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A decrease in the plasma DHEA to cortisol ratio during smoking abstinence may predict relapse: a preliminary study

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Abstract

Rationale

Increases in depressive symptoms during smoking cessation have been associated with risk for relapse. Several studies have linked plasma levels of cortisol and dehydroepiandrosterone (DHEA) or DHEA-sulfate (DHEAS) to depressive symptoms.

Objectives

To determine whether changes in plasma cortisol, DHEA, or DHEAS levels and emergence of depressive symptoms during smoking cessation are associated with smoking relapse.

Materials and methods

Subjects were healthy non-medicated men and women, aged 39±12 years, who smoked, on average, 22 cigarettes per day. Depressive symptoms, smoking withdrawal symptoms, and plasma steroid levels were measured before and after 8 days of verified smoking abstinence. Relapse status at day 15 was then determined.

Results

In the full sample (n=63), there was a trend for changes in depressive symptoms to be associated with relapse. In the subset of 25 subjects with plasma neuroactive steroid data, there was a significant interaction between the change in the plasma DHEA/cortisol ratio from day 0 to day 8 and relapse status at day 15. This ratio was similar before abstinence, but lower at day 8 in relapsed, compared to abstinent, subjects. Changes in the DHEA/cortisol ratio tended to predict changes in depressive symptoms in the women only.

Conclusion

A decrease in the plasma DHEA/cortisol ratio during 8 days of smoking abstinence was associated with relapse over the following week. Further research is needed to fully characterize sex-specific relationships between abstinence-induced changes in neuroactive steroid levels, depressive or withdrawal symptoms, and relapse. Such research may lead to new interventions for refractory smoking dependence.

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Acknowledgements

This work was supported by the Yale Interdisciplinary Research Scholar Program on Women and Drug Abuse via the NIH Office of Research on Women’s Health (ORWH) and NIDA 1K12DA14038-01, the Yale Transdisciplinary Tobacco Use Research Center: P50DA13334, and a VA Merit Award to Dr. Rasmusson.

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Authors and Affiliations

  1. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Ann M. Rasmusson, Ran Wu, Prashni Paliwal & Suchitra Krishnan-Sarin

  2. Clinical Neuroscience Division, VA National Center for PTSD, West Haven, CT, USA

    Ann M. Rasmusson

  3. Department of Laboratory Medicine and Transdisciplinary Tobacco Use Research Center, Yale University School of Medicine, New Haven, CT, USA

    Ran Wu, George M. Anderson & Suchitra Krishnan-Sarin

  4. Division of Women’s Behavioral Health, Yale University School of Medicine, New Haven, CT, USA

    Prashni Paliwal

  5. Child Study Center, Yale University, New Haven, CT, USA

    George M. Anderson

  6. Psychiatry Service/116A, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA

    Ann M. Rasmusson

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Correspondence to Ann M. Rasmusson.

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Rasmusson, A.M., Wu, R., Paliwal, P. et al. A decrease in the plasma DHEA to cortisol ratio during smoking abstinence may predict relapse: a preliminary study. Psychopharmacology 186, 473–480 (2006). https://doi.org/10.1007/s00213-006-0367-6

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