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

Authors Kawai A, Kurita M, Nishino S, Hirata E, Sato T, Okubo Y

Received 16 June 2017

Accepted for publication 7 August 2017

Published 18 September 2017 Volume 2017:13 Pages 2419—2424

DOI https://doi.org/10.2147/NDT.S144181

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Prof. Dr. Roumen Kirov

Peer reviewer comments 2

Editor who approved publication: Dr Roger Pinder


Atsuko Kawai,1,2 Masatake Kurita,1,3,4 Satoshi Nishino,3,4 Eishin Hirata,5 Tadahiro Sato,5 Yoshiro Okubo1

1Department of Psychiatry and Behavioral Science, Nippon Medical School, Bunkyo-ku, 2Total Health Clinic, Nanyo, 3Natori Station Front Clinic, Natori, 4Laboratory of Pharmacotherapy of Life-Style Related Diseases, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, 5Sato Hospital, Nanyo, Japan

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.

Keywords: brain-derived neurotrophic factor, dopamine, nicotine, noradrenaline, tobacco, withdrawal symptoms

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