-prevalence abstinence in follow-up. The association between depression symptoms and abstinence was moderated by intervention group at end of treatment, and by region during follow-up: more severe symptoms were associated with end-of-treatment relapse for placebo (odds ratio [OR] = 0.91, p = .003), but not varenicline (OR = 0.99, p = .568). During follow-up, increased symptoms of depression predicted greater likelihood of smoking for European (p = .009) but not US participants. Europeans were more likely to be abstinent for both outcomes (p < .01). Conclusions These results extend studies demonstrating varenicline is associated with less withdrawal-related depression, and suggest it aids cessation even in smokers with depressive symptoms. Findings also suggest regional differences in the relationship between depressive symptoms and cessation that may be related to differences in prevalence. Implications This study indicates varenicline may aid cessation partially by reducing withdrawal-related symptoms of depression. It also suggests that the impact of depressive symptoms on cessation varies regionally, and that this variation may be related to differences in smoking prevalence.
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Affiliation(s)
- Neal Doran
- Department of Psychiatry, Health Sciences, University of California, San Diego
- Mental Health Care Line, Veterans Affairs San Diego Healthcare System
| | | | - Robert M Anthenelli
- Department of Psychiatry, Health Sciences, University of California, San Diego
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Butler K, Le Foll B. Impact of Substance Use Disorder Pharmacotherapy on Executive Function: A Narrative Review. Front Psychiatry 2019; 10:98. [PMID: 30881320 PMCID: PMC6405638 DOI: 10.3389/fpsyt.2019.00098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/11/2019] [Indexed: 12/20/2022] Open
Abstract
Substance use disorders are chronic, relapsing, and harmful conditions characterized by executive dysfunction. While there are currently no approved pharmacotherapy options for stimulant and cannabis use disorders, there are several evidence-based options available to help reduce symptoms during detoxification and aid long-term cessation for those with tobacco, alcohol and opioid use disorders. While these medication options have shown clinical efficacy, less is known regarding their potential to enhance executive function. This narrative review aims to provide a brief overview of research that has investigated whether commonly used pharmacotherapies for these substance use disorders (nicotine, bupropion, varenicline, disulfiram, acamprosate, nalmefene, naltrexone, methadone, buprenorphine, and lofexidine) effect three core executive function components (working memory, inhibitory control and cognitive flexibility). While pharmacotherapy-induced enhancement of executive function may improve cessation outcomes in dependent populations, there are limited and inconsistent findings regarding the effects of these medications on executive function. We discuss possible reasons for the mixed findings and suggest some future avenues of work that may enhance the understanding of addiction pharmacotherapy and cognitive training interventions and lead to improved patient outcomes.
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Affiliation(s)
- Kevin Butler
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Alcohol Research and Treatment Clinic, Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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36
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Sutherland MT, Stein EA. Functional Neurocircuits and Neuroimaging Biomarkers of Tobacco Use Disorder. Trends Mol Med 2018; 24:129-143. [PMID: 29398401 DOI: 10.1016/j.molmed.2017.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/07/2017] [Accepted: 12/10/2017] [Indexed: 12/30/2022]
Abstract
Drug abuse and addiction remain major public health issues, exemplified by the opioid epidemic currently devastating the United States. Treatment outcomes across substance use disorders remain unacceptably poor, wherein drug discovery/development for this multifaceted neuropsychiatric disorder focuses on single molecular-level targets. Rather, our opinion is that a systems-level neuroimaging perspective is crucial for identifying novel therapeutic targets, biomarkers to stratify patients, and individualized treatment strategies. Focusing on tobacco use disorder, we advocate a brain systems-level perspective linking two abuse-related facets (i.e., statelike withdrawal and traitlike addiction severity) with specific neurocircuitry (insula- and striatum-centered networks). To the extent that precise neurocircuits mediate distinct facets of abuse, treatment development must adopt not only a systems-level perspective, but also multi-intervention rather than mono-intervention practices.
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Affiliation(s)
| | - Elliot A Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, NIH/DHHS, Baltimore, MD, USA.
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Schuster RM, Pachas GN, Stoeckel L, Cather C, Nadal M, Mischoulon D, Schoenfeld DA, Zhang H, Ulysse C, Dodds EB, Sobolewski S, Hudziak V, Hanly A, Fava M, Evins AE. Phase IIb Trial of an α7 Nicotinic Receptor Partial Agonist With and Without Nicotine Patch for Withdrawal-Associated Cognitive Deficits and Tobacco Abstinence. J Clin Psychopharmacol 2018; 38:307-316. [PMID: 29912798 PMCID: PMC6019566 DOI: 10.1097/jcp.0000000000000919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE/BACKGROUND The objective of this study was to determine whether a novel α7 nicotinic acetylcholine receptor partial agonist improves cognition during nicotine withdrawal and improves abstinence rates. To do so, the effect of the α7 nicotinic acetylcholine receptor partial agonist, encenicline, on cognition and abstinence was evaluated when given as monotherapy and when combined with transdermal nicotine patch (nicotine replacement therapy [NRT]). METHODS Adult daily smokers, n = 160, who were motivated to quit smoking completed cognitive testing at satiated baseline and after overnight abstinence and then were randomized to receive a 12-week trial of encenicline 1 mg twice daily or identical placebo the day of the overnight abstinent cognitive testing. In the first 6 weeks of the 12-week encenicline administration, participants were also randomized to 6 weeks of NRT patch or placebo patch. Primary outcomes were cognition during abstinence and 7-day point-prevalence abstinence at week 12. RESULTS No beneficial effects of encenicline were observed on cognition or abstinence when compared with placebo or when combined with NRT compared with placebo capsule + NRT. Of the 4 conditions, abstinence rates were lowest among those assigned to encenicline alone. CONCLUSIONS Beneficial effects of NRT were observed on cognitive and abstinence outcomes when combined with encenicline compared with encenicline plus placebo patch. Addition of NRT to encenicline improved odds of abstinence approximately 3-fold compared with encenicline plus placebo patch. We conclude that encenicline, 1 mg/d, did not improve abstinence-associated cognitive impairment or abstinence rates as monotherapy or adjunctive therapy to NRT patch.
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Affiliation(s)
| | - Gladys N Pachas
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | - Luke Stoeckel
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney
Diseases
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | - Mireya Nadal
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | - David A. Schoenfeld
- Harvard Medical School
- Department of Biostatistics, Massachusetts General Hospital
| | - Haiyue Zhang
- Department of Biostatistics, Massachusetts General Hospital
| | | | | | | | | | - Ailish Hanly
- Department of Psychiatry, Massachusetts General Hospital
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
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Green R, Ray LA. Effects of varenicline on subjective craving and relative reinforcing value of cigarettes. Drug Alcohol Depend 2018; 188:53-59. [PMID: 29751347 DOI: 10.1016/j.drugalcdep.2018.03.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/15/2018] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Varenicline is an FDA approved medication for the treatment of nicotine dependence. While the efficacy and safety of this medication have been demonstrated, success rates remain low, and efforts to understand mechanisms of efficacy are in progress. A behavioral economics framework is one unique way to examine how demand for a drug changes under different circumstances. Therefore, the current randomized placebo-controlled, cross-over study aimed to examine effects of varenicline on subjective cigarette craving and objective demand for cigarettes measured by a hypothetical behavioral economic task as well as associations between subjective craving and objective demand. METHOD Non-treatment seeking (n = 37) daily smokers (>10 cigarettes per day) completed a measure of subjective craving for cigarettes and the Cigarette Purchase Task following overnight nicotine abstinence. Participants completed these measures after 10 days on varenicline (1 mg twice per day) and matched placebo. RESULTS Analyses revealed a significant reduction in subjective craving for cigarettes while on varenicline (p = 0.01), as compared to placebo, and a sex effect such that females exhibited greater craving than males (p = 0.03). However, there were no medication × sex effects (p = 0.84). Analyses of objective demand for cigarettes found varenicline reduced maximum expenditure (Omax) (p = 0.03). Subjective craving was also associated with various indices of demand. CONCLUSION Results demonstrated varenicline's efficacy in attenuating subjective craving and objective demand for cigarettes and highlight the partial overlap between dimensions of acute drug motivation, namely subjective craving and behavioral economic indices of cigarette demand.
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Affiliation(s)
- ReJoyce Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, United States
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, United States; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095, United States.
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Bagdas D, Alkhlaif Y, Jackson A, Carroll FI, Ditre JW, Damaj MI. New insights on the effects of varenicline on nicotine reward, withdrawal and hyperalgesia in mice. Neuropharmacology 2018; 138:72-79. [PMID: 29860196 DOI: 10.1016/j.neuropharm.2018.05.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/16/2018] [Accepted: 05/19/2018] [Indexed: 12/16/2022]
Abstract
Varenicline, a partial agonist for α4β2* nicotinic acetylcholine receptors (nAChRs) and a full agonist for α3β4 and α7 nAChRs, is approved for smoking cessation treatment. Although, partial agonism at α4β2* nAChRs is believed to be the mechanism underlying the effects of varenicline on nicotine reward, the contribution of other nicotinic subtypes to varenicline's effects on nicotine reward is currently unknown. Therefore, we examined the role of α5 and α7 nAChR subunits in the effects of varenicline on nicotine reward using the conditioned place preference (CPP) test in mice. Moreover, the effects of varenicline on nicotine withdrawal-induced hyperalgesia and aversion are unknown. We also examined the reversal of nicotine withdrawal in mouse models of dependence by varenicline. Varenicline dose-dependently blocked the development and expression of nicotine reward in the CPP test. The blockade of nicotine reward by varenicline (0.1 mg/kg) was preserved in α7 knockout mice but reduced in α5 knockout mice. Administration of varenicline at high dose of 2.5 mg/kg resulted in a place aversion that was dependent on α5 nAChRs but not β2 nAChRs. Furthermore, varenicline (0.1 and 0.5 mg/kg) reversed nicotine withdrawal signs such as hyperalgesia and somatic signs and withdrawal-induced aversion in a dose-related manner. Our results indicate that the α5 nAChR subunit plays a role in the effects of varenicline on nicotine reward in mice. Moreover, the mediation of α5 nAChRs, but not β2 nAChRs are probably needed for aversive properties of varenicline at high dose. Varenicline was also shown to reduce several nicotine withdrawal signs.
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Affiliation(s)
- Deniz Bagdas
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, United States; The Center for the Study for Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States.
| | - Yasmin Alkhlaif
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, United States
| | - Asti Jackson
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, United States
| | - F Ivy Carroll
- Center for Organic and Medicinal Chemistry, Research Triangle Institute, Research Triangle Park, NC, United States
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - M Imad Damaj
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, United States; The Center for the Study for Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
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Perkins KA, Roy Chengappa KN, Karelitz JL, Boldry MC, Michael V, Herb T, Gannon J, Brar J, Ford L, Rassnick S, Brunzell DH. Initial Cross-Over Test of A Positive Allosteric Modulator of Alpha-7 Nicotinic Receptors to Aid Cessation in Smokers With Or Without Schizophrenia. Neuropsychopharmacology 2018; 43:1334-1342. [PMID: 29185480 PMCID: PMC5916362 DOI: 10.1038/npp.2017.292] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/20/2017] [Accepted: 11/20/2017] [Indexed: 12/20/2022]
Abstract
Preclinical research shows that compounds acting at α7 nicotinic receptors (nAChRs) can reduce nicotine self-administration, suggesting that a positive allosteric modulator (PAM) of α7 receptors, JNJ-39393406, may aid smoking cessation. Moreover, individuals with schizophrenia, who have very high rates of smoking, have reduced expression of α7 nAChRs and may particularly benefit from this compound. In two parallel studies using a within-subject cross-over design, 36 healthy smokers (Study 1) and 62 smokers with schizophrenia (Study 2), both groups high in quit interest, attempted to initiate quitting temporarily during each of two 3-week phases. Treatments were the α7 nicotinic receptor PAM JNJ-39393406 (100 mg b.i.d.) or placebo (double-blind, counter-balanced). In each phase, all smoked ad lib with no drug on week 1 or during dose run-up on week 2, and then tried to quit every day during week 3. Abstinence (confirmed by CO <5 p.p.m.) and smoking reduction (CO <8), as well as cigarettes/day (in Study 1), were assessed daily (Monday-Friday) each quit week and compared between conditions. Secondary outcomes included abstinence symptoms (withdrawal and craving) and cognitive test responding (N-back; continuous performance task). In both studies, compared with placebo, active JNJ-39393406 did not increase the number of abstinent days nor reduce total smoking exposure. We also found no significant improvements in craving, withdrawal, or cognitive function. With this dose and study duration, our findings do not support further testing of this α7 nAChR PAM compound for possible efficacy in smoking cessation, in smokers with or without schizophrenia.
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Affiliation(s)
- Kenneth A Perkins
- Department of Psychiatry, WPIC, University of Pittsburgh School of Medicine, Pittsburgh PA, USA,Department of Psychiatry, WPIC, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, USA, Tel: +1 412 246 5395, Fax: +1 412 246 5390, E-mail:
| | - K N Roy Chengappa
- Department of Psychiatry, WPIC, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Joshua L Karelitz
- Department of Psychiatry, WPIC, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Margaret C Boldry
- Department of Psychiatry, WPIC, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Valerie Michael
- Department of Psychiatry, WPIC, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Taylor Herb
- Department of Psychiatry, WPIC, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Jessica Gannon
- Department of Psychiatry, WPIC, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Jaspreet Brar
- Department of Psychiatry, WPIC, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Lisa Ford
- Janssen Research and Development, Janssen Pharmaceuticals, Titusville NJ, USA
| | - Stefanie Rassnick
- Janssen Research and Development, Janssen Pharmaceuticals, Titusville NJ, USA
| | - Darlene H Brunzell
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond VA, USA
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Nahvi S, Arnsten JH. Missed opportunities to test the neuropsychiatric safety--and efficacy--of varenicline among smokers with substance use disorders. Drug Alcohol Depend 2018; 185:245-247. [PMID: 30369710 PMCID: PMC6201286 DOI: 10.1016/j.drugalcdep.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shadi Nahvi
- Departments of Medicine, and of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine / Montefiore Medical Center, 111 East 210th Street, Bronx, NY, USA,
| | - Julia H. Arnsten
- Departments of Medicine, of Psychiatry & Behavioral Sciences, and of Epidemiology & Population Health, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, USA,
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Differential effects of α4β2 nicotinic receptor antagonists and partial-agonists on contextual fear extinction in male C57BL/6 mice. Psychopharmacology (Berl) 2018; 235:1211-1219. [PMID: 29383396 PMCID: PMC5871575 DOI: 10.1007/s00213-018-4837-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/19/2018] [Indexed: 02/06/2023]
Abstract
RATIONALE Numerous studies have attributed the psychopathology of post-traumatic stress disorder (PTSD) to maladaptive behavioral responses such as an inability to extinguish fear. While exposure therapies are mostly effective in treating these disorders by enhancing extinction learning, relapse of PTSD symptoms is common. Although several studies indicated a role for cholinergic transmission and nicotinic acetylcholine receptors (nAChRs) in anxiety and stress disorder symptomatology, very little is known about the specific contribution of nAChRs to fear extinction OBJECTIVES: In the present study, we examined the effects of inhibition and desensitization of α4β2 nAChRs via a full antagonist (Dihydro-beta-erythroidine (DhβE)) and two α4β2 nAChR partial-agonists (varenicline and sazetidine-A) on contextual fear extinction, locomotor activity, and spontaneous recovery of contextual fear in mice. METHODS We trained and tested the subjects in a contextual fear extinction as well as an open field paradigm and spontaneous recovery following injections of DhβE, varenicline, and sazetidine-A. RESULTS Our results demonstrated that lower doses of DhβE (1 mg/kg) and sazetidine-A (0.01 mg/kg) enhanced contextual fear extinction whereas higher doses of varenicline (0.1 mg/kg) and sazetidine-A (0.1 mg/kg) resulted in impaired contextual fear extinction. However, the higher dose of sazetidine-A (0.1 mg/kg) decreased locomotor activity, which may contribute to increased freezing response observed during fear extinction. Finally, we found that the low dose of DhβE, but not sazetidine-A, also decreased spontaneous recovery of contextual fear following fear extinction. CONCLUSIONS Overall, these results suggest that inhibition and desensitization of α4β2 nAChRs enhance extinction of contextual fear memories. This suggests that modulation of α4β2 nAChRs may be employed as an alternative pharmacological strategy to aid exposure therapies associated with PTSD by augmenting contextual fear extinction processes.
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Pujol CN, Paasche C, Laprevote V, Trojak B, Vidailhet P, Bacon E, Lalanne L. Cognitive effects of labeled addictolytic medications. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:306-332. [PMID: 28919445 DOI: 10.1016/j.pnpbp.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Alcohol, tobacco, and illegal drug usage is pervasive throughout the world, and abuse of these substances is a major contributor to the global disease burden. Many pharmacotherapies have been developed over the last 50years to target addictive disorders. While the efficacy of these pharmacotherapies is largely recognized, their cognitive impact is less known. However, all substance abuse disorders are known to promote cognitive disorders like executive dysfunction and memory impairment. These impairments are critical for the maintenance of addictive behaviors and impede cognitive behavioral therapies that are regularly administered in association with pharmacotherapies. It is also unknown if addictolytic medications have an impact on preexisting cognitive disorders, and if this impact is modulated by the indication of prescription, i.e. abstinence, reduction or substitution, or by the specific action of the medication. METHOD We reviewed the cognitive effects of labeled medications for tobacco addiction (varenicline, bupropion, nicotine patch and nicotine gums), alcohol addiction (naltrexone, nalmefene, baclofen, disulfiram, sodium oxybate, acamprosate), and opioid addiction (methadone, buprenorphine) in human studies. Studies were selected following MOOSE guidelines for systematic reviews of observational studies, using the keywords [Cognition] and [Cognitive disorders] and [treatment] for each medication. RESULTS 971 articles were screened and 77 studies met the inclusion criteria and were reported in this review (for alcohol abuse, n=21, for tobacco n=22, for opioid n=34. However, very few comparative clinical trials have explored the chronic effects of addictolytic medications on cognition in addictive behaviors, and there are no clinical trials on the cognitive impact of nalmefene in patients suffering from alcohol use disorders. DISCUSSION Although some medications seem to enhance cognition in patients suffering from cognitive disorders, others could promote cognitive impairments, and our work highlights a lack of literature on this subject. In conclusion, more comparative clinical trials are needed to better understand the cognitive impact of addictolytic medications.
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Affiliation(s)
- Camille Noélie Pujol
- Department of Neurosciences, Institute for Functional Genomics, INSERM U-661, CNRS UMR-5203, 34094 Montpellier, France
| | - Cecilia Paasche
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France
| | - Vincent Laprevote
- Centre Psychothérapique de Nancy, Laxou, F-54520, France.; EA 7298, INGRES, Université de Lorraine, Vandoeuvre-lès-, Nancy F-54000, France; CHU Nancy, Maison des Addictions, Nancy, F-54000, France.
| | - Benoit Trojak
- Department of Psychiatry and Addictology, University Hospital of Dijon, France; EA 4452, LPPM, University of Burgundy, France.
| | - Pierre Vidailhet
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France; Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France..
| | - Elisabeth Bacon
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France.
| | - Laurence Lalanne
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France; Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France..
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Roberts W, McKee SA. Effects of varenicline on cognitive performance in heavy drinkers: Dose-response effects and associations with drinking outcomes. Exp Clin Psychopharmacol 2018; 26:49-57. [PMID: 29389170 PMCID: PMC5797996 DOI: 10.1037/pha0000161] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Varenicline reduces drinking in people with alcohol use disorder, but little is known about the mechanisms underlying this effect. Varenicline targets α4β2 and α7 nicotinic acetylcholine receptors, which are associated with several cognitive functions such as working memory. Varenicline may improve drinking outcomes by enhancing cognitive functioning. The current manuscript reports on cognitive outcomes from a placebo-controlled, double-blind human laboratory experiment examining the effects of varenicline on drinking behavior (Verplaetse et al., 2016a). Participants were 55 adult heavy drinkers who met criteria for an alcohol use disorder. They were randomized to receive varenicline (1 mg/day, 2 mg/day) or placebo. They completed a baseline assessment of cognitive functioning (i.e., digits backward task, continuous performance task) before starting medication. After a medication titration period, they attended a laboratory session (post medication Day 8) where they completed the cognitive assessment battery and an alcohol-primed ad libitum drinking task. Blood was collected to measure plasma varenicline levels. Varenicline produced dose-dependent improvements in working memory. Although there was no significant effect of oral varenicline dose on response time on the continuous performance task, participants with higher levels of plasma varenicline showed greater improvement of reaction time (RT). Among participants receiving 2 mg/day varenicline, larger improvements in working memory were associated less drinking, although mediation analyses did not find a significant indirect effect. These findings suggest that varenicline can improve working memory above baseline levels in heavy drinkers. Varenicline may reduce rates of alcohol use by improving working memory. (PsycINFO Database Record
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Affiliation(s)
- Walter Roberts
- Yale School of Medicine, Department of Psychiatry, New Haven CT
- Corresponding author: Telephone: (203) 737-3529, Fax: (203) 737-4243, address: 2 Church St. South, Suite 109, Yale University School of Medicine, New Haven, CT 06519, , ORCID ID: 0000-0001-6817-884X
| | - Sherry A. McKee
- Yale School of Medicine, Department of Psychiatry, New Haven CT
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O’Malley SS, Zweben A, Fucito LM, Wu R, Piepmeier ME, Ockert DM, Bold KW, Petrakis I, Muvvala S, Jatlow P, Gueorguieva R. Effect of Varenicline Combined With Medical Management on Alcohol Use Disorder With Comorbid Cigarette Smoking: A Randomized Clinical Trial. JAMA Psychiatry 2018; 75:129-138. [PMID: 29261824 PMCID: PMC5838706 DOI: 10.1001/jamapsychiatry.2017.3544] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Individuals with alcohol use disorder have high rates of cigarette smoking. Varenicline tartrate, an approved treatment for smoking cessation, may reduce both drinking and smoking. OBJECTIVES To test the efficacy of varenicline with medical management for patients with alcohol use disorder and comorbid smoking seeking alcohol treatment, and to evaluate the secondary effects on smoking abstinence. DESIGN, SETTING, AND PARTICIPANTS This phase 2, randomized, double-blind, parallel group, placebo-controlled trial was conducted at 2 outpatient clinics from September 19, 2012, to August 31, 2015. Eligible participants met alcohol-dependence criteria and reported heavy drinking (≥5 drinks for men and ≥4 drinks for women) 2 or more times per week and smoking 2 or more times per week; 131 participants were randomized to either varenicline or placebo stratified by sex and site. All analyses were of the intention-to-treat type. Data analysis was conducted from February 5, 2016, to September 29, 2017. INTERVENTIONS Varenicline tartrate, 1 mg twice daily, and matching placebo pills for 16 weeks. Medical management emphasized medication adherence for 4 weeks followed by support for changing drinking. MAIN OUTCOMES AND MEASURES Percentage of heavy drinking days (PHDD) weeks 9 to 16, no heavy drinking days (NHDD) weeks 9 to 16, and prolonged smoking abstinence weeks 13 to 16. RESULTS Of 131 participants, 39 (29.8%) were women and 92 (70.2%) were men, the mean (SD) age was 42.7 (11.7) years, and the race/ethnicity self-identified by most respondents was black (69 [52.7%]). Sixty-four participants were randomized to receive varenicline, and 67 to receive placebo. Mean change in PHDD between varenicline and placebo across sex and site was not significantly different. However, a significant treatment by sex by time interaction for PHDD (F1,106 = 4.66; P = .03) revealed that varenicline compared with placebo resulted in a larger decrease in log-transformed PHDD in men (least square [LS] mean difference in change from baseline, 0.54; 95% CI, -0.09 to 1.18; P = .09; Cohen d = 0.45) but a smaller decrease in women (LS mean difference, -0.69; 95% CI, -1.63 to 0.25; P = .15; Cohen d = -0.53). Thirteen of 45 men (29%) had NHDD taking varenicline compared with 3 of 47 men (6%) taking placebo (Cohen h = 0.64; 95% CI, 0.22-1.03), whereas 1 of 19 women (5%) had NHDD compared with 5 of 20 women (25%) taking placebo (Cohen h = -0.60; 95% CI, -1.21 to 0.04). Taking varenicline, 8 of 64 participants (13%) achieved prolonged smoking abstinence; no one (0 of 67) quit smoking taking placebo (P = .003; Cohen h = 0.72; 95% CI, 0.38-1.07). CONCLUSIONS AND RELEVANCE Varenicline with medical management resulted in decreased heavy drinking among men and increased smoking abstinence in the overall sample. Varenicline could be considered to promote improvements in men with these dual behavioral health risks. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01553136.
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Affiliation(s)
| | - Allen Zweben
- School of Social Work, Columbia University, New York, New York
| | - Lisa M. Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Ran Wu
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | | | - Krysten W. Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Ismene Petrakis
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Srinivas Muvvala
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Peter Jatlow
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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Shoaib M, Buhidma Y. Why are Antidepressant Drugs Effective Smoking Cessation Aids? Curr Neuropharmacol 2018; 16:426-437. [PMID: 28925882 PMCID: PMC6018185 DOI: 10.2174/1570159x15666170915142122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 07/20/2017] [Accepted: 09/09/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Before the advent of varenicline, antidepressant drugs were reported to exhibit better clinical efficacy than nicotine replacement therapy as smoking cessation aids. The most studied is bupropion, a clinically-effective antidepressant, the first to be marketed throughout Europe for smoking cessation. Since depression and tobacco smoking have a high incidence of cooccurrence, this would implicate an underlying link between these two conditions. If this correlation can be confirmed, then by treating one condition the related state would also be treated. OBJECTIVES This review article will evaluate the various theories relating to the use of antidepressant drugs as smoking cessation aids and the underlying mechanisms link tobacco smoking and depression to explain the action of antidepressants in smoking cessation. One plausible theory of self-medication which proposes that people take nicotine to treat their own depressive symptoms and the affective withdrawal symptoms seen with abstinence from the drug. If the depression can instead be treated with antidepressants, then they may stop smoking altogether. Another theory is that the neurobiological pathways underlying smoking and depression may be similar. By targeting the pathways of depression in the brain, antidepressants would also treat the pathways affected by smoking and ease nicotine cravings and withdrawal. The role of genetic variation predisposing an individual to depression and initiation of tobacco smoking has also been discussed as a potential link between the two conditions. Such variation could either occur within the neurobiological pathways involved in both disorders or it could lead to an individual being depressed and selfmedicating with nicotine.
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Affiliation(s)
- Mohammed Shoaib
- Institute of Neuroscience, Medical School, Newcastle University, Newcastle, UK
| | - Yazead Buhidma
- Institute of Neuroscience, Medical School, Newcastle University, Newcastle, UK
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Valentine G, Sofuoglu M. Cognitive Effects of Nicotine: Recent Progress. Curr Neuropharmacol 2018; 16:403-414. [PMID: 29110618 PMCID: PMC6018192 DOI: 10.2174/1570159x15666171103152136] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/11/2017] [Accepted: 07/30/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cigarette smoking is the main cause of preventable death in developed countries. While the direct positive behavioral reinforcing effect of nicotine has historically been considered the primary mechanism driving the development of TUD, accumulating contemporary research suggests that the cognitive-enhancing effects of nicotine may also significantly contribute to the initiation and maintenance of TUD, especially in individuals with pre-existing cognitive deficits. METHODS We provide a selective overview of recent advances in understanding nicotine's effects on cognitive function, a discussion of the role of cognitive function in vulnerability to TUD, followed by an overview of the neurobiological mechanisms underlying the cognitive effects of nicotine. RESULTS Preclinical models and human studies have demonstrated that nicotine has cognitiveenhancing effects. Attention, working memory, fine motor skills and episodic memory functions are particularly sensitive to nicotine's effects. Recent studies have demonstrated that the α4, β2, and α7 subunits of the nicotinic acetylcholine receptor (nAChR) participate in the cognitive-enhancing effects of nicotine. Imaging studies have been instrumental in identifying brain regions where nicotine is active, and research on the dynamics of large-scale networks after activation by, or withdrawal from, nicotine hold promise for improved understanding of the complex actions of nicotine on human cognition. CONCLUSION Because poor cognitive performance at baseline predicts relapse among smokers who are attempting to quit smoking, studies examining the potential efficacy of cognitive-enhancement as strategy for the treatment of TUD may lead to the development of more efficacious interventions.
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Affiliation(s)
| | - Mehmet Sofuoglu
- Address correspondence to this author at the Yale University School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; Tel: 1 203 737 4882; Fax: 1 203 737 3591; E-mail:
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Miglin R, Kable JW, Bowers ME, Ashare RL. Withdrawal-Related Changes in Delay Discounting Predict Short-Term Smoking Abstinence. Nicotine Tob Res 2017; 19:694-702. [PMID: 28486708 DOI: 10.1093/ntr/ntw246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/29/2016] [Indexed: 11/14/2022]
Abstract
Introduction Impulsive decision making is associated with smoking behavior and reflects preferences for smaller, immediate rewards and intolerance of temporal delays. Nicotine withdrawal may alter impulsive decision making and time perception. However, little is known about whether withdrawal-related changes in decision making and time perception predict smoking relapse. Methods Forty-five smokers (14 female) completed two laboratory sessions, one following 24-hour abstinence and one smoking-as-usual (order counterbalanced; biochemically verified abstinence). During each visit, participants completed measures of time perception, decision making (ie, discount rates), craving, and withdrawal. Following the second laboratory session, subjects underwent a well-validated model of short-term abstinence (quit week) with small monetary incentives for each day of biochemically confirmed abstinence. Results Smokers significantly overestimated time during abstinence, compared to smoking-as-usual (p = .021), but there were no abstinence effects on discount rates (p = .6). During the quit week, subjects were abstinent for 3.5 days (SD = 2.15) and smoked a total of 12.9 cigarettes (SD = 15.8). Importantly, higher discount rates (ie, preferences for immediate rewards) during abstinence (abstinence minus smoking difference score) predicted greater number of days abstinent (p = .01) and fewer cigarettes smoked during the quit week (p = .02). Withdrawal-related change in time reproduction did not predict relapse (p = .2). Conclusions These data suggest that individuals who have a greater preference for immediate rewards during abstinence (vs. smoking-as-usual) may be more successful at maintaining short-term abstinence when provided with frequent (eg, daily) versus less frequent incentive schedules (eg, 1 month). Abstinence-induced changes in decision making may be important for identifying smokers who may benefit from interventions that incentivize abstinence such as contingency management (CM). Implications The present results suggest that smokers who place greater subjective value on immediate rewards during withdrawal (compared to smoking-as-usual) may be less likely to relapse if offered small, frequent monetary incentives to maintain abstinence. Thus, the current findings may have important implications for identifying smokers most likely to benefit from particular interventions such as CM. Future research might evaluate whether withdrawal-related changes in delay discounting moderate treatment response to different incentive schedules with the goal of optimizing CM effectiveness to improve abstinence rates.
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Affiliation(s)
- Rickie Miglin
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joseph W Kable
- Department of Psychology, University of Pennsylvania, Philadelphia, PA
| | - Maureen E Bowers
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD
| | - Rebecca L Ashare
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Peng AR, Morales M, Wileyto EP, Hawk LW, Cinciripini P, George TP, Benowitz NL, Nollen NL, Lerman C, Tyndale RF, Schnoll R. Measures and predictors of varenicline adherence in the treatment of nicotine dependence. Addict Behav 2017; 75:122-129. [PMID: 28728040 DOI: 10.1016/j.addbeh.2017.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/28/2017] [Accepted: 07/08/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION While adherence to medication in smoking cessation clinical trials is strongly associated with clinical outcome, very few studies have evaluated the validity of pill count as a measure of adherence relative to a biological assay, and evaluated a broad range of correlates of adherence. METHODS In a smoking cessation clinical trial of varenicline, we compared pill counts collected over 4 different time periods to varenicline salivary levels taken after 2weeks of treatment, as well as evaluated predictors of adherence to varenicline. RESULTS Using a binary measure of adherence based on salivary varenicline levels, adherence was higher among older, white, and more educated participants. Relative to 3, 7, and 14-day pill count, 12-week pill count was the only significant measure able to discriminate adherence as defined by salivary varenicline levels (assessed by area under the receiver operating characteristic curve; AUC=0.59, p=0.004). Seventy-two percent of participants who indicated adherence on 12-week pill count were classified as adherent based on varenicline saliva levels (sensitivity=0.80; specificity=0.40). There was modest variability in the relationship between 12-week pill count and varenicline levels across race and rate of nicotine metabolism. Lastly, General Estimating Equation models demonstrated that longitudinal changes in withdrawal, craving, negative and positive affect, and side effect count and severity were not related to adherence based on salivary varenicline levels. CONCLUSIONS These results indicate that 12-week pill count was the best, albeit a relatively weak, measure of varenicline adherence; additional factors associated with treatment adherence need to be identified.
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Affiliation(s)
- Annie R Peng
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
| | - Mark Morales
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
| | - E Paul Wileyto
- Department of Biostatistics & Epidemiology, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA 19104, United States.
| | - Larry W Hawk
- Department of Psychology, State University of New York at Buffalo, 230 Park Hall, Buffalo, NY 14260-4110, United States.
| | - Paul Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States.
| | - Tony P George
- Addictions Division, Centre for Addiction and Mental Health and Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada.
| | - Neal L Benowitz
- Department of Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, United States; Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, United States.
| | - Nicole L Nollen
- Department of Preventive Medicine & Public Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66160, United States.
| | - Caryn Lerman
- Department of Psychiatry, Annenberg School for Communication, Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Rachel F Tyndale
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Cir, Toronto, ON M5S 1A8, Canada; Addictions Division, Centre for Addiction and Mental Health and Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada.
| | - Robert Schnoll
- Department of Psychiatry, Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, United States.
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Theng YM, Wahab S, Wahab NAA, Sidi H, Das S. Schizophrenia and Nicotine Dependence: What Psychopharmacological Treatment Options are Available for the Duo Perturbationes? Curr Drug Targets 2017; 20:173-181. [PMID: 29046149 DOI: 10.2174/1389450118666171017163741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 09/27/2017] [Accepted: 10/12/2017] [Indexed: 11/22/2022]
Abstract
Nicotine dependence has progressively become a foremost community health interest in both the developed and developing nations due to the economic burden and health-related problems. Smoking was significantly higher among patients with schizophrenia in comparison to the general population. Nicotine dependence is not only associated with public stress, but among patients with schizophrenia, smoking brings major challenges to the management. Nicotine may diminish the therapeutic efficacy of the bioavailability of the psychopharmacological agents in-vivo. These duo perturbations, i.e. two clinical conditions co-existed may prevent psychotic symptoms remission among patients suffering from schizophrenia who smoke at the same time. The aim of this review was to highlight the role of pharmacological treatment options and strategies for patients with nicotine dependence in schizophrenia with emphasis on the underlying neurobiological process. The role of nicotine replacement therapy, i.e. norepinephrine-dopamine reuptake inhibition (NDRI) e.g. bupropion and selective partial agonist of α4β2 and full α7-nicotinic acetylcholine receptor e.g. varenicline was deliberated. An ideal choice of drug targets for patients with schizophrenia with nicotine dependence is pivotal to foster a better therapeutic alliance.
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Affiliation(s)
- Yoong Mei Theng
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Suzaily Wahab
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Noor Alaudin A Wahab
- Audiology Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Wilayah Persekutuan, Malaysia
| | - Hatta Sidi
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Srijit Das
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
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