Reward Responsiveness Varies by Smoking Status in Women with a History of Major Depressive Disorder

Abstract

Major depressive disorder (MDD) and nicotine dependence are highly comorbid, with studies showing that ~50% of individuals with MDD smoke. The link between these disorders persists even after the clinical symptoms of depression subside, as indicated by high levels of nicotine dependence among individuals with remitted depression (rMDD). Recent evidence indicates that individuals with rMDD show blunted responses to reward as measured by a probabilistic reward task (PRT), which assesses the ability to modify behavior as a function of reward history. Given nicotine's ability to enhance reward responsiveness, individuals with rMDD might smoke to address this persistent reward deficit. However, it is unclear whether smokers with rMDD show enhanced reward responsiveness relative to rMDD individuals who do not smoke. To test this hypothesis, we evaluated reward responsiveness on the PRT in four groups (N=198): individuals with and without rMDD who were or were not nicotine dependent. As hypothesized, rMDD nonsmokers had lower reward responsiveness relative to both control nonsmokers and rMDD smokers; conversely, smokers with rMDD showed behavioral patterns comparable to those without a history of depression. Given nicotine's ability to enhance reward sensitivity, it is possible that nicotine normalizes the otherwise blunted reward responsiveness in individuals with rMDD. Therapies aimed at enhancing this reward-based deficit may be beneficial in the treatment of both nicotine dependence and MDD.

Blunted Neural Responses to Reward in Remitted Major Depression: A High-Density Event-Related Potential Study

“…Specifically, blunted response bias has been observed following administration of a low dose of the D2/D3 agonist pramipexole (which is assumed to reduce phasic DA signaling via DA autoreceptor stimulation [34]) and following a lab-based stressor hypothesized to interfere with phasic DA signaling [35]. Deficits on the PRT have also been found to improve in acutely depressed [36] as well as remitted depressed [37] individuals who smoke, putatively because nicotine increases phasic DA firing [38, 39]. These separate lines of evidence provide support for the hypothesis that the blunted response bias observed in our rMDD sample may reflect a trait-like dysfunction in phasic DA signaling that persists beyond depression remission.…”

Cigarette craving is associated with blunted reward processing in nicotine-dependent smokers

“…The task was adapted from Tripp and Alsop (1999) by Pizzagalli et al (2005) to objectively assess reward responsivity by identifying an individual’s propensity to modify behavior as a function of recent reinforcement history. The task has been described in detail elsewhere (see Pizzagalli et al, 2005) and validated in multiple, independent samples (e.g., Barr et al 2008b; Janes et al, 2015; Pizzagalli et al 2008, 2009; Pergadia et al, 2004).…”

“…Nicotine’s ability to enhance reward function suggests that the propensity to smoke may be higher in those with blunted hedonic capacity (Audrain-McGovern et al, 2012), implying that nicotine may ameliorate an underlying disruption in reward function (Cardenas et al, 2002; Janes et al, 2015). This hypothesis would explain the high prevalence of nicotine dependence in psychiatric disorders that are characterized by blunted hedonic capacity such as major depressive disorder (Glassman et al, 1990) and schizophrenia (de Leon et al, 1995; de Leon and Diaz, 2005).…”

“…This task has been used extensively to evaluate individual’s ability to modify behavior as a function of monetary (non-drug) reinforcement (AhnAllen et al, 2012; Janes et al, 2015; Pechtel et al, 2013; Pizzagalli et al, 2005, 2008, 2009; Santesso et al, 2008) and is sensitive enough to detect not only disruptions in reward processing (Pizzagalli et al, 2005, 2008), but nicotine-related perturbations in reward sensitivity (Barr et al, 2008; Janes et al, 2015; Pergadia et al, 2014). …”

Behavioral and Electrophysiological Alterations for Reinforcement Learning in Manic and Euthymic Patients with Bipolar Disorder

“…However, we cannot completely rule out the potential effects of psychotropic medications. Third, we did not consider smoking effects on the reward learning, although smoking status and cravings may modulate reward learning .…”