Progesterone improves cognitive performance and attenuates smoking urges in abstinent smokers

Sofuoglu, Mehmet; Mouratidis, Maria; Mooney, Marc E

doi:10.1016/j.psyneuen.2010.07.005

Cited by 68 publications

(70 citation statements)

References 89 publications

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“…Serum levels of progesterone were comparable to previous studies administering similar doses (200 mg twice daily) of exogenous progesterone. 57 No participants required alteration of dosage. Daily vaginal bleeding was reported in 22% of participants, regardless of randomization, or breastfeeding status and is a common occurrence with progesterone treatment.…”

Section: Discussionmentioning

confidence: 99%

Progesterone and Postpartum Smoking Relapse: A Pilot Double-Blind Placebo-Controlled Randomized Trial

Allen

Lunos

et al. 2016

NICTOB

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Introduction: Pregnancy is a strong motivator to quit smoking, yet postpartum relapse rates are high. Growing evidence suggests a role of sex hormones in drug abuse behavior and given the precipitous drop in sex hormones at delivery, they may play a role in postpartum relapse. This pilot study evaluates the feasibility and potential role of exogenous progesterone in postpartum smoking relapse. Methods: This 12-week double-blind placebo-controlled randomized pilot trial randomized 46 abstinent postpartum women to active progesterone (PRO; 200 mg twice a day) versus placebo (PBO) for 4 weeks. Participants were followed for relapse for 12 weeks. Main study outcomes include abstinence (point prevalence), feasibility (compliance per number of clinic visits attended, pill counts and Electronic Data Capture [EDC] completed) and self-reported acceptability. Safety was also measured by depressive symptom scores, adverse events, and breastfeeding. Results: Overall retention rate was 87% at week 12. At week 4, abstinence rates were 75% in the PRO group and 68.2% in the PBO group (p = .75). Medication adherence was 68% and clinic visit attendance was 80%, with no differences by randomization. Depressive symptom scores, adverse events, and breastfeeding did not vary by randomization. Conclusions: Although the study was not powered to evaluate abstinence rates, we did observe a higher prevalence of abstinence at week 4 in the PRO group. Further, exogenous progesterone was well tolerated and did not adversely affect depressive symptoms or breastfeeding. Thus, the results of this pilot study indicate further investigation into progesterone as a postpartum relapse prevention strategy is warranted. Implications: This innovative pilot trial determined the feasibility of delivering exogenous progesterone as a potential prevention of postpartum smoking relapse. We observed high retention and moderate adherence rates, as well as high acceptability among participants. Further, though not statistically significant, more women in the treatment group remained abstinent from smoking during follow-up. This project adds to the growing body of literature on the role of sex hormones in smoking relapse and also provides support for a fully powered clinical trial.

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Section: Discussionmentioning

confidence: 99%

Progesterone and Postpartum Smoking Relapse: A Pilot Double-Blind Placebo-Controlled Randomized Trial

Allen

Lunos

et al. 2016

NICTOB

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“…The most commonly studied outcome variable was cigarette smoking and these studies yielded mixed results: six studies reported no differences in number of cigarettes smoked by menstrual cycle phase 49,59,60,63 or ovarian hormones, 41,43 three studies reported greater cigarette smoking during the luteal phase, 40,57,61 and five studies reported greater smoking during menses compared either to later in the follicular phase 47,62,67 or other phases (Table 2). 61,68 Smoking Topography Because only two studies were identified that examined smoking topography, 41,67 there were insufficient data for a meta-analysis.…”

Section: Ad Lib Smokingmentioning

confidence: 99%

“…43,50,55 There were insufficient data for meta-analysis so the individual studies are reviewed below. The first study 38 found lower reported positive subjective effects in response to intravenous (IV) nicotine (e.g., "high," "feel good," "want more") for women in the luteal phase compared to women in the follicular phase.…”

Section: Subjective Effects Of Smokingmentioning

confidence: 99%

“…Responses to progesterone versus placebo for just female participants were not reported. Finally, participants in the fourth study 43 were 30 women in the early part of the follicular phase and 34 men who were randomly assigned to receive 200 mg of progesterone, 400 mg progesterone, or placebo for four days. Participants were asked to abstain from smoking for the last three days of medication administration and then completed a laboratory session where subjective effects of smoking were rated after a 2-hr ad lib smoking period.…”

Section: Subjective Effects Of Smokingmentioning

confidence: 99%

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Systematic and Meta-Analytic Review of Research Examining the Impact of Menstrual Cycle Phase and Ovarian Hormones on Smoking and Cessation

Weinberger¹,

Smith

Allen

et al. 2015

Nicotine & Tobacco Research

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Introduction: To determine the effect of ovarian hormones on smoking, we conducted a systematic review of menstrual cycle effects on smoking (i.e., ad lib smoking, smoking topography, and subjective effects) and cessation-related behaviors (i.e., cessation, withdrawal, tonic craving, and cue-induced craving). Methods: Thirty-six papers were identified on MEDLINE that included a menstrual-related search term (e.g., menstrual cycle, ovarian hormones), a smoking-related search term (e.g., smoking, nicotine), and met all inclusion criteria. Thirty-two studies examined menstrual phase, 1 study measured hormone levels, and 3 studies administered progesterone. Results: Sufficient data were available to conduct meta-analyses for only 2 of the 7 variables: withdrawal and tonic craving. Women reported greater withdrawal during the luteal phase than during the follicular phase, and there was a nonsignificant trend for greater tonic craving in the luteal phase. Progesterone administration was associated with decreased positive and increased negative subjective effects of nicotine. Studies of menstrual phase effects on the other outcome variables were either small in number or yielded mixed outcomes. Conclusions: The impact of menstrual cycle phase on smoking behavior and cessation is complicated, and insufficient research is available upon which to conduct meta-analyses on most smoking outcomes. Future progress will require collecting ovarian hormone levels to more precisely quantify the impact of dynamic changes in hormone levels through the cycle on smoking behavior. Clarifying the relationship between hormones and smoking-particularly related to quitting, relapse, and medication response-could determine the best type and timing of interventions to improve quit rates for women.

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“…These findings are supported by experimental animal studies, which have demonstrated decreased motivation for nicotine when progesterone levels are high (Lynch, 2009). However, the effects of progesterone on smoking behavior in women are less clear (Sofuoglu, Babb, & Hatsukami, 2001;Sofuoglu, Mouratidis, & Mooney, 2011).The majority of research examining the effects of ovarian hormones on smoking has used menstrual cycle phase as a proxy for ovarian hormone function. These studies typically compare women in different phases of the menstrual cycle (e.g., follicular vs. luteal), and the results have been quite mixed.…”

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confidence: 99%

Association between ovarian hormones and smoking behavior in women.

Schiller¹,

Saladin²,

Gray³

et al. 2014

Translational Issues in Psychological Science

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Studies examining the association between menstrual cycle phases and smoking behavior in women have yielded mixed results. The purpose of this study was to elucidate the associations between ovarian hormones and smoking by directly measuring ovarian hormone levels and obtaining a laboratory assessment of smoking behaviors. Four hypotheses were tested: increased smoking will be associated with 1) low absolute levels of estradiol and progesterone; 2) decreasing (i.e., dynamic changes in) estradiol and progesterone; 3) lower ratios of progesterone to estradiol, and 4) higher ratios of estradiol to progesterone. Female smokers (≥10 cigarettes/day) with regular menstrual cycles were recruited as part of a larger, ongoing study examining the influence of ovarian hormones on smoking cessation treatment. Participants completed two study visits, including a one-hour adlib smoking topography session, which provided a detailed assessment of smoking behavior. Both the change in hormone levels over time and the relative ratios of ovarian hormones were associated with smoking behavior, but each to a limited extent. Decreases in estradiol (r=−.21, p=.048), and decreases in progesterone (r=−.23, p=.03) were associated with increased puff intensity. Lower ratios of progesterone to estradiol were associated with a greater number of puffs (r=−.26, p=.01) and weight of cigarettes smoked (r=−.29, p=.005). The best predictors of smoking behavior were the ratio of progesterone to estradiol (z=−2.7, p=. 004) and the change in estradiol and progesterone over time (z=−2.1, p=.02). This pattern of results may help to explain inconsistent findings in previous studies and suggest potential mechanisms by which hormones influence nicotine addiction. KeywordsEstrogen; progesterone; nicotine; tobacco; women Smoking is the leading cause of preventable death in the United States (Danaei et al., 2009). Although men are more likely to smoke than women (USDHS, 2010), women may be more sensitive to certain aspects of nicotine addition. For example, women are more sensitive to * Corresponding author. University of North Carolina at Chapel Hill, Department of Psychiatry, CB#7175, Chapel Hill, NC 27599. Phone: (919) 843-2482 Fax: (919) 966-0708 crystal_schiller@med.unc.edu. Drs. Saladin, Gray, Carpenter, and Hartwell designed the study and wrote the protocol. Dr. Schiller conducted literature searches, provided summaries of previous research studies, and conducted the statistical analysis. Dr. Schiller wrote the first draft of the manuscript, and all authors contributed to and have approved the final manuscript.The authors declare that they have no additional conflicts of interest. (Myers, Taylor, Moolchan, & Heishman, 2008;Sofuoglu, Mitchell, & Mooney, 2009) and more likely to cite tension reduction, stimulation, social dynamics (Berlin et al., 2003), and appetite suppression as reasons for smoking (Reid, Pipe, Riley, & Sorensen, 2009). Smoking is associated with significant health risks in women (Perkins, 2001), and more women than men r...

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Progesterone improves cognitive performance and attenuates smoking urges in abstinent smokers

Cited by 68 publications

References 89 publications

Progesterone and Postpartum Smoking Relapse: A Pilot Double-Blind Placebo-Controlled Randomized Trial

Progesterone and Postpartum Smoking Relapse: A Pilot Double-Blind Placebo-Controlled Randomized Trial

Systematic and Meta-Analytic Review of Research Examining the Impact of Menstrual Cycle Phase and Ovarian Hormones on Smoking and Cessation

Association between ovarian hormones and smoking behavior in women.

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