Is the Effect of Anhedonia on Smoking Cessation Greater for Women Versus Men?

Abstract

Introduction: Anhedonia has been recognized as a major risk factor for smoking persistence. Potential gender differences in the effect of anhedonia on smoking cessation have not been studied. Using data from a completed clinical trial of maintenance nicotine patch therapy, we hypothesized that gender would moderate the effect of anhedonia on short-term abstinence, such that anhedonic women would be less likely to achieve abstinence. Methods: Participants (N = 525; 50% female, 48.2% Black/African American, average age: 46 years) received 21 mg/day nicotine patch and four brief behavior counseling sessions over 8 weeks. Participants were classified at baseline using the Snaith-Hamilton Pleasure Scale as anhedonic (scores > 2) or hedonic (scores ≤ 2). Bioverified 7-day point prevalence abstinence was measured at week 8. Using logistic regression analysis, we tested the interaction of anhedonia by gender predicting abstinence, adjusting for age, race, nicotine dependence, and baseline depressive symptomatology. Results: Seventy participants (13%) were classified as anhedonic. Men were more likely to be anhedonic than women (16.6% vs. 10.2%, p = .03). Contrary to our hypothesis, the interaction of anhedonic status (hedonic vs. anhedonic) by gender was nonsignificant (p = .18). There was a main effect of hedonic capacity, such that anhedonia predicted abstinence, odds ratio = 3.24, 95% confidence interval = 1.39-7.51, p = .006. Conclusion: Both male and female anhedonic smokers were more likely to be abstinent, which contrasts with prior research indicating that anhedonia is a risk factor for difficulty quitting. This unexpected finding may be explained by a possible selective benefit of nicotine patch therapy, which has been observed in some studies to have antidepressant effects. Implications: This is the first study to examine whether the association between pretreatment anhedonia and smoking cessation differs by gender. For both women and men, anhedonia was associated with a greater likelihood of abstinence after 8 weeks of treatment with 21 mg/day nicotine patch and behavior counseling. Our findings indicate that the association between anhedonia and smoking cessation is not as clear as has been assumed and may depend in part on the type of treatment delivered.

Positive Affect as a Predictor of Smoking Cessation and Relapse: Does It Offer Unique Predictive Value among Depressive Symptom Domains?

“…The present findings, along with those of prior studies that show either no relationship between low PA and quitting (Schnoll et al, 2013) or a positive relationship between anhedonia and quitting (Powers et al, 2016), suggest caution regarding the proposal that increased PA should be a central focus of targeted treatments in order to improve cessation outcomes (Audrain-McGovern, Wileyto, Ashare, Cuevas, & Strasser, 2014; Hoeppner, Hoeppner, Kelly, Schick, & Kelly, 2017; Leventhal et al, 2014; Leventhal et al, 2008). At the same time, the results of three pilot studies do suggest some early potential for interventions that focus primarily on boosting PA to assist smokers with low PA to quit successfully (Kahler et al, 2014; Kahler et al, 2015; MacPherson et al, 2010).…”

“…Cook, Spring, McChargue, & Doran, 2010) smokers, or (b) smokers receiving antidepressant pharmacotherapy (Doran et al, 2006), limiting generalizability. Recent studies that do not have these characteristics have been more mixed, with some studies supporting the relationship between low PA or anhedonia and smoking cessation (Castro et al, 2014; Leventhal et al, 2014) and others failing to demonstrate a relationship (Schnoll, Leone, & Hitsman, 2013) or showing that anhedonia predicted better cessation outcomes (Powers et al, 2016). Consequently, additional evaluation of the predictive value of PA or smoking cessation is warranted, including a replication of the finding that low PA offers unique predictive value beyond the broader construct of depression.…”

Addiction, Anhedonia, and Comorbid Mood Disorder. A Narrative Review

“…Only in one study did anhedonia have a positive effect on treatment (30). In the clinical cessation trial on 21-mg nicotine patch a day for 8 weeks, 70 participants were anhedonic based on the SHAPS.…”

“…Of interest in this review is the finding that substitution treatment (i.e., nicotine patch) might be beneficial specifically for smokers scoring high on anhedonia. Powers et al (30) showed an increased likelihood of short-term abstinence using a 21-mg/day nicotine patch therapy. Cook et al (34) observed that administering nicotine replacement therapy suppressed abstinence-induced anhedonia and alleviated nicotine withdrawal symptoms during short-term abstinence.…”

“…It has been hypothesized that nicotine exposure ameliorates the hypoactivation in crucial structures of the reward pathway (including caudate, nucleus accumbens, putamen) among depressed smokers, with data showing increased activation after nicotine administration in the dorsal striatum during anticipatory reward responding and in the medial prefrontal cortex associated with sensitivity to reward (67). It has to be noted that the sample of anhedonic participants in the study of Powers et al (30) was small, and the lack of a placebo condition made it difficult to draw inferences about the impact of nicotine patch therapy on pretreatment anhedonia or depression more generally. Finally, there is preliminary evidence that aripiprazole might promote alcohol abstinence and reduce anhedonia, possibly via dopaminergic and serotonergic modulations at the fronto-subcortical circuitries (68).…”