Reward and Affective Regulation in Depression-Prone Smokers

Abstract

Background There is a disproportionately high smoking prevalence among individuals who are prone to depression. While depression has been conceptualized as a disorder of dysregulated positive affect and disrupted reward processing, little research has been conducted to determine the role of smoking in these processes among depression-prone smokers. Methods Depression-prone smokers (DP+; n = 34) and smokers not depression-prone (DP-; n=49) underwent two laboratory sessions, once while smoking abstinent and once while smoking ad-libitum, to assess the relative reinforcing value of smoking and reward sensitivity. Using experience sampling methods, participants completed self-report measures of subjective reward, positive affect, and negative affect across three days while smoking as usual and three days while smoking abstinent. Results DP+ were two times more likely to work for cigarette puffs versus money in a progressive ratio, choice task (OR 2.05; CI 95% 1.04 to 4.06, p=0.039) compared to DP-. Reward sensitivity as measured by the signal detection task did not yield any significant findings. Mixed models regressions revealed a 3-way interaction (depression group, smoking phase, and time) for subjective reward, negative affect and positive affect. For all three of these outcomes, the slopes for DP- and DP+ differed significantly from each other (p's < 0.05), and the effect of smoking (vs. abstinence) over time was greater for DP+ than DP- smokers (p's <0.05). Conclusions These findings indicate that the effects of smoking on reward and positive affect regulation are specific to DP+ smokers and highlight novel targets for smoking cessation treatment in this population.

Cognitive deficits specific to depression-prone smokers during abstinence.

“…Specifically, after overnight abstinence from smoking, the DP+ group responded more slowly to positive compared with neutral stimuli, which is thought to reflect the allocation of resources to emotionally salient stimuli (Epp et al, 2012). These data are also consistent with those from the larger study that found that smoking abstinence increased negative affect across all smokers, but the DP+ group also showed greater changes in positive affect (Audrain-McGovern et al, in press). In addition, depression-prone smokers experienced a greater loss of pleasure from other reinforcers during nicotine withdrawal suggesting that smoking may regulate positive affect, rather than simply reducing negative affect for depression-prone smokers (Audrain-McGovern et al, in press).…”

“…These data are also consistent with those from the larger study that found that smoking abstinence increased negative affect across all smokers, but the DP+ group also showed greater changes in positive affect (Audrain-McGovern et al, in press). In addition, depression-prone smokers experienced a greater loss of pleasure from other reinforcers during nicotine withdrawal suggesting that smoking may regulate positive affect, rather than simply reducing negative affect for depression-prone smokers (Audrain-McGovern et al, in press). Perhaps the reduction in the rewarding effects of other reinforcers during nicotine withdrawal contributed to the abstinence-induced attentional bias to positive stimuli in the DP+ group.…”

“…In the current study, abstinence-induced attentional bias to negative stimuli was only evident among males. This is partially consistent Audrain-McGovern and colleagues (in press) suggesting that abstinence alters the salience of negative stimuli, regardless of depression status. These findings highlight, for the first time, a more complex model of the relationship between depression status and the increased risk of smoking relapse.…”

Depression and cigarette smoking behavior: A critical review of population-based studies

“…Compared to adults who smoke and do not have depression, adults who smoke and have depression more strongly endorse beliefs about smoking including smoking to relieve negative affect (71,72). Adult smokers with depression also respond more strongly to smoking cues (73,74) and report greater reward from smoking (75)(76)(77). Further, adult smokers with depression also report more withdrawal symptoms and more severe symptoms of withdrawal during quit attempts (73,(78)(79)(80).…”

Diminished effort on a progressive ratio task in both unipolar and bipolar depression

“…The maximal effort exerted before choosing not to respond further provides a measure of motivation, referred to as a “breakpoint.” PRTs have been used to study motivation in humans, primarily in the context of addiction. For example, depressed smokers show greater PRT motivation to obtain nicotine than money (Audrain-McGovern et al, 2014) and recreational drinkers show increased PRT motivation for alcohol following depressed mood induction (Willner et al, 1998b). A strength of the PRT is its applicability in both animal models and humans, making this task especially useful for translational investigation (Scheggi et al, 2015; Willner et al, 1998a).…”