Need for medication to complement catecholamines in smoking cessation of hardcore smokers

Abstract

Many smokers find it difficult to stop smoking without assistance. The antidepressants bupropion and nortriptyline can aid smoking cessation. The main aim of this study was to understand the pathophysiology of smoking cessation better based on biological backgrounds. We investigated the following biological markers for any alterations during smoking cessation in the absence of pharmacotherapy: the dopamine metabolite homovanillic acid (HVA), the noradrenaline metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) and brain-derived neurotrophic factor (BDNF). Assessment and blood sampling were performed at a baseline (the start) time point and at a critical time point during smoking cessation. Seven of 30 smokers quit during a 16-week follow-up period; these smokers were defined as remission group from tobacco dependence. The remaining 23 smokers were categorized as hardcore smokers. The smoking group was compared with 23 non-smokers matched for age and gender. We compared blood levels of biological markers in each of the three groups. The hardcore smoker group showed significant decreases in HVA and MHPG levels between baseline and the critical time point (p=0.018 and p=0.033, respectively). However, the remission from tobacco dependence group exhibited no significant changes in any of the biomarkers examined. They had lower scores on the Minnesota nicotine withdrawal scale than the hardcore smoker group (p=0.002). The hardcore smoker group had higher MHPG and BDNF levels than the non-smoker group (p=0.002 and p<0.001, respectively). Hardcore smokers experience severe nicotine withdrawal symptoms. Nicotine withdrawal is associated with catecholamine deficiency. The resulting withdrawal symptoms make quitting difficult for hardcore smokers. These hardcore smokers may require medication to compensate for the catecholamine deficit. Non-nicotinic medications such as bupropion, nortriptyline, or varenicline may be required to bolster the catecholamine deficit in hardcore smokers.

The Impacts of Supervised Exercise Intervention on Tobacco Withdrawal Symptoms

“… 15 Furthermore, exercise intervention can help to maintain the catecholamine homeostasis to increase the pleasure effect during abstinence from smoking. 66 In a previous study, heavy smokers were found to face difficulty in regulating immediate brain catecholamine release as mediated by decreases in dopamine and noradrenaline, thus predisposing them to more severe withdrawal symptoms. 66 To counteract these negative effects, antidepressants were prescribed to increase the catecholamine level during abstinence.…”

“… 66 In a previous study, heavy smokers were found to face difficulty in regulating immediate brain catecholamine release as mediated by decreases in dopamine and noradrenaline, thus predisposing them to more severe withdrawal symptoms. 66 To counteract these negative effects, antidepressants were prescribed to increase the catecholamine level during abstinence. When taken, the synergistic effect between antidepressants and catecholamines can contribute to more severe TWS.…”

“…A previous study reported that TWS severity was related to decreased levels of dopamine and catecholamine. 66 In this context, most pharmacotherapy treatment targets the actions of dopamine as its reduction can promote intense withdrawal. 66 Indirectly, this demonstrated the beneficial effects of our exercise intervention, as reported by.…”

“… 66 In this context, most pharmacotherapy treatment targets the actions of dopamine as its reduction can promote intense withdrawal. 66 Indirectly, this demonstrated the beneficial effects of our exercise intervention, as reported by. 15 Furthermore, exercise intervention can help to maintain the catecholamine homeostasis to increase the pleasure effect during abstinence from smoking.…”

Improving patient education about tobacco withdrawal and nicotine gum use by registered nurses in inpatient psychiatry: A feasibility study

“…Tobacco withdrawal symptoms are believed to be caused by decreased levels of both dopamine and norepinephrine (Kawai et al, 2017). Irregularities in these catecholamines are also involved in many psychiatric diagnoses, including depressive and anxiety disorders, bipolar disorder, schizophrenia and gambling disorder (Cousins, Butts, & Young, 2009;Felger & Lotrich, 2013;Hook et al, 2014;Mittal et al, 2017;Potenza, 2013).…”