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Giner P, Ortegon S, Bagdas D, O'Dell LE. The influence of ovarian hormones on the putative mechanisms that promote female nicotine use. Curr Opin Neurobiol 2024; 88:102900. [PMID: 39153250 DOI: 10.1016/j.conb.2024.102900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/16/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024]
Abstract
Nicotine use is driven by pleasurable effects, but following chronic exposure, nicotine use becomes largely driven by the desire need to avoid withdrawal symptoms. Current cessation strategies focusing on alleviating withdrawal, but current cessation interventions are less effective for women than men. Also, hormone fluctuations across the menstrual cycle appear to impact use patterns, withdrawal severity, and treatment efficacy. This raises important questions regarding optimal quit dates and the application of hormone interventions to alleviate withdrawal in women. This review surveys the existing literature assessing the impact of ovarian hormones on nicotine withdrawal severity. This is an important issue because women seeking cessation treatments may be using hormone-based contraceptives or hormone replacement post-menopause. Hormone interventions may also offer a novel treatment avenue that is more effective than current cessation approaches. Future work in this area is important for reducing health disparities produced by excessive nicotine use in women.
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Affiliation(s)
- Priscilla Giner
- Department of Psychology, The University of Texas at El Paso, El Paso, TX, 79902, USA
| | - Sebastian Ortegon
- Department of Psychology, The University of Texas at El Paso, El Paso, TX, 79902, USA
| | - Deniz Bagdas
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06511, USA; Yale Tobacco Center of Regulatory Science, Yale School of Medicine, New Haven, CT, 06511, USA.
| | - Laura E O'Dell
- Department of Psychology, The University of Texas at El Paso, El Paso, TX, 79902, USA.
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2
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García-Cabrerizo R, Cryan JF. A gut (microbiome) feeling about addiction: Interactions with stress and social systems. Neurobiol Stress 2024; 30:100629. [PMID: 38584880 PMCID: PMC10995916 DOI: 10.1016/j.ynstr.2024.100629] [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: 11/23/2023] [Revised: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
In recent years, an increasing attention has given to the intricate and diverse connection of microorganisms residing in our gut and their impact on brain health and central nervous system disease. There has been a shift in mindset to understand that drug addiction is not merely a condition that affects the brain, it is now being recognized as a disorder that also involves external factors such as the intestinal microbiota, which could influence vulnerability and the development of addictive behaviors. Furthermore, stress and social interactions, which are closely linked to the intestinal microbiota, are powerful modulators of addiction. This review delves into the mechanisms through which the microbiota-stress-immune axis may shape drug addiction and social behaviors. This work integrates preclinical and clinical evidence that demonstrate the bidirectional communication between stress, social behaviors, substance use disorders and the gut microbiota, suggesting that gut microbes might modulate social stress having a significance in drug addiction.
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Affiliation(s)
- Rubén García-Cabrerizo
- IUNICS, University of the Balearic Islands, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Spain
| | - John F. Cryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
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3
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Schick MR, Baker NL, Hood CO, Tomko RL, Gray KM, Ramakrishnan VR, Saladin ME, McClure EA. Effects of Ovarian Hormone Levels on Stress, Cigarette Craving, and Smoking in a Laboratory Relapse Paradigm Among Females Who Smoke Daily. Nicotine Tob Res 2024; 26:392-396. [PMID: 37493638 PMCID: PMC10882430 DOI: 10.1093/ntr/ntad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/04/2023] [Accepted: 07/24/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Females, versus males, have shown a slower decline in smoking prevalence, greater smoking-related mortality and morbidity, and tend to have more difficulty achieving and maintaining abstinence. Identifying sex-specific risk factors is needed to improve outcomes. Though ovarian hormones have been evaluated for their role in smoking and relapse, measures tend to be static and infrequent, failing to capture the influence of increasing or decreasing levels. AIMS AND METHODS The present study evaluated the effect of static and fluctuating levels of ovarian hormones (ie, progesterone, estradiol, and estrogen to progesterone [E/P] ratio) on stress reactivity, cigarette craving, and smoking during a laboratory relapse paradigm. Female participants (assigned female at birth) reporting daily cigarette smoking (N = 91, ages 18-45) were recruited from the community. Participants provided daily salivary ovarian hormone levels leading up to a laboratory session, in which stress was induced and stress reactivity, cigarette craving, latency to smoke, and ad-libitum smoking were measured. RESULTS Static levels of estradiol were associated with stress reactivity (β = 0.28, SE = 0.13) and static E/P ratio was associated with smoking in the laboratory (HR = 1.4). Preceding 3-day changes in estradiol and E/P ratio, but neither static levels nor preceding 3-day changes in progesterone were associated with stress reactivity, cigarette craving, or smoking in a relapse paradigm. CONCLUSIONS Ovarian hormones are among several sex-specific factors involved in the complex neuroendocrine response to stress, and their interaction with other biological, social, and psychological factors in the real-world environment is not yet fully understood. IMPLICATIONS Findings of the present study provide novel information regarding the role of ovarian hormones among female participants who smoke daily in stress reactivity and smoking in the context of a laboratory relapse paradigm and highlight several avenues for future research. We found that same-day estradiol levels were associated with increased subjective stress reactivity and same-day estrogen to progesterone ratio was associated with increased likelihood of smoking in a relapse paradigm. Ovarian hormones are among several sex-specific factors contributing to the complex neuroendocrine response to stress, and their interaction with other biological, social, and psychological factors in the real-world environment is not yet fully understood.
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Affiliation(s)
- Melissa R Schick
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Caitlyn O Hood
- Department of Psychiatry, University of Kentucky, Lexington, KY, USA
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Viswanathan R Ramakrishnan
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Michael E Saladin
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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4
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Farris SG, Smith JE, Steinberg DR, Altman BR, Lambert-Messerlian GM, Dunsiger SI, Williams DM, Saladin ME, Abrantes AM. Methodological approach for an integrated female-specific study of anxiety and smoking comorbidity. Front Psychiatry 2023; 14:1267753. [PMID: 38076702 PMCID: PMC10704195 DOI: 10.3389/fpsyt.2023.1267753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/08/2023] [Indexed: 02/12/2024] Open
Abstract
Two primary ovarian hormones that fluctuate across the female menstrual cycle-estradiol and progesterone-have been independently linked in separate literatures to nicotine reinforcement and anxiety psychopathology. We identify existing methodological limitations in these literatures, describe an example protocol that was developed to address such limitations, highlight case examples, and offer insights on the resulting advantages and challenges. This protocol was an observational, prospective, within-subjects study of female cigarette smokers who were followed over the course of a complete menstrual cycle. Non-treatment seeking, female cigarette smokers (N = 50), between the ages of 18-40 who have a normal menstrual cycle (25-35 days in length) were recruited from the community. Females with anxiety or mood psychopathology represented 38.0% of the sample. Salivary progesterone and estradiol were assessed each morning via at-home saliva collection methods. Self-reported within-day momentary ratings of anxiety and nicotine reinforcement were collected using ecological momentary assessment (EMA) via a mobile app. Protocol compliance was >85%. Within- and between-subjects heterogeneity was observed in the progesterone and estradiol, anxiety, and nicotine craving measures, especially in the context of anxiety psychopathology. We aimed to integrate the anxiety and nicotine dependence literatures and advance the empirical study of the role of ovarian hormones. This protocol reflects an intensive, yet feasible approach to collecting daily-level naturalistic data related to estradiol, progesterone, anxiety, and nicotine reinforcement.
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Affiliation(s)
- Samantha G. Farris
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Jacqueline E. Smith
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Dana R. Steinberg
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Brianna R. Altman
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Geralyn M. Lambert-Messerlian
- Pathology and Laboratory Medicine and Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, United States
| | - Shira I. Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - David M. Williams
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Michael E. Saladin
- Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, United States
| | - Ana M. Abrantes
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, United States
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Peltier MR, McKee SA. The role of sex hormones in targeting stress-induced tobacco craving, stress-reactivity, and smoking with guanfacine among women who smoke. ADDICTION NEUROSCIENCE 2023; 7:100084. [PMID: 37396408 PMCID: PMC10311966 DOI: 10.1016/j.addicn.2023.100084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Women who smoke are particularly vulnerable to tobacco craving, smoking behaviors, and relapse in the context of stress when compared to men who smoke. One factor in this sex difference may be sex hormones, including estradiol and progesterone; however, smoking cessation medication trials often do not explore the impact of sex hormones on drug effects. This secondary analysis of a double-blind, placebo-controlled study explored the impact of levels of actual estradiol and progesterone on guanfacine, a noradrenergic α2a agonist, which attenuates stress-induced smoking behaviors in women. Women who smoke (n = 43) completed a stress induction laboratory paradigm followed by an ad-libitum smoking period. Assessment of tobacco craving, and stress-reactivity (via cortisol response) occurred pre- and post-stress induction. Results indicated that guanfacine attenuated stress-induced tobacco craving (F = 10.94, p = 0.02) and cortisol response (F = 14.23, p < 0.001); however, high levels of estradiol overrode guanfacine's effect on craving (F = 4.00, p = 0.05), cortisol response (F = 14.23, p < 0.001), and smoking during the ad-libitum period (F = 12.23, p = 0.001). Additionally, progesterone proved to be protective against tobacco craving and enhanced guanfacine's medication effect on craving (F = 5.57, p = 0.02). The present study found that sex hormones had a significant impact on medication effects in a smoking cessation trial and thus underscore the importance of examining the role of sex hormones in future medication trials.
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Affiliation(s)
- MacKenzie R. Peltier
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 109, Yale School of Medicine, New Haven, CT 06519, USA
- Psychology Service, VA Connecticut Healthcare System West Haven, CT 06516, USA
| | - Sherry A. McKee
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 109, Yale School of Medicine, New Haven, CT 06519, USA
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Galindo-Caballero ÓJ, Alzate-Pamplona FA, Gangestad SW, Cruz JE. A review and p-curve analysis of research on the menstrual cycle correlates of consumer preferences and economic decisions. Horm Behav 2023; 150:105317. [PMID: 36731300 DOI: 10.1016/j.yhbeh.2023.105317] [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: 10/09/2021] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Abstract
A number of studies have been claimed to show that ovarian hormones, whose levels fluctuate throughout the menstrual cycle, affect consumer preferences and financial decisions. The present article aims to critically analyze the literature examining associations between the phases of the menstrual cycle (peri-ovulatory vs. non-ovulatory) with particular consumer preferences (especially regarding clothing choices) and economic decisions (especially in regards to economic games and risk-taking). A search for studies was conducted in Web of Science and Scopus between 2004 and 2022, by combining keywords of the menstrual cycle, consumer preferences, and economic decisions. Once articles were selected, we identified the main findings, the characteristics of the population, and the methods for determining the phases of the cycle. We performed a p-curve analysis on previously reported statistically significant effects. These analyses find evidence for associations between peri-ovulatory status and specific consumer preferences, most strongly for appearance-enhancing products. They yield no compelling evidence for associations between peri-ovulatory status and financial decisions and risk-taking. We offer provisional conclusions and call for additional studies that possess sufficient statistical power to detect true meaningful effects, especially in the domain of financial decisions.
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Affiliation(s)
| | | | | | - Julio Eduardo Cruz
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de los Andes, Bogotá, Colombia
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Medvescek K, Allen AM. Feasibility of Remotely Assessing Hormonal Contraceptive Use and Smoking-Related Symptomatology: Evidence from a Preliminary Prospective Cohort Study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100145. [PMID: 37009029 PMCID: PMC10060171 DOI: 10.1016/j.dadr.2023.100145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
Background Half of women who smoke cigarettes also use hormonal contraceptives (HCs). Prior research suggests that variations in ovarian hormones may undermine smoking cessation efforts made by premenopausal women. However, clinical findings of these hormonal effects are inconsistent, potentially due to methodological limitations. The goal of this preliminary prospective cohort study is to determine the feasibility and acceptability of a fully remote protocol to longitudinally examine changes in smoking-related behavior and symptoms in relation to hormone use in women of reproductive age. Methods Eligible participants (n = 60) were biologically female, current age 18-35 years old, smokes ≥ 5 cigarettes/day, and classified into three groups: naturally-cycling (NC; n = 17), using a monophasic oral contraceptive (OC; n = 21), or using depot medroxyprogesterone acetate (DMPA; n = 22). Participants completed daily surveys and weekly dried blood spot collections. Results Overall, 92% (55/60) participants completed the study with 90% of daily surveys completed and 87% of participants collecting at least 5 of the 6 dried blood spot samples. Participants were "somewhat" (13%) or "extremely" (87%) likely to participate in the study again. Preliminary observations also suggested differences in self-reported cigarettes/day and premenstrual pain over time by study group. Conclusions This study outlines a fully remote protocol that may be used to clarify the relationships between hormonal contraceptive use and smoking-related outcomes over time. Preliminary results add to existing evidence that HC use may reduce relapse risk for premenopausal women.
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8
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Franklin TR, Spilka NH, Keyser H, Maron M, Jagannathan K, Wetherill RR. Impact of the natural hormonal milieu on ventral striatal responses to appetitive cigarette smoking cues: A prospective longitudinal study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100119. [PMID: 36844172 PMCID: PMC9948852 DOI: 10.1016/j.dadr.2022.100119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/25/2022] [Accepted: 11/12/2022] [Indexed: 11/15/2022]
Abstract
Background The female sex hormones estradiol (E) and progesterone (P) galvanize the ventral striatal reward pathway. E elevates ventral striatal dopamine and accelerates drug-cued reinstatement, while P has opposing 'protective' effects on drug-related behavior. We hypothesize that women may exhibit greater ventral striatal responses to smoking cues (SCs) during the late follicular phase of the menstrual cycle (MC) when E is high and unimpeded by P, and reduced responses during the late luteal phase when P is high. Methods To test our hypothesis, 24 naturally cycling cigarette-dependent women completed functional magnetic resonance (fMRI) sessions over the course of 3 MCs at select time points to reflect the early follicular (low E and P; LEP, control condition), late follicular (high E, low P; HE) and mid-luteal (high E, high P; HEP) MC phases. During fMRI sessions (counterbalanced by phase), women were exposed to a SC versus nonSC audio-visual clip. Ovulation was verified for each MC, and hormone levels were acquired prior to sessions. Results Contrasts within conditions showed that ventral striatal brain responses to SCs versus nonSCs were negligible during LEP and greater during HE (p=0.009) and HP (p=0.016). Contrasts across conditions showed that HE and HEP had greater responses than LEP (p=0.005), and HE had greater responses than HEP (p=0.049). Conclusions Results support and extend our retrospective cross-sectional study of the influence of the hormonal milieu on SC reactivity. Results are clinically relevant as they may guide novel, hormonally-informed and immediately translatable treatment strategies that can potentially reduce relapse in naturally cycling women.
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Affiliation(s)
- Teresa R. Franklin
- The Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA 19104, United States
| | - Nathaniel H. Spilka
- The Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA 19104, United States
| | - Heather Keyser
- The Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA 19104, United States
| | - Melanie Maron
- The Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA 19104, United States
| | - Kanchana Jagannathan
- The Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA 19104, United States
| | - Reagan R. Wetherill
- The Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA 19104, United States
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Longpré-Poirier C, Dougoud J, Jacmin-Park S, Moussaoui F, Vilme J, Desjardins G, Cartier L, Cipriani E, Kerr P, Le Page C, Juster RP. Sex and Gender and Allostatic Mechanisms of Cardiovascular Risk and Disease. Can J Cardiol 2022; 38:1812-1827. [PMID: 36150584 DOI: 10.1016/j.cjca.2022.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular diseases are leading causes of mortality and morbidity in adults worldwide. Multiple studies suggest that there are clinically relevant sex differences in cardiovascular disease. Women and men differ substantially in terms of prevalence, presentation, management, and outcomes of cardiovascular disease. To date, however, little is known about why cardiovascular disease affects women and men differently. Because many studies do not differentiate the concept of sex and gender, it is sometimes difficult to discriminate sociocultural vs biological contributors that drive observed clinical differences. Female sex has some biological advantages in relation to cardiovascular disease, but many of these advantages seem to disappear as soon as women develop cardiovascular risk factors (eg, type 2 diabetes, hypertension, dyslipidemia). Furthermore, stress and allostatic load could play an important role in the relationship between sex/gender and cardiovascular diseases. In this narrative review, we argue that chronic stress and psychosocial factors might better encompass the patterns of allostatic load increases seen in women, while biological risk factors and unhealthy behaviours might be more important mechanisms that drive increased allostatic load in men. Indeed, men show allostatic load patterns that are more associated with impaired anthropometric, metabolic, and cardiovascular functioning and women have greater dysregulation in neuroendocrine and immune functioning. Thus gender-related factors might contribute to the pathogenesis of cardiovascular disease especially through stress mechanisms. It is important to continue to study the mechanisms by which gender influences chronic stress, because chronic stress could influence modifiable gendered factors to promote cardiovascular disease prevention.
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Affiliation(s)
- Christophe Longpré-Poirier
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.
| | - Jade Dougoud
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Silke Jacmin-Park
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Fadila Moussaoui
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada
| | - Joanna Vilme
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Gabriel Desjardins
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Louis Cartier
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
| | - Enzo Cipriani
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
| | - Philippe Kerr
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
| | - Cécile Le Page
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada
| | - Robert-Paul Juster
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
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10
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Oliva A, Reed SC, Brooks DJ, Levin FR, Evans SM. Safety and tolerability of progesterone treatment for women with cocaine use disorder: a pilot treatment trial. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:586-595. [PMID: 36095308 DOI: 10.1080/00952990.2022.2114004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Problematic cocaine use remains a significant public health issue, particularly among women. However, no concerted efforts have been made to target a pharmacological treatment option for women with cocaine use disorder (CUD) despite preclinical, human laboratory, and a limited number of clinical studies demonstrating that progesterone can attenuate the effects of cocaine to a greater extent in women than men.Objectives: To evaluate the safety, tolerability, and preliminary efficacy of progesterone for treating women with CUD.Methods: A 10-week double-blind randomized treatment trial was conducted. Prior to randomization, participants were required to achieve cocaine abstinence (1 week) before assignment to progesterone (up to 400 mg/day) or placebo. The primary efficacy outcomes were days to relapse and cocaine abstinence during the last 3 weeks of the trial. The frequency of side effects was also assessed.Results: 227 women were assessed for eligibility. Twenty-five women entered treatment and 21 were randomized to progesterone (n = 11) or placebo (n = 10). The majority of women relapsed in less than 4 days with no differences between the two groups. Further, there were no significant differences between the progesterone and placebo groups in terms of cocaine abstinence during the last 3 weeks of the trial (27% and 10% respectively). The most commonly reported side effects were headache and fatigue, but no group differences were noted.Conclusions: Progesterone was well tolerated and safe and supports further study is in a larger sample to determine if exogenous progesterone is an effective treatment option for women with CUD.(ClinicalTrials.gov Identifier: NCT00632099).
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Affiliation(s)
- Alyssa Oliva
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Stephanie C Reed
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Daniel J Brooks
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Frances R Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Suzette M Evans
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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11
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Green R, Roche DJO, Ray LA. The Effects of Menstrual Cycle Hormones on Responses to Varenicline and Naltrexone Among Female Heavy Drinking Smokers. Alcohol Alcohol 2022; 57:609-614. [PMID: 35470371 PMCID: PMC9465527 DOI: 10.1093/alcalc/agac017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/10/2022] [Accepted: 03/19/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Women often experience poorer smoking cessation outcomes in comparison to men. Menstrual cycle phase and sex hormones may influence smoking behavior and alter response to opioid antagonist medications. Less is known about the effects of sex hormones in response to pharmacotherapy for female heavy drinking smokers.
Methods
This study is a secondary analysis of premenopausal female heavy drinking smokers who completed a 12-week randomized clinical trial comparing varenicline plus placebo versus varenicline plus naltrexone for smoking cessation and drinking reduction. Participants (n = 26; total observations = 66) provided saliva samples for assays of progesterone (P4) and estradiol (E2) post-randomization at Weeks 4, 8 and 12. We examined the effects of P4/E2 ratio and medication on smoking and drinking outcomes.
Results
For drinking outcomes, there was a significant interaction for percent days abstinent (b = 0.017, P = 0.05), suggesting that greater P4/E2 ratio is associated with greater percent days abstinent for women assigned to the varenicline plus naltrexone condition. There were no interaction effects for the remaining drinking outcomes (P’s ≥ 0.12). Results found no significant interaction effect of P4/E2 ratio and medication on smoking abstinence (P = 0.19).
Conclusion
Our results imply that when women show a greater P4/E2 ratio, typically observed during the luteal phase of the menstrual cycle, they experience an added benefit of naltrexone, versus placebo, for drinking outcomes as shown by greater percent days abstinent. Additional studies in larger samples are warranted as sex hormones offer important information above and beyond comparing women versus men.
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Affiliation(s)
- ReJoyce Green
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Daniel J O Roche
- Department of Psychiatry, University of Maryland Baltimore, Baltimore, MD, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:• Discuss and outline the general and overlapping effects of the menstrual cycle on women's mental health. ABSTRACT A growing body of research demonstrates menstrual cycle-dependent fluctuations in psychiatric symptoms; these fluctuations can therefore be considered as prevalent phenomena. Possible mechanisms underlying these fluctuations posit behavioral, psychological, and neuroendocrine influences. Recent reviews document cyclic exacerbation of symptoms and explore these mechanisms in the context of specific and often single disorders. The question remains, however, as to whether there are general and overlapping effects of the menstrual cycle on women's mental health. To address this gap, we synthesized the literature examining the exacerbation of a variety of psychiatric symptoms across the menstrual cycle in adult women. Results show that the premenstrual and menstrual phases are most consistently implicated in transdiagnostic symptom exacerbation. Specifically, strong evidence indicates increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during these phases. Anxiety, stress, and binge eating appear to be elevated more generally throughout the luteal phase. The subjective effects of smoking and cocaine use are reduced during the luteal phase, but fewer data are available for other substances. Less consistent patterns are demonstrated for panic disorder, symptoms of posttraumatic stress disorder, and borderline personality disorder, and it is difficult to draw conclusions for symptoms of generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and trichotillomania because of the limited data. Future research should focus on developing standardized approaches to identifying menstrual cycle phases and adapting pharmacological and behavioral interventions for managing fluctuations in psychiatric symptoms across the menstrual cycle.
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Investigation of the Relationship between Premenstrual Syndrome, and Childhood Trauma and Mental State in Adolescents with Premenstrual Syndrome. J Pediatr Nurs 2021; 61:e65-e71. [PMID: 33931259 DOI: 10.1016/j.pedn.2021.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE This study was aimed at investigating the relationship between premenstrual syndrome (PMS), and childhood trauma and mental state in adolescents with PMS. DESIGN AND METHODS This descriptive study was conducted with 702 students between September 2020 and November 2020. An Information Form, the PMS Scale, the Childhood Trauma Questionnaire (CTQ) and Symptom Checklist (SCL)-90 were used as the data collection tools. RESULTS The mean scores the participants with PMS obtained from the Symptom Checklist (SCL)-90 and Childhood Trauma Questionnaire (CTQ) were higher than were those obtained by the participants without PMS. The Pearson correlation analysis revealed a positive and weak statistically significant relationship between the PMS Scale, and SCL-90 and CTQ. CONCLUSIONS The results of the study demonstrated that adolescents with PMS suffered from childhood traumas and mental problems more.
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Ethier AR, McKinney TL, Tottenham LS, Gordon JL. The effect of reproductive hormones on women's daily smoking across the menstrual cycle. Biol Sex Differ 2021; 12:41. [PMID: 34112267 PMCID: PMC8194227 DOI: 10.1186/s13293-021-00384-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women attempt to quit smoking less often than men and are less likely to maintain abstinence. Reproductive hormones have been postulated as a reason for this sex difference, though this remains to be clarified. Research suggests that estradiol and progesterone may influence nicotine addiction, though various methodologies have led to inconsistent findings. The current study aimed to directly examine the effect of reproductive hormones on women's smoking behavior. METHODS Over the course of one menstrual cycle, twenty-one female smokers recorded the number of cigarettes smoked in a day, as well as their perceived need for and enjoyment of cigarettes smoked. Additionally, they provided 12 urine samples for the measurement of the urinary metabolites of estradiol (estrone-3-glucuronide, E1G) and progesterone (pregnanediol glucuronide, PdG). Multilevel modeling was used to examine the effects of hormone levels as well as hormone change on smoking outcomes. RESULTS When PdG levels were low, they were inversely associated with daily cigarettes smoked. Furthermore, E1G level was negatively associated with both self-reported need for and enjoyment of cigarettes smoked but not the number of cigarettes smoked. Examining the effect of hormonal change on smoking outcomes revealed a significant interaction between change in PdG and E1G on number of cigarettes smoked such that only a simultaneous drop or increase in both hormones was associated with a greater number of cigarettes. Hormonal change effects on need for and enjoyment of cigarettes were not significant. CONCLUSIONS The present study suggests that (1) elevated progesterone levels lessen the propensity to smoke in women, (2) estrogen levels influence women's subjective experience of smoking, and (3) simultaneous drops or increases in these hormones are associated with increased smoking.
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Affiliation(s)
- Ashley R Ethier
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Ty L McKinney
- Department of Psychology, College of Social and Behavioral Science, University of Utah, Salt Lake City, Utah, USA
| | | | - Jennifer L Gordon
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada.
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Wetherill RR, Spilka NH, Maron M, Keyser H, Jagannathan K, Ely AV, Franklin TR. Influence of the natural hormonal milieu on brain and behavior in women who smoke cigarettes: Rationale and methodology. Contemp Clin Trials Commun 2021; 21:100738. [PMID: 33718654 PMCID: PMC7932892 DOI: 10.1016/j.conctc.2021.100738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
Women experience more severe health consequences from smoking, have greater difficulty quitting, and respond less favorably to nicotine replacement therapy than men. The influence of fluctuating ovarian hormones, specifically estradiol (E) and progesterone (P), on brain and behavioral responses during exposure to smoking reminders (i.e., cues) may be a contributing factor. Results from our laboratory suggest that women in the late follicular phase of their menstrual cycle (MC) have enhanced smoking cue (SC) vulnerabilities and reduced functional connectivity in neurocircuitry underlying cognitive control, potentially placing them at greater risk for continued smoking and relapse. The primary aim of this study is to examine and link hormonal status with brain and behavioral responses to SCs over the course of three monthly MCs in naturally cycling women who are chronic cigarette smokers. This longitudinal, counterbalanced study collects brain and behavioral responses to SCs at three time points during a woman's MC. Participants complete psychological and physical examinations, biochemical hormonal verification visits, and at least three laboratory/neuroimaging scan visits. The scan visits include a 10-min SC task during blood oxygen level-dependent (BOLD) data acquisition and are timed to occur during the early follicular phase (low E and P), late follicular phase (high E, unopposed by P), and mid-luteal phase (high P, high E). The primary outcomes include brain responses to SCs (compared to non-SCs), subjective craving, E and P hormone levels, and behavioral responses to SCs. This study addresses a critical gap in our knowledge: namely, the impact of the natural hormonal milieu on brain and behavioral responses to SCs, a powerful relapse trigger. Additionally, this study will provide a roadmap for human sex differences researchers who are obliged to consider the often confounding cyclic hormonal fluctuations of women.
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Affiliation(s)
| | | | - Melanie Maron
- Perelman School of Medicine, The University of Pennsylvania, The Department of Psychiatry, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Heather Keyser
- Perelman School of Medicine, The University of Pennsylvania, The Department of Psychiatry, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Kanchana Jagannathan
- Perelman School of Medicine, The University of Pennsylvania, The Department of Psychiatry, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Alice V. Ely
- Perelman School of Medicine, The University of Pennsylvania, The Department of Psychiatry, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Teresa R. Franklin
- Perelman School of Medicine, The University of Pennsylvania, The Department of Psychiatry, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
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Baker NL, Gray KM, Ramakrishnan V, Tomko RL, McClure EA, Carpenter MJ, Saladin ME. Increases in endogenous progesterone attenuate smoking in a cohort of nontreatment seeking women: An exploratory prospective study. Addict Biol 2021; 26:e12918. [PMID: 32476209 DOI: 10.1111/adb.12918] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 12/16/2022]
Abstract
Despite advances in prevention and treatment, cigarette smoking remains a leading cause of preventable death in the United States. Although men and women are equally likely to attempt to quit smoking cigarettes, women are far less likely to achieve abstinence both during and following cessation treatment. Recent evidence suggests that ovarian hormone levels may play a role in successful abstinence attempts in women smokers. The primary goal of this exploratory prospective observational study was to estimate the association between within-participant levels of progesterone and estradiol with associated cigarettes smoked per day in adult women smokers (n = 104). The primary study outcome was self-reported cigarettes smoked per day (CPD) during a 2-week observational period collected using a daily smoking diary. Additionally, participants collected saliva daily, from which hormone levels (progesterone and estradiol) were derived. Higher within-participant progesterone levels were associated with a significant decrease in CPD (p = .008) whereas within-participant estradiol levels were unrelated to CPD (p = .25). Regression models indicated a single change in the trajectory of smoking behavior for both within-participant progesterone and estradiol. When progesterone values were below the change point, there was a significant inverse relationship between within-participant progesterone levels and smoking behavior (p = .025) whereas the relationship was attenuated for higher within-participant progesterone levels (p = .59). The effect of estradiol on smoking behavior was not significant when it was either below (p = .92) or above (p = .16) the change point. Higher within-participant levels of progesterone but not estradiol are associated with reduced CPD in nontreatment seeking women smokers.
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Affiliation(s)
- Nathaniel L. Baker
- Department Public Health Sciences Medical University of South Carolina (MUSC) Charleston South Carolina USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina (MUSC) Charleston South Carolina USA
- Youth Division, Department of Psychiatry and Behavioral Sciences Medical University of South Carolina (MUSC) Charleston South Carolina USA
| | - Viswanathan Ramakrishnan
- Department Public Health Sciences Medical University of South Carolina (MUSC) Charleston South Carolina USA
| | - Rachel L. Tomko
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina (MUSC) Charleston South Carolina USA
| | - Erin A. McClure
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina (MUSC) Charleston South Carolina USA
| | - Matthew J. Carpenter
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina (MUSC) Charleston South Carolina USA
- Hollings Cancer Center Medical University of South Carolina (MUSC) Charleston South Carolina USA
| | - Michael E. Saladin
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina (MUSC) Charleston South Carolina USA
- Department of Health Sciences and Research Medical University of South Carolina (MUSC) Charleston South Carolina USA
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Liang X, Cheng S, Ye J, Chu X, Wen Y, Liu L, Qi X, Jia Y, Zhang F. Evaluating the genetic effects of sex hormone traits on the development of mental traits: a polygenic score analysis and gene-environment-wide interaction study in UK Biobank cohort. Mol Brain 2021; 14:3. [PMID: 33407712 PMCID: PMC7788797 DOI: 10.1186/s13041-020-00718-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the genetic effects of sex hormone traits on the development of mental traits in middle-aged adults. METHODS The SNPs associated with sex hormone traits were derived from a two-stage genome-wide association study (GWAS). Four sex hormone traits were selected in the current study, including sex hormone-binding globulin (SHBG), testosterone, bioavailable testosterone and estradiol. The polygenic risk score (PRS) of sex hormone traits were calculated from individual-level genotype data of the United Kingdom (UK) Biobank cohort. We then used logistic and linear regression models to assess the associations between individual PRS of sex hormone traits and the frequency of alcohol consumption, anxiety, intelligence and so on. Finally, gene-environment-wide interaction study (GEWIS) was performed to detect novel candidate genes interacting with the sex hormone traits on the development of fluid intelligence and the frequency of smoking and alcohol consumption by PLINK2.0. RESULTS We observed positive association between SHBG and the frequency of alcohol consumption (b = 0.0101, p = 3.84 × 10-11) in middle-aged males and females. In addition, estradiol was positively associated with the frequency of alcohol consumption (b = 0.0128, p = 1.96 × 10-8) in middle-aged males. Moreover, bioavailable testosterone was associated with the fluid intelligence (b = - 0.0136, p = 5.74 × 10-5) in middle-aged females. Finally, GEWIS identified one significant loci, Tenascin R (TNR) (rs34633780, p = 3.45 × 10-8) interacting with total testosterone for fluid intelligence. CONCLUSION Our study results support the genetic effects of sex hormone traits on the development of intelligence and the frequency of alcohol consumption in middle-aged adults in UK.
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Affiliation(s)
- Xiao Liang
- National Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - ShiQiang Cheng
- Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 71006, China
| | - Jing Ye
- Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 71006, China
| | - XiaoMeng Chu
- Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 71006, China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 71006, China
| | - Li Liu
- Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 71006, China
| | - Xin Qi
- Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 71006, China
| | - YuMeng Jia
- Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 71006, China
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 71006, China.
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Ng JS, Chin KY. Potential mechanisms linking psychological stress to bone health. Int J Med Sci 2021; 18:604-614. [PMID: 33437195 PMCID: PMC7797546 DOI: 10.7150/ijms.50680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic psychological stress affects many body systems, including the skeleton, through various mechanisms. This review aims to provide an overview of the factors mediating the relationship between psychological stress and bone health. These factors can be divided into physiological and behavioural changes induced by psychological stress. The physiological factors involve endocrinological changes, such as increased glucocorticoids, prolactin, leptin and parathyroid hormone levels and reduced gonadal hormones. Low-grade inflammation and hyperactivation of the sympathetic nervous system during psychological stress are also physiological changes detrimental to bone health. The behavioural changes during mental stress, such as altered dietary pattern, cigarette smoking, alcoholism and physical inactivity, also threaten the skeletal system. Psychological stress may be partly responsible for epigenetic regulation of skeletal development. It may also mediate the relationship between socioeconomic status and bone health. However, more direct evidence is required to prove these hypotheses. In conclusion, chronic psychological stress should be recognised as a risk factor of osteoporosis and stress-coping methods should be incorporated as part of the comprehensive osteoporosis-preventing strategy.
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Affiliation(s)
- Jia-Sheng Ng
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
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Allen A, Petersen A, Harrison K, Nair U, Allen S. Effect of exogenous progesterone administration on smoking topography. Addict Behav 2021; 112:106570. [PMID: 32763623 DOI: 10.1016/j.addbeh.2020.106570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Progesterone has been implicated as protective against drug taking behaviors, including combustible cigarettes. While prior research indicates higher endogenous progesterone levels are associated with a reduction in smoking intensity (as measured by smoking topography), it is unknown if exogenous delivery of progesterone may have the same effect. METHODS This double-blind, counterbalanced, cross-over randomized trial enrolled women between the ages of 18 and 40 who smoked at least five cigarettes per day and were currently using oral contraceptives. After overnight abstinence participants attended two topography lab sessions. One lab session was conducted during progesterone (200 mg twice per day) treatment and the other was during placebo treatment. Analyses included linear mixed effect models to examine the effect of exogenous progesterone administration and endogenous progesterone values on topography outcomes. RESULTS Participants (n = 43) were 23.8 (standard deviation [SD] ± 4.5) years old, smoked 10.5 (SD ± 3.7) cigarettes per day. Compared to placebo administration, progesterone administration reduced cumulative puff volume by 300 mL (95% confidence interval [CI]: -536, -65; p-value = 0.01) with additional trends indicating possible reductions in the number of puffs, average puff volume, and average flow. There were no significant effects of endogenous progesterone on smoking topography outcomes. CONCLUSIONS Progesterone administration has the potential to reduce smoking intensity after overnight abstinence in women of reproductive age. Additional research is needed to explore how this may relate to smoking cessation outcomes in women of reproductive age.
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Affiliation(s)
- Alicia Allen
- Department of Family and Community Medicine, College of Medicine - Tucson, University of Arizona, United States.
| | - Ashley Petersen
- Division of Biostatistics, School of Public Health, University of Minnesota, United States
| | - Katherine Harrison
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, United States
| | - Uma Nair
- Department of Family and Community Medicine, College of Medicine - Tucson, University of Arizona, United States
| | - Sharon Allen
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, United States
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Allen A, Mallahan S, Ortega A, Miller H, Saleh A, Bonny AE. Administration of Exogenous Hormones and the Implications for Cigarette Smoking-Related Behaviors. Curr Psychiatry Rep 2020; 22:70. [PMID: 33089443 DOI: 10.1007/s11920-020-01197-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Preclinical evidence indicates progesterone and estrogen influence drug-taking behaviors, including nicotine/tobacco. However, clinical research on this relationship is less clear. This lack of clarity may be due to measuring naturally occurring endogenous hormones to examine this relationship, which introduces substantial error. Therefore, the goal of this review is to examine the link between the delivery of exogenous hormones and cigarette smoking-related behavior. RECENT FINDINGS Exogenous progesterone may have favorable effects on cognition, symptomatology, consumption, and smoking cessation. Hormonal replacement therapy does not have a clear relationship with smoking-related behaviors. Oral contraceptive use may have adverse effects on stress response, nicotine metabolism, and symptomatology. Additional research is needed to explore how the administration of exogenous hormones may (a) strengthen research methodology on this topic, (b) enhance our understanding of the role of progesterone/estrogen on smoking-related behaviors, and (c) improve smoking cessation outcomes.
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Affiliation(s)
- Alicia Allen
- Department of Family and Community Medicine, College of Medicine, Tucson, University of Arizona, Tucson, AZ, 85721, USA.
| | - Stephanie Mallahan
- Department of Family and Community Medicine, College of Medicine, Tucson, University of Arizona, Tucson, AZ, 85721, USA
| | - Alexis Ortega
- Office of Equity, Diversity, and Inclusion, Health Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Heather Miller
- Department of Obstetrics and Gynecology, College of Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | - Ahlam Saleh
- Health Sciences Library, University Libraries, University of Arizona, Tucson, AZ, 85721, USA
| | - Andrea E Bonny
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH, 43215, USA
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Hiatt RA, Engmann NJ, Balke K, Rehkopf DH. A Complex Systems Model of Breast Cancer Etiology: The Paradigm II Conceptual Model. Cancer Epidemiol Biomarkers Prev 2020; 29:1720-1730. [PMID: 32641370 DOI: 10.1158/1055-9965.epi-20-0016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/09/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The etiology of breast cancer is a complex system of interacting factors from multiple domains. New knowledge about breast cancer etiology continues to be produced by the research community, and the communication of this knowledge to other researchers, practitioners, decision makers, and the public is a challenge. METHODS We updated the previously published Paradigm model (PMID: 25017248) to create a framework that describes breast cancer etiology in four overlapping domains of biologic, behavioral, environmental, and social determinants. This new Paradigm II conceptual model was part of a larger modeling effort that included input from multiple experts in fields from genetics to sociology, taking a team and transdisciplinary approach to the common problem of describing breast cancer etiology for the population of California women in 2010. Recent literature was reviewed with an emphasis on systematic reviews when available and larger epidemiologic studies when they were not. Environmental chemicals with strong animal data on etiology were also included. RESULTS The resulting model illustrates factors with their strength of association and the quality of the available data. The published evidence supporting each relationship is made available herein, and also in an online dynamic model that allows for manipulation of individual factors leading to breast cancer (https://cbcrp.org/causes/). CONCLUSIONS The Paradigm II model illustrates known etiologic factors in breast cancer, as well as gaps in knowledge and areas where better quality data are needed. IMPACT The Paradigm II model can be a stimulus for further research and for better understanding of breast cancer etiology.
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Affiliation(s)
- Robert A Hiatt
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California. .,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | | | - Kaya Balke
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
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Allen S, Petersen A, Harrison K, Tosun N, Cameron J. Response to nicotine following overnight smoking abstinence during short-term progesterone treatment in women. Exp Clin Psychopharmacol 2020; 28:306-316. [PMID: 31464476 PMCID: PMC7048655 DOI: 10.1037/pha0000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Preclinical and clinical literature suggest that sex hormones impact tobacco use behaviors in women. The goal of this double-blind crossover laboratory study was to examine the effect of oral exogenous progesterone (200 mg twice per day) versus placebo on nicotine response using measures of motor speed and cognitive function in women following overnight smoking abstinence. We hypothesized that increased progesterone would blunt the nicotine response whereby producing less change in motor speed and cognition in response to nicotine exposure. Female smokers, age 18-35, were randomized to participate in two 9-day crossover testing weeks. Participants completed a lab session following overnight abstinence where they were administered nicotine nasal spray and asked to complete measures of immediate memory (IMT), delayed memory (DMT), word recall (WR), and finger tapping speed (FT). After the first 9-day testing week, participants resumed smoking and returned the following month to complete the identical lab session in the crossover condition. Forty-seven women were included in this analysis (n = 47). We found no differences in the magnitude of response for IMT, DMT, and WR between conditions. For FT, women had a blunted response to nicotine during the placebo condition. When examining the association between hormone levels and relative performance, we found increases in DMT, WR, and FT but decreases in IMT during the progesterone condition. We observed differences between progesterone versus placebo in relative change in some measures of nicotine response following overnight abstinence. Future studies are needed to further characterize this response. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Sharon Allen
- Department of Family Medicine & Community Health, University of Minnesota 516 Delaware Street SE, Minneapolis, MN 55455
| | - Ashley Petersen
- Division of Biostatistics, School of Public Health, University of Minnesota 420 Delaware Street SE, Minneapolis, MN 55455
| | - Katherine Harrison
- Department of Family Medicine & Community Health, University of Minnesota 717 Delaware Street SE, Minneapolis, MN 55414
| | - Nicole Tosun
- Department of Family Medicine & Community Health, University of Minnesota 717 Delaware Street SE, Minneapolis, MN 55414
| | - Jacquelyn Cameron
- William Beaumont School of Medicine, Oakland University 586 Pioneer Dr, Rochester, MI 48309
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Peltier MR, Flores JM, Smith PH, Roberts W, Verplaetse TL, Moore KE, Hacker R, Oberleitner LM, McKee SA. Smoking Across the Menopausal Transition in a 10-Year Longitudinal Sample: The Role of Sex Hormones and Depressive Symptoms. Nicotine Tob Res 2020; 22:872-877. [PMID: 31058288 PMCID: PMC7249927 DOI: 10.1093/ntr/ntz069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 04/26/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Current cigarette smoking rates among older women remain problematic, especially given that this population experiences increased smoking-related health consequences. Despite these increased health concerns, little research to date has explored smoking patterns across the menopausal transition (pre-, early-peri-, late-peri-, and postmenopausal) or the effect of unique factors such as sex hormones and depression during this transition. METHODS This study used 10 yearly waves of data from the Study of Women's Health Across the Nation, a longitudinal dataset. Data included 1397 women endorsing ever smoking regularly at baseline. Random-effects logistic regression models were used to examine smoking transitions. RESULTS Although there were no associations between menopausal transition stage and smoking behavior, increased estradiol was associated with an increased likelihood of quitting regular smoking (eg, transitioning from regular smoking to non-regular or no smoking; odds ratio [OR] = 1.28), whereas increased testosterone was associated with an increased likelihood of relapsing to regular smoking (eg, transitioning from former or nonregular smoking to regular smoking OR = 2.56). Depression was associated with increased likelihood of continued smoking (OR = 0.97) and relapse (OR = 1.03). CONCLUSIONS The results emphasize the need to develop interventions to target initiated or continued smoking among women across the menopausal transition and specifically highlight the importance of developing treatments that target depressive symptoms in this population. In addition, although singular hormone measures were associated with smoking behavior, there is a need for future study of dynamic changes in hormones, as well as the impact of progesterone on smoking behaviors across the menopausal transition. IMPLICATIONS To date, no studies have examined smoking behaviors across the menopausal transition. In this study, although menopausal transition status was not significantly related to transitions in smoking behavior, important relationships between sex hormones and depression were observed. Increased estradiol was associated with an increased likelihood of quitting regular smoking, whereas increased testosterone was associated with an increased likelihood of relapsing to regular smoking behavior. Higher depression scores were related to continued smoking and relapse to regular smoking behavior. These results highlight the need to develop interventions to target smoking cessation among women across the menopausal transition.
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Affiliation(s)
| | - José M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Philip H Smith
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | | | - Kelly E Moore
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Robyn Hacker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | | | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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Abstract
OBJECTIVE Marijuana is the most commonly used illicit drug in the United States and co-use with tobacco is increasing. Preliminary studies have indicated that marijuana may suppress luteinizing hormone (LH) or shorten the luteal phase. Although the literature is mixed, these sex hormones may play a role in smoking cessation outcomes. This secondary subgroup analysis aims to explore the menstrual cycle of females who co-use marijuana and tobacco compared with females who only use tobacco in a sample of tobacco treatment-seeking individuals. METHODS Female participants, aged 18 to 50 years, who self-reported regular menstrual cycles and co-use of marijuana and tobacco were matched 1:3 by age to participants who only use tobacco. Length of the follicular and luteal phases was determined using First Response Urine LH tests. Wilcoxon 2-sample t tests were used to determine differences in phase lengths between groups. RESULTS Thirteen women who co-use marijuana and tobacco, and 39 women who only use tobacco were included in this analysis. Overall, participants were 37.3 ± 8.0 (SD) years of age, mostly Caucasian (67%), and smoked 12.6 ± 5.2 (SD) cigarettes per day. The luteal phase length among participants who co-use marijuana and tobacco (11.4 days ± 2.2 [SD]) was significantly shorter than among participants who only use tobacco (16.8 days ± 11.3 [SD]; P = 0.002). No differences were found in follicular phase length or menstrual cycle length. CONCLUSIONS These data suggest that females who co-use marijuana and tobacco may have a shortened luteal phase in comparison with females who only use tobacco. Further studies are needed to better understand how marijuana use may impact the menstrual cycle and affect smoking outcomes.
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Peltier MR, McKee SA. Commentary on Tosun et al. (2019): Dynamic changes in sex hormones and smoking cessation. Addiction 2019; 114:1814-1815. [PMID: 31347245 PMCID: PMC6732031 DOI: 10.1111/add.14728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/01/2019] [Indexed: 11/26/2022]
Abstract
There is growing evidence suggesting that exogenous progesterone may improve smoking cessation outcomes among women. We hypothesize that exogenous progesterone administration can result in stable progesterone levels, and that it is the absence of dynamic hormone change that may lead to improved smoking cessation outcomes.
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Affiliation(s)
- MacKenzie R. Peltier
- Veterans Affairs Connecticut Health System, West Haven, CT,
US,Department of Psychiatry, Yale School of Medicine, New
Haven, CT, US
| | - Sherry A. McKee
- Department of Psychiatry, Yale School of Medicine, New
Haven, CT, US
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Martel MM, Eisenlohr-Moul T, Roberts B. Interactive effects of ovarian steroid hormones on alcohol use and binge drinking across the menstrual cycle. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 126:1104-1113. [PMID: 29154570 DOI: 10.1037/abn0000304] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patterns and features of substance use and abuse vary across the menstrual cycle in humans. Yet, little work has systematically examined the within-person relationships between ovarian hormone changes and alcohol use across the menstrual cycle. Our study was the first to examine the roles of within-person levels of estradiol (E2) and progesterone (P4) in relation to daily alcohol use and binge drinking in young women. Participants were 22 naturally cycling women, ages 18-22, recruited through a university subject pool who reported any alcohol use and who completed a screening visit assessing study eligibility, followed by 35 subsequent days of data collection. E2 and P4 were obtained via enzyme immunoassay of saliva samples collected by participants each morning, 30 min after waking. Presence and degree of daily substance use were obtained using an adaptation of the Timeline FollowBack Interview completed daily. Results indicated that elevated E2 in the context of decreased P4 levels were associated with higher risk of drinking and binge drinking. These effects were present only on weekend days. Results are suggestive of a dual risk model in which both ovulatory E2 increases and perimenstrual P4 decreases increase risk for drinking. Differential associations of steroids with drinking across the menstrual cycle may suggest the need for clinical assessment of substance use to take into account hormone dynamics and menstrual cycle phase. (PsycINFO Database Record
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Franklin TR, Jagannathan K, Ketcherside A, Spilka N, Wetherill RR. Menstrual cycle phase modulates responses to smoking cues in the putamen: Preliminary evidence for a novel target. Drug Alcohol Depend 2019; 198:100-104. [PMID: 30901743 PMCID: PMC6467805 DOI: 10.1016/j.drugalcdep.2019.01.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND The preclinical literature identifies the ventral striatum (VS) as a key player in drug-conditioned responses, guiding hypotheses examining neural substrates involved in human drug cue reactivity, including the study of sex differences. Men show a replicable response that includes the VS, while women's responses have been weaker and variable. New evidence suggests that the hormonal milieu modulates women's responses to drug cues in the dorsal striatum (DS), specifically, in the putamen. Here we tested the hypothesis that the hormonal milieu affects neural responses to smoking cues (SCs) in the putamen in women cigarette smokers. METHODS We re-examined our three previous neuroimaging studies of the influence of sex and menstrual cycle (MC) phase effects on SC neuroactivity, incorporating the DS as a region of interest. RESULTS As previously shown, men exhibited increased ventral medial prefrontal cortex (vmPFC) and VS/V pallidum responses, and women showed increased vmPFC responses that were greater in women during the follicular phase (high estradiol), compared to the luteal phase (high progesterone). Reducing the statistical threshold within luteal phase women revealed select deactivation of the putamen. CONCLUSIONS These preliminary findings shed light upon factors that may modulate drug cue reactivity in women, specifically the influence of hormones on DS responses. Emerging literature suggests that manipulating the hormonal milieu may open a fundamental window into sex-specific treatment targets. More rigorous study of the brain substrates involved in drug cue reactivity and other reward-related behavior that may be influenced by sex and the hormonal milieu is imperative.
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Allen AM, Weinberger AH, Wetherill RR, Howe CL, McKee SA. Oral Contraceptives and Cigarette Smoking: A Review of the Literature and Future Directions. Nicotine Tob Res 2019; 21:592-601. [PMID: 29165663 PMCID: PMC6468133 DOI: 10.1093/ntr/ntx258] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/16/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Evidence continues to mount indicating that endogenous sex hormones (eg, progesterone and estradiol) play a significant role in smoking-related outcomes. Although approximately one out of four premenopausal smokers use oral contraceptives (OCs), which significantly alter progesterone and estradiol levels, relatively little is known about how OCs may influence smoking-related outcomes. Thus, the goal of this review article is to describe the state of the literature and offer recommendations for future directions. METHODS In March 2017, we searched seven databases, with a restriction to articles written in English, using the following keywords: nicotine, smoker(s), smoking, tobacco, cigarettes, abstinence, withdrawal, and craving(s). We did not restrict on the publication date, type, or study design. RESULTS A total of 13 studies were identified. Three studies indicated faster nicotine metabolism in OC users compared to nonusers. Five of six laboratory studies that examined physiological stress response noted heightened response in OC users compared to nonusers. Three studies examined cessation-related symptomatology (eg, craving) with mixed results. One cross-sectional study observed greater odds of current smoking among OC users, and no studies have explored the relationship between OC use and cessation outcomes. CONCLUSIONS Relatively few studies were identified on the role of OCs in smoking-related outcomes. Future work could explore the relationship between OC use and mood, stress, weight gain, and brain function/connectivity, as well as cessation outcomes. Understanding the role of OC use in these areas may lead to the development of novel smoking cessation interventions for premenopausal women. IMPLICATIONS This is the first review of the relationship between oral contraceptives (OCs) and smoking-related outcomes. The existing literature suggests that the use of OCs is related to increased nicotine metabolism and physiological stress response. However, the relationship between OC use and smoking-related symptoms (eg, craving) is mixed. Further, no published data were available on OC use and smoking cessation outcomes. Therefore, we recommend additional research be conducted to characterize the relationship between OC use and smoking cessation outcomes, perhaps as a function of the effect of OC use on mood, stress, weight gain, and brain function/connectivity.
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Affiliation(s)
- Alicia M Allen
- Family & Community Medicine Department, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, USA
| | - Reagan R Wetherill
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Carol L Howe
- University of Arizona Health Sciences Library, University of Arizona, Tucson, AZ
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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Abstract
PURPOSE OF REVIEW Risk for suicidal behavior may fluctuate across the menstrual cycle. Here, we use the RDoC framework to review potential mechanisms by which the cycle may increase acute suicide risk. RECENT FINDINGS The menstrual cycle impacts the majority of RDoC constructs linked to suicide risk, particularly among hormone-sensitive women, such as those with premenstrual dysphoric disorder or premenstrual exacerbation of a psychiatric disorder. Despite this, there are no published studies examining suicidal ideation, planning, or behavior longitudinally across the cycle. More work is needed to understand how hormone sensitivity may relate to both trait and state suicide risk. Intensive multilevel investigations of cyclical hormone effects on suicide risk through specific RDoC mechanisms are suggested. This is a fertile research area and may provide key insights regarding the mechanisms of acute suicide risk.
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Affiliation(s)
- Sarah A Owens
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tory Eisenlohr-Moul
- Department of Psychiatry, Women's Mental Health Research Program, University of Illinois at Chicago, 912 S Wood St., South Tower, Room 335, Chicago, IL, 60612, USA.
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, 60612, USA.
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Farris SG, Abrantes AM, Zvolensky MJ. Emotional distress and tobacco demand during the menstrual cycle in female smokers. Cogn Behav Ther 2018; 48:177-183. [PMID: 30064348 DOI: 10.1080/16506073.2018.1494208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Fluctuations in ovarian hormones over the menstrual cycle contribute to cigarette reward, however less is known about menstrual cycle influences on emotional distress in female smokers. We examined between-group differences in emotional distress (negative affectivity, emotion dysregulation, distress intolerance) and hypothetical cigarette purchasing (i.e. tobacco demand) among female smokers at three different menstrual stages. Women (n = 32) were non-treatment seeking daily smokers not on hormonal contraceptive, and were currently in their follicular (estradiol-dominant; n = 10), early-mid luteal (progesterone-dominant; n = 15), and late-luteal phase (decreasing progesterone/estradiol; n = 7). Effect sizes are reported given the small sample. Women in the late-luteal phase, relative to the follicular and early-mid luteal phases, reported higher levels of negative affectivity (d = 0.69), emotion dysregulation (d = 1.03), and distress intolerance (d = -0.86). Compared to the early-mid luteal and late-luteal phases, women in the follicular phase reported the highest hypothetical cigarette consumption when cigarettes were free (d = 0.71) and made the largest maximum expenditures on cigarettes (d = 0.74). Findings offer preliminary evidence that the late-luteal phase is characterized by emotional distress, and the follicular phase is associated with elevated tobacco demand, which if replicated could implicate ovarian hormones in emotion-focused smoking.
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Affiliation(s)
- Samantha G Farris
- a Department of Psychiatry and Human Behavior Alpert Medical School of Brown University , Providence , RI , USA.,b Centers for Behavioral and Preventative Medicine, The Miriam Hospital , Providence , RI , USA.,c Department of Psychology , Rutgers, the State University of New Jersey , Piscataway , NJ , USA
| | - Ana M Abrantes
- a Department of Psychiatry and Human Behavior Alpert Medical School of Brown University , Providence , RI , USA.,d Behavioral Medicine and Addictions Research Group , Butler Hospital , Providence , RI , USA
| | - Michael J Zvolensky
- e Department of Psychology , University of Houston , Houston , TX , USA.,f Department of Behavioral Science , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Ovarian Hormones and Transdermal Nicotine Administration Independently and Synergistically Suppress Tobacco Withdrawal Symptoms and Smoking Reinstatement in the Human Laboratory. Neuropsychopharmacology 2018; 43:828-837. [PMID: 28905874 PMCID: PMC5809791 DOI: 10.1038/npp.2017.216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/08/2017] [Accepted: 09/10/2017] [Indexed: 12/19/2022]
Abstract
Modeling intra-individual fluctuations in estradiol and progesterone may provide unique insight into the effects of ovarian hormones on the etiology and treatment of nicotine dependence. This randomized placebo-controlled laboratory study tested the independent and interactive effects of intra-individual ovarian hormone variation and nicotine on suppression of tobacco withdrawal symptoms and smoking behavior. Female smokers randomized to 21 mg nicotine (TNP; n=37) or placebo (PBO; n=43) transdermal patch following overnight abstinence completed three sessions occurring during hormonally distinct menstrual cycle phases. At each session, participants provided saliva for hormone assays and completed repeated self-report measures (ie, tobacco withdrawal symptoms, smoking urge, and negative affect (NA)) followed by an analog smoking reinstatement task for which participants could earn money to delay smoking and subsequently purchase cigarettes to smoke. Higher (vs lower) progesterone levels were associated with greater reductions in NA. Higher (vs lower) progesterone levels and progesterone to estradiol ratios were associated with reducing smoking urges over time to a greater extent with TNP compared to PBO. There was an interaction between Patch and estradiol on NA. With TNP, higher-than-usual estradiol was associated with greater decreases in NA. However with PBO, lower-than-usual estradiol was associated with greater decreases in NA. These results suggest that the effects of TNP on mood- and smoking-related outcomes may vary depending on the ovarian hormone levels.
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Pang RD, Andrabi N, Leventhal AM. Premenstrual symptoms and factors implicated in smoking cessation among woman smokers. Exp Clin Psychopharmacol 2017; 25:235-241. [PMID: 28682101 PMCID: PMC5546922 DOI: 10.1037/pha0000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Premenstrual symptoms (PMS) may reduce smoking cessation success. Yet, little is known about the factors that may impact smoking cessation among women with elevated PMS, leaving little data to guide smoking cessation science and practice for this population. This cross-sectional study is a secondary analysis of data from laboratory studies focused on menstrual cycle effects and smoking. Premenopausal woman daily smokers (n = 157) completed self-report measures of tobacco dependence and other cessation-relevant factors (i.e., smoking cessation history, withdrawal during previous quit attempts, use of smoking cessation aids) as well as a measure assessing 3 domains of PMS-affective, water retention, and pain. After controlling for depression and race, affective PMS were associated with greater daytime tobacco dependence, withdrawal symptoms during most recent quit attempt, and number of smoking cessation aids used in past quit attempts (βs = .19-.28, ps < .05). Additionally, affective PMS were associated with increased odds of having used e-cigarettes during past quit attempts (odds ratio = 1.54, 95% confidence interval [1.06, 2.24]) after adjusting for depression and race. These results across different domains of PMS suggest that affective PMS may play a particularly important role in smoking cessation. Women with elevated affective PMS may be more inclined to try cessation aids and require special clinical attention to controlling tobacco withdrawal during quit attempts to increase success. (PsycINFO Database Record
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Carroll ME, Lynch WJ. How to study sex differences in addiction using animal models. Addict Biol 2016; 21:1007-29. [PMID: 27345022 PMCID: PMC4970981 DOI: 10.1111/adb.12400] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/17/2016] [Accepted: 02/27/2016] [Indexed: 11/30/2022]
Abstract
The importance of studying sex as a biological variable in biomedical research is becoming increasingly apparent. There is a particular need in preclinical studies of addiction to include both sexes, as female animals are often excluded from studies, leaving large gaps in our knowledge of not only sex differences and potential prevention and treatment strategies but also with regard to the basic neurobiology of addiction. This review focuses on methodology that has been developed in preclinical studies to examine sex differences in the behavioral aspects and neurobiological mechanisms related to addiction across the full range of the addiction process, including initiation (acquisition), maintenance, escalation, withdrawal, relapse to drug seeking and treatment. This review also discusses strategic and technical issues that need to be considered when comparing females and males, including the role of ovarian hormones and how sex differences interact with other major vulnerability factors in addiction, such as impulsivity, compulsivity and age (adolescent versus adult). Novel treatments for addiction are also discussed, such as competing non-drug rewards, repurposed medications such as progesterone and treatment combinations. Practical aspects of conducting research comparing female and male animals are also considered. Making sex differences a point of examination requires additional effort and consideration; however, such studies are necessary given mounting evidence demonstrating that the addiction process occurs differently in males and females. These studies should lead to a better understanding of individual differences in the development of addiction and effective treatments for males and females.
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Affiliation(s)
- Marilyn E. Carroll
- Marilyn E. Carroll, Department of Psychiatry, University of Minnesota, MMC 392, Minneapolis, MN, USA
| | - Wendy J. Lynch
- Wendy J. Lynch, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, PO Box 801402, Charlottesville, VA
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Carroll ME, Collins M, Kohl EA, Johnson S, Dougen B. Sex and menstrual cycle effects on chronic oral cocaine self-administration in rhesus monkeys: Effects of a nondrug alternative reward. Psychopharmacology (Berl) 2016; 233:2973-84. [PMID: 27318989 PMCID: PMC4935578 DOI: 10.1007/s00213-016-4343-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/20/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND In previous studies, female monkeys self-administered more oral phencyclidine (PCP) than males, and PCP intake differed by phase of menstrual cycle. OBJECTIVES The purpose of this study was to examine sex and hormonal influences on oral cocaine self-administration in male and female rhesus monkeys in the follicular vs. luteal phases of the menstrual cycle, with concurrent access to an alternative nondrug reward, saccharin (SACC) vs. water. MATERIALS AND METHODS Concurrent access to cocaine (0.2, 0.4, and 0.8 mg/ml) and SACC or water was available from two drinking spouts under concurrent fixed-ratio (FR) 2, 4, and 8 schedules during daily 3-h sessions. RESULTS Cocaine deliveries were similar in males and females in the females' luteal phase, but cocaine deliveries were higher in females during the follicular phase than the luteal phase and compared to males. When SACC was available, cocaine deliveries were reduced in females in the follicular phase of the cycle, and cocaine intake (mg/kg) was reduced in males and in females' follicular and luteal phases. CONCLUSIONS Access to concurrent SACC (vs. water) reduced cocaine intake (mg/kg) in males and in females during both menstrual phases, and the magnitude of the reduction in cocaine intake was greatest during the females' follicular phase. Thus, a nondrug alternative reward, SACC, is a viable alternative treatment for reducing cocaine's rewarding effects on male and female monkeys, and reductions in cocaine seeking were optimal in the females' luteal phase.
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Affiliation(s)
- Marilyn E Carroll
- Department of Psychiatry, University of Minnesota, MMC 392, Minneapolis, MN, 55455, USA.
| | - Molly Collins
- Department of Psychiatry, University of Minnesota, MMC 392, Minneapolis, MN, 55455, USA
| | - Emily A Kohl
- Department of Psychiatry, University of Minnesota, MMC 392, Minneapolis, MN, 55455, USA
| | - Seth Johnson
- Department of Psychiatry, University of Minnesota, MMC 392, Minneapolis, MN, 55455, USA
| | - Ben Dougen
- Department of Psychiatry, University of Minnesota, MMC 392, Minneapolis, MN, 55455, USA
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Carroll ME, Smethells JR. Sex Differences in Behavioral Dyscontrol: Role in Drug Addiction and Novel Treatments. Front Psychiatry 2016; 6:175. [PMID: 26903885 PMCID: PMC4745113 DOI: 10.3389/fpsyt.2015.00175] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 11/30/2015] [Indexed: 11/22/2022] Open
Abstract
The purpose of this review is to discuss recent findings related to sex differences in behavioral dyscontrol that lead to drug addiction, and clinical implications for humans are discussed. This review includes research conducted in animals and humans that reveals fundamental aspects of behavioral dyscontrol. The importance of sex differences in aspects of behavioral dyscontrol, such as impulsivity and compulsivity, is discussed as major determinants of drug addiction. Behavioral dyscontrol during adolescence is also an important consideration, as this is the time of onset for drug addiction. These vulnerability factors additively increase drug-abuse vulnerability, and they are integral aspects of addiction that covary and interact with sex differences. Sex differences in treatments for drug addiction are also reviewed in terms of their ability to modify the behavioral dyscontrol that underlies addictive behavior. Customized treatments to reduce behavioral dyscontrol are discussed, such as (1) using natural consequences such as non-drug rewards (e.g., exercise) to maintain abstinence, or using punishment as a consequence for drug use, (2) targeting factors that underlie behavioral dyscontrol, such as impulsivity or anxiety, by repurposing medications to relieve these underlying conditions, and (3) combining two or more novel behavioral or pharmacological treatments to produce additive reductions in drug seeking. Recent published work has indicated that factors contributing to behavioral dyscontrol are an important target for advancing our knowledge on the etiology of drug abuse, intervening with the drug addiction process and developing novel treatments.
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Affiliation(s)
| | - John R. Smethells
- Program in PharmacoNeuroImmunology, Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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Torres OV, O'Dell LE. Stress is a principal factor that promotes tobacco use in females. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:260-8. [PMID: 25912856 PMCID: PMC4618274 DOI: 10.1016/j.pnpbp.2015.04.005] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
Tobacco use is a major economic and health problem. It is particularly concerning that women consume more tobacco products, have a more difficult time quitting smoking, and are less likely to benefit from smoking cessation therapy than men. As a result, women are at higher risk of developing tobacco-related diseases. Clinical evidence suggests that women are more susceptible to anxiety disorders, and are more likely to smoke in order to cope with stress than men. During smoking abstinence, women experience more intense anxiety than men and report that the anxiety-reducing effects of smoking are the main reason for their continued tobacco use and relapse. Consistent with this, pre-clinical studies using rodent models suggest that females display more intense stress during nicotine withdrawal than males. This review posits that in women, stress is a principal factor that promotes the initiation of tobacco use and relapse behavior during abstinence. Studies are reviewed at both the clinical and pre-clinical levels to provide support for our hypothesis that stress plays a central role in promoting tobacco use vulnerability in females. The clinical implications of this work are also considered with regard to treatment approaches and the need for more research to help reduce health disparities produced by tobacco use in women.
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Affiliation(s)
- Oscar V Torres
- Molecular Neuropsychiatry Research Branch, DHHS/NIH/NIDA Intramural Research Program National Institutes of Health, 251 Bayview Boulevard, Baltimore, MD 21224
| | - Laura E O'Dell
- Department of Psychology, The University of Texas at El Paso, El Paso, TX 79902, USA.
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Wetherill RR, Franklin TR, Allen SS. Ovarian hormones, menstrual cycle phase, and smoking: a review with recommendations for future studies. CURRENT ADDICTION REPORTS 2016; 3:1-8. [PMID: 27134810 DOI: 10.1007/s40429-016-0093-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cigarette smoking continues to be the leading cause of preventable morbidity and mortality. Similar to other addictive substances, the prevalence of cigarette smoking is greater among men than women, yet women are less successful at quitting smoking. Preclinical and clinical research suggests that ovarian hormones (i.e., estradiol and progesterone), which fluctuate over the course of the menstrual cycle, may contribute to these sex differences. Specifically, research suggests that progesterone may protect against cigarette smoking and nicotine addiction; whereas estradiol may underlie enhanced vulnerability. In this review, we discuss new research on ovarian hormone and menstrual cycle phase effects on smoking-related responses and behavior in women, including studies examining neural responses to smoking cues, hormonal influences on medication-assisted smoking cessation, and acute smoking abstinence. We highlight innovative studies with strong research methodology and provide suggestions for future research that may allow evidence-based knowledge for immediate translation to the clinic to guide novel, hormonally-informed treatment strategies. Thus, rigorous scientific study holds the potential to reduce relapse rates, thus improving the health and saving the lives of the many thousands of women who unfortunately do not respond to current treatments.
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Affiliation(s)
- Reagan R Wetherill
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; Mailing Address: 3900 Chestnut Street, Philadelphia, Pennsylvania, USA 19104;
| | - Teresa R Franklin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; Mailing Address: 3900 Chestnut Street, Philadelphia, Pennsylvania, USA 19104;
| | - Sharon S Allen
- Department of Family Medicine & Community Health, Medical School, University of Minnesota; Mailing Address: 420 Delaware Street SE, MMC 381 Mayo, Minneapolis, Minnesota, USA 55455;
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Park SJ, Yi B, Lee HS, Oh WY, Na HK, Lee M, Yang M. To quit or not: Vulnerability of women to smoking tobacco. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2016; 34:33-56. [PMID: 26669465 DOI: 10.1080/10590501.2015.1131539] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tobacco smoking is currently on the rise among women, and can pose a greater health risk. In order to understand the nature of the increase in smoking prevalence among women, we focused on the vulnerability of women to smoking behaviors--smoking cessation or tobacco addiction--and performed a systematic review of the socioeconomic and intrinsic factors as well as tobacco ingredients that affect women's susceptibility to smoking tobacco. We observed that nicotine and other tobacco components including cocoa-relatives, licorice products, and menthol aggravate tobacco addiction in women rather than in men. Various genetic and epigenetic alterations in dopamine pathway and the pharmaco-kinetics and -dynamic factors of nicotine also showed potential evidences for high susceptibility to tobacco addiction in women. Therefore, we suggest systemic approaches to prevent tobacco smoking-related health risks, considering gene-environment-gender interaction.
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Affiliation(s)
- Se-Jung Park
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
| | - Bitna Yi
- b Department of Neurosurgery , Stanford University School of Medicine , Stanford , California , USA
| | - Ho-Sun Lee
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
| | - Woo-Yeon Oh
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
| | - Hyun-Kyung Na
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
| | - Minjeong Lee
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
| | - Mihi Yang
- a Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University , Seoul , Republic of Korea
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Saladin ME, McClure EA, Baker NL, Carpenter MJ, Ramakrishnan V, Hartwell KJ, Gray KM. Increasing progesterone levels are associated with smoking abstinence among free-cycling women smokers who receive brief pharmacotherapy. Nicotine Tob Res 2015; 17:398-406. [PMID: 25762749 DOI: 10.1093/ntr/ntu262] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Preclinical and human laboratory research suggests that (a) progesterone may decrease drug reward, craving, and smoking behavior, and (b) estradiol may enhance drug reward and smoking behavior. A modest majority of treatment research examining the relationship between menstrual cycle phase and outcomes suggests that the luteal menstrual phase, with its uniquely higher progesterone levels, is associated with better cessation outcomes. However, no studies to date have examined the effects of naturally occurring variation in progesterone and estradiol levels on medication-assisted smoking cessation. The present study sought to fill this notable gap in the treatment literature. METHODS Weekly plasma progesterone and estradiol levels were obtained from nicotine-dependent female smokers enrolled in a 4-week cessation trial. Participants (N = 108) were randomized to receive a 4-week course of either varenicline (VAR) tablets and placebo patches or placebo tablets and nicotine patches. Plasma samples were obtained 1 week before their cessation attempt and weekly during medication administration. Abstinence was assessed weekly. RESULTS Weekly hormone data replicated commonly observed menstrual cycle patterns of progesterone and estradiol levels. Importantly, increases in progesterone level were associated with a 23% increase in the odds for being abstinent within each week of treatment. This effect was driven primarily by nicotine patch-treated versus VAR-treated females. CONCLUSIONS This study was the first to identify an association between progesterone level (increasing) and abstinence outcomes in free-cycling women smokers who participated in a medication-based treatment. Furthermore, the potential benefits of progesterone may vary across different pharmacotherapies. Implications of these findings for smoking cessation intervention are discussed.
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Affiliation(s)
- Michael E Saladin
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC; Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC;
| | - Erin A McClure
- Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC
| | - Nathaniel L Baker
- Department Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Matthew J Carpenter
- Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | | | - Karen J Hartwell
- Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC; Substance Abuse Treatment Center, Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Kevin M Gray
- Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC; Youth Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Weinberger AH, Smith PH, Allen SS, Cosgrove KP, Saladin ME, Gray KM, Mazure CM, Wetherington CL, McKee SA. Systematic and meta-analytic review of research examining the impact of menstrual cycle phase and ovarian hormones on smoking and cessation. Nicotine Tob Res 2015; 17:407-21. [PMID: 25762750 DOI: 10.1093/ntr/ntu249] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION To determine the effect of ovarian hormones on smoking, we conducted a systematic review of menstrual cycle effects on smoking (i.e., ad lib smoking, smoking topography, and subjective effects) and cessation-related behaviors (i.e., cessation, withdrawal, tonic craving, and cue-induced craving). METHODS Thirty-six papers were identified on MEDLINE that included a menstrual-related search term (e.g., menstrual cycle, ovarian hormones), a smoking-related search term (e.g., smoking, nicotine), and met all inclusion criteria. Thirty-two studies examined menstrual phase, 1 study measured hormone levels, and 3 studies administered progesterone. RESULTS Sufficient data were available to conduct meta-analyses for only 2 of the 7 variables: withdrawal and tonic craving. Women reported greater withdrawal during the luteal phase than during the follicular phase, and there was a nonsignificant trend for greater tonic craving in the luteal phase. Progesterone administration was associated with decreased positive and increased negative subjective effects of nicotine. Studies of menstrual phase effects on the other outcome variables were either small in number or yielded mixed outcomes. CONCLUSIONS The impact of menstrual cycle phase on smoking behavior and cessation is complicated, and insufficient research is available upon which to conduct meta-analyses on most smoking outcomes. Future progress will require collecting ovarian hormone levels to more precisely quantify the impact of dynamic changes in hormone levels through the cycle on smoking behavior. Clarifying the relationship between hormones and smoking-particularly related to quitting, relapse, and medication response-could determine the best type and timing of interventions to improve quit rates for women.
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Affiliation(s)
| | - Philip H Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Sharon S Allen
- Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT
| | - Kelly P Cosgrove
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN
| | - Michael E Saladin
- Departments of Psychiatry, Diagnostic Radiology, and Neurobiology, Yale University School of Medicine, New Haven, CT
| | - Kevin M Gray
- Departments of Health Sciences and Research and Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT
| | - Cora Lee Wetherington
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Sherry A McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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Allen AM, Lunos S, Heishman SJ, al'Absi M, Hatsukami D, Allen SS. Subjective response to nicotine by menstrual phase. Addict Behav 2015; 43:50-3. [PMID: 25553511 DOI: 10.1016/j.addbeh.2014.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The luteal menstrual phase might be a favorable time for smoking cessation when non-nicotine interventions (e.g. counseling, bupropion) are used, whereas the follicular menstrual phase appears favorable when nicotine interventions are used. Thus, there may be an interaction between menstrual phase and response to nicotine. We sought to examine the role of menstrual phase on response to nicotine during acute smoking abstinence. METHODS In this controlled cross-over trial, women completed two identical experimental sessions (follicular [F] vs. luteal [L] phase) after four days of biochemically-verified smoking abstinence. During the sessions, nicotine nasal spray was administered, and participants provided a series of subjective assessments. RESULTS Participants (n=140) were 29.7±6.6years old and smoked 12.6±5.8 cigarettes per day. Compared to the F phase, the L phase was associated with a greater increase in stimulation (7.2±2.2 vs. 14.4±2.3, p=0.01, respectively) and greater decrease in urge to smoke (-13.6±2.3 vs. -21.1±2.5, p=0.02, respectively) after the first dose of nicotine. No other significant differences were observed. CONCLUSIONS Out of 13 total measures examined at two different time points, we observed only two significant menstrual phase differences in the subjective response to nicotine. Therefore, these data do not provide strong evidence for a menstrual phase difference in the subjective response to nicotine. Additional research is needed to confirm this relationship and explore how non-nicotine smoking reinforcements (such as sensory sensations) may vary by menstrual phase.
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Affiliation(s)
- Alicia M Allen
- Department of Family Medicine & Community Health, Medical School, University of Minnesota, 717 Delaware Street SE, Room 422, Minneapolis, MN, USA 55414.
| | - Scott Lunos
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN 55414, USA
| | - Stephen J Heishman
- Nicotine Psychopharmacology Section, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mustafa al'Absi
- Department of Behavioral Sciences, Medical School, University of Minnesota, DuluthDuluth, MN 55812, USA
| | - Dorothy Hatsukami
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN 55414, USA
| | - Sharon S Allen
- Department of Family Medicine & Community Health, Medical School, University of Minnesota, Minneapolis, MN 55414, USA
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Ovarian hormones and borderline personality disorder features: Preliminary evidence for interactive effects of estradiol and progesterone. Biol Psychol 2015; 109:37-52. [PMID: 25837710 DOI: 10.1016/j.biopsycho.2015.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 03/22/2015] [Accepted: 03/23/2015] [Indexed: 11/22/2022]
Abstract
Cyclical fluctuations in the ovarian hormones 17β-estradiol (E2; estrogen) and progesterone (P4) predict emotions, cognitive processes, and behaviors relevant to Borderline Personality Disorder (BPD); however, there are individual differences in sensitivity to normal hormone shifts. This study examined associations of naturally occurring hormonal changes with concurrent BPD feature expression. Forty women sampled for a flat distribution of the PAI-BOR (n=10 where T<50, n=10 where 50<T<60, n=10 where 60<T<70, and n=10 where T>70) provided four weekly saliva samples and psychological assessments. Across most outcomes (e.g., BPD features, felt rejection, anger rumination, negative urgency) P4 deviation (from one's person mean) moderated the effect of current E2 deviation (from one's person mean) among women high (+1 SD) in trait BPD features such that E2 deviation was negatively associated with symptoms only when P4 was higher-than-usual. Cyclical hormone changes (e.g., higher P4 in the luteal phase; E2 fluctuations at ovulation and in the luteal phase) may impact BPD feature expression among at-risk women.
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Franklin TR, Jagannathan K, Wetherill RR, Johnson B, Kelly S, Langguth J, Mumma J, Childress AR. Influence of menstrual cycle phase on neural and craving responses to appetitive smoking cues in naturally cycling females. Nicotine Tob Res 2015; 17:390-7. [PMID: 25762748 DOI: 10.1093/ntr/ntu183] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Functional magnetic resonance imaging (fMRI) has been used extensively in an attempt to understand brain vulnerabilities that mediate maladaptive responses to drug cues. Using perfusion fMRI, we have consistently shown reward-related activation (medial orbitofrontal cortex/ventral striatum) to smoking cues (SCs). Because preclinical and clinical studies generally show that progesterone may reduce reward and craving, we hypothesized that females in the follicular phase of the cycle (FPs; when progesterone levels are low) would have greater reward-related neural responses to SCs compared with females in the luteal phase (LPs). METHODS Sated cigarette-dependent premenopausal naturally cycling females underwent pseudo-continuous arterial spin-labeled perfusion fMRI during exposure to 10-min audio visual clips of appetitive SCs and non-SCs. Brain responses to SCs relative to non-SCs were examined among females grouped according to menstrual cycle (MC) phase at the time of scanning (22 FPs, 15 LPs). Craving scores were acquired pre- and post-SC exposure. RESULTS FPs showed increased neural responses to SCs compared with non-SCs in the medial orbitofrontal cortex (p ≤ .05 corrected), whereas LPs did not. FPs reported SC-elicited craving (p ≤ .005), whereas LPs did not. Within FPs, SC-induced craving correlated with increased neural responses in the anterior insula (r = 0.73, p < .0001). CONCLUSIONS FPs may be more vulnerable to relapse during appetitive SC exposure than LPs. Because the influence of MC phase on drug cue neural activity has not been examined, these results contribute to our knowledge of the neurobiological underpinnings of responses to drug cues, and they highlight the importance of monitoring menstrual cycle phase in all areas of addiction research.
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Affiliation(s)
- Teresa R Franklin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Kanchana Jagannathan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Reagan R Wetherill
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Barbara Johnson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Shannon Kelly
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Jamison Langguth
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Joel Mumma
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Anna Rose Childress
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
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Hinderaker K, Allen AM, Tosun N, al'Absi M, Hatsukami D, Allen SS. The effect of combination oral contraceptives on smoking-related symptomatology during short-term smoking abstinence. Addict Behav 2015; 41:148-51. [PMID: 25452059 DOI: 10.1016/j.addbeh.2014.10.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/12/2014] [Accepted: 10/19/2014] [Indexed: 12/20/2022]
Abstract
Although an estimated 25% of premenopausal smokers report using oral contraceptives (OC), little is known about how OC use may influence smoking cessation. The purpose of this study was to examine the difference in smoking-related symptomatology during acute smoking abstinence between women on a standardized combination OC (Tri-Sprintec(™)) compared to women not on OCs (no-OC). Participants were women aged 18-40 who smoked ≥5 cigarettes/day and reported regular menstrual cycles. Using a controlled cross-over design, participants completed two six-day testing weeks: Low Progesterone Week (LPW; Follicular (F) phase in no-OC or 1st week of pills in OC) and High Progesterone Week (HPW; Luteal (L) phase in no-OC or 3rd week of pills in OC). Each testing week included daily assessment of symptomatology and biochemical confirmation of smoking status. During smoking abstinence, the OC group (n=14) reported significantly lower levels of positive affect (21.56±7.12 vs. 24.57±6.46; β=3.63, p=0.0323) than the no-OC group (n=28). Further significant interactions between group and testing week were observed as follows: Smoking satisfaction was higher during LPW in the OC group (LPW: 4.29±1.30 vs. HPW: 4.10±1.37) but higher during HPW in the no-OC group (LPW: 3.91±1.30 vs. HPW: 4.23±1.30; β=-0.5499, p<0.0001). Similar interactions were noted in negative affect and psychological reward of smoking. These results suggest that women on OCs may have different patterns of smoking-related symptomatology during short-term smoking abstinence as compared to women not on OCs. Additional work is needed to examine how this may affect smoking cessation efforts.
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Abstract
There are significant gender differences in course, symptomology, and treatment of substance use disorders. In general data from clinical and preclinical studies of substance use disorders suggest that women are more vulnerable than men to the deleterious consequences of drug use at every phase of the addiction process. In addition data from epidemiologic studies suggest that the gender gap in the prevalence of substance use is narrowing particularly among adolescence. Therefore, understanding the role of estrogen and progesterone in mediating responses to drugs of abuse is of critical importance to women's health. In this review we will discuss findings from clinical and preclinical studies of (1) reproductive cycle phase; (2) endogenous ovarian hormones; and (3) hormone replacement on responses to stimulants, nicotine, alcohol, opioids, and marijuana. In addition, we discuss data from recent studies that have advanced our understanding of the neurobiologic mechanisms that interact with estrogen and progesterone to mediate drug-seeking behavior.
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Saladin ME, Wray JM, Carpenter MJ, McClure EA, LaRowe SD, Upadhyaya HP, Gray KM. Menstrual cycle phase effects in the gender dimorphic stress cue reactivity of smokers. Nicotine Tob Res 2014; 17:607-11. [PMID: 25324432 DOI: 10.1093/ntr/ntu203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/22/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION We previously reported that female smokers evidence greater subjective craving and stress/emotional reactivity to personalized stress cues than males. The present study employed the same dataset to assess whether females in the follicular versus luteal phase of the menstrual cycle accounted for the gender differences. METHODS Two objective criteria, onset of menses and luteinizing hormone surge (evaluated via home testing kits), were used to determine whether female smokers were in either the follicular (n = 22) or the luteal (n = 15) phase of their menstrual cycle, respectively. The females and a sample of male smokers (n = 53) were then administered a laboratory-based cue reactivity paradigm that involved assessment of craving, stress, and emotional reactivity in response to counterbalanced presentations of both a personalized stress script and neutral/relaxed script. RESULTS While there were no significant differences between females in the follicular versus luteal phase on any outcome measure, females in the luteal menstrual phase reported greater craving than males whereas females in the follicular phase reported greater stress and arousal than males and perceived the stress cues as more emotionally aversive than males. CONCLUSIONS This preliminary investigation suggests that gender differences in craving versus affective responding to stress cues may, in part, be explained variation by menstrual cycle phase. Study limitations and implications of the findings for future research and treatment are briefly discussed.
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Affiliation(s)
- Michael E Saladin
- Department of Health Sciences and Research, Medical University of South Carolina (MUSC), Charleston, SC; Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC;
| | - Jennifer M Wray
- Department of Health Sciences and Research, Medical University of South Carolina (MUSC), Charleston, SC; Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC
| | - Matthew J Carpenter
- Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC; Hollings Cancer Center, MUSC, Charleston, SC
| | - Erin A McClure
- Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC
| | - Steven D LaRowe
- Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC; Substance Abuse Treatment Center, Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | | | - Kevin M Gray
- Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC; Youth Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC
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DeVito EE, Herman AI, Waters AJ, Valentine GW, Sofuoglu M. Subjective, physiological, and cognitive responses to intravenous nicotine: effects of sex and menstrual cycle phase. Neuropsychopharmacology 2014; 39:1431-40. [PMID: 24345818 PMCID: PMC3988546 DOI: 10.1038/npp.2013.339] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/20/2013] [Accepted: 12/07/2013] [Indexed: 11/09/2022]
Abstract
Nicotine dependence is a serious public health concern. Optimal treatment of nicotine dependence will require greater understanding of the mechanisms that contribute to the maintenance of smoking behaviors. A growing literature indicates sex and menstrual phase differences in responses to nicotine. The aim of this study was to assess sex and menstrual phase influences on a broad range of measures of nicotine response including subjective drug effects, cognition, physiological responses, and symptoms of withdrawal, craving, and affect. Using a well-established intravenous nicotine paradigm and biochemical confirmation of overnight abstinence and menstrual cycle phase, analyses were performed to compare sex (age 18-50 years; 115 male and 45 female) and menstrual cycle phase (29 follicular and 16 luteal) effects. Females had diminished subjective drug effects of, but greater physiological responses to, nicotine administration. Luteal-phase females showed diminished subjective drug effects and better cognition relative to follicular-phase women. These findings offer candidate mechanisms through which the luteal phase, wherein progesterone is dominant relative to estradiol, may be protective against vulnerability to smoking.
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Affiliation(s)
- Elise E DeVito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, Suite 701, 1 Church Street, New Haven, CT 06510, USA, Tel: +1 203 737 4882, Fax: +1 203 737 3591, E-mail:
| | - Aryeh I Herman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Science, Bethesda, MD, USA
| | - Gerald W Valentine
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,VA Connecticut Healthcare System, West Haven, CT, USA
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48
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Biases of attention in chronic smokers: Men and women are not alike. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2014; 14:742-55. [DOI: 10.3758/s13415-014-0287-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Allen AM, Oncken C, Hatsukami D. Women and Smoking: The Effect of Gender on the Epidemiology, Health Effects, and Cessation of Smoking. CURRENT ADDICTION REPORTS 2014; 1:53-60. [PMID: 27213132 PMCID: PMC4871621 DOI: 10.1007/s40429-013-0003-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Smoking is still the leading cause of premature morbidity and mortality. This paper examines new research on gender differences and the epidemiology of smoking, smoking-related morbidity and mortality, and factors that affect smoking cessation. The rate of decline in the prevalence of smoking has been slowing, especially among adolescent girls. New research suggests that, compared with men, women may be more susceptible to smoking-related morbidity and mortality. Gender-related barriers to smoking cessation include weight gain, sex hormones, and mood. Furthermore, the sensory aspects of smoking may have more of an effect on smoking treatment for women than for men. We discuss new studies that examine smoking-cessation interventions that may be particularly beneficial for women, including exercise (as an adjunct intervention), very low nicotine content cigarettes, and a variety of pharmacotherapy. Further research is needed to identify and target the gender-specific needs of smokers.
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Affiliation(s)
- Alicia M Allen
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, 717 Delaware Street SE, Room 422, Minneapolis, MN 55414, USA
| | - Cheryl Oncken
- Department of Medicine and Obstetrics and Gynecology, University of Connecticut School of Medicine, 263 Farmington, Farmington, CT 06030, USA,
| | - Dorothy Hatsukami
- Department of Psychiatry, Medical School, University of Minnesota, 717 Delaware Street SE, Room 256, Minneapolis, MN 55414, USA,
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McClure EA, Saladin ME, Baker NL, Carpenter MJ, Gray KM. Smoking topography and abstinence in adult female smokers. Addict Behav 2013; 38:2833-6. [PMID: 24018226 DOI: 10.1016/j.addbeh.2013.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/08/2013] [Accepted: 08/06/2013] [Indexed: 11/28/2022]
Abstract
Preliminary evidence, within both adults and adolescents, suggests that the intensity with which cigarettes are smoked (i.e., smoking topography) is predictive of success during a cessation attempt. These reports have also shown topography to be superior compared to other variables, such as cigarettes per day, in the prediction of abstinence. The possibility that gender may influence this predictive relationship has not been evaluated but may be clinically useful in tailoring gender-specific interventions. Within the context of a clinical trial for smoking cessation among women, adult daily smokers completed a laboratory session that included a 1-hour ad libitum smoking period in which measures of topography were collected (N=135). Participants were then randomized to active medication (nicotine patch vs. varenicline) and abstinence was monitored for 4weeks. Among all smoking topography measures and all abstinence outcomes, a moderate association was found between longer puff duration and greater puff volume and continued smoking during the active 4-week treatment phase, but only within the nicotine patch group. Based on the weak topography-abstinence relationship among female smokers found in the current study, future studies should focus on explicit gender comparisons to examine if these associations are specific to or more robust in male smokers.
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Affiliation(s)
- Erin A McClure
- Medical University of South Carolina, Charleston, SC, USA.
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