Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Ave. MC 3077, Chicago, IL 60637, USA.
Psychopharmacology (Berl). 2011 Nov;218(1):39-48. doi: 10.1007/s00213-010-2150-y. Epub 2011 Jan 15.
Relapse to smoking is often precipitated by stress, yet little is known about the effects of nicotine withdrawal on responses to acute stress, or whether nicotine replacement reverses withdrawal-induced changes in stress response.
The aim of the present study is to use an effective social stressor, the Trier Social Stress Test (TSST), to study subjective, cardiovascular and hormonal responses to stress during withdrawal, and examine whether nicotine replacement moderates responses to stress during withdrawal.
Forty-nine current regular smokers were randomly assigned to smoke as normal (SM), 12-h abstention with placebo patch (PL), or 12-h abstention with nicotine patch (NIC). They participated in a single session using the TSST, during which subjective affect, heart rate (HR), mean arterial blood pressure (MAP) and salivary cortisol were measured.
The TSST produced expected increases in subjective negative affect, HR, MAP, and cortisol. Groups did not differ in subjective or cardiovascular responses, but the PL group exhibited larger stress-induced increase in cortisol than the other groups.
The increased cortisol response might indicate a greater hormonal stress response during nicotine withdrawal. Alternatively, considering that cortisol also provides negative feedback to the stress system, and blunted cortisol responses are predictive of smoking relapse, the lower cortisol responses in the NIC and SM groups might indicate chronic dysregulation of the stress system. In this case, restoration of cortisol response by nicotine treatment to the lower levels seen during regular smoking may actually represent an undesired side effect of nicotine replacement.
吸烟复发通常是由压力引发的，但人们对尼古丁戒断对急性应激反应的影响知之甚少，也不知道尼古丁替代是否能逆转戒断引起的应激反应变化。
本研究旨在使用有效的社会应激源，即特里尔社会应激测试（TSST），来研究戒断期间应激的主观、心血管和激素反应，并研究尼古丁替代是否能调节戒断期间的应激反应。
49 名当前的经常吸烟者被随机分配吸烟正常组（SM）、12 小时戒断安慰剂贴片组（PL）或 12 小时戒断尼古丁贴片组（NIC）。他们参加了一次使用 TSST 的单一疗程，在此期间测量了主观情感、心率（HR）、平均动脉血压（MAP）和唾液皮质醇。
TSST 产生了预期的主观负性情绪、HR、MAP 和皮质醇增加。各组在主观或心血管反应方面没有差异，但 PL 组皮质醇的应激诱导增加大于其他组。
皮质醇反应的增加可能表明在尼古丁戒断期间存在更大的激素应激反应。或者，考虑到皮质醇也对应激系统提供负反馈，并且皮质醇反应迟钝是吸烟复发的预测因素，NIC 和 SM 组皮质醇反应较低可能表明应激系统的慢性失调。在这种情况下，通过尼古丁治疗将皮质醇反应恢复到正常吸烟时的较低水平实际上可能代表尼古丁替代的一种不良副作用。
