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Randomized Controlled Trial
. 2017 Jun 1;19(6):703-709.
doi: 10.1093/ntr/ntw247.

Anhedonia: Its Dynamic Relations With Craving, Negative Affect, and Treatment During a Quit Smoking Attempt

Jessica W Cook  1   2 , Stephanie T Lanza  3   4 , Wanghuan Chu  5 , Timothy B Baker  1 , Megan E Piper  1
Affiliations
Randomized Controlled Trial

Anhedonia: Its Dynamic Relations With Craving, Negative Affect, and Treatment During a Quit Smoking Attempt

Jessica W Cook et al. Nicotine Tob Res. .

Abstract

Introduction: Research shows that abstinence from tobacco leads to a withdrawal-related decrement in responsivity to nondrug rewards (ie, anhedonia). However, it remains unclear how anhedonia relates to other key withdrawal symptoms and withdrawal-related constructs over time. We analyzed ecological momentary assessment data to examine whether a decrement in response to rewards during a 10-day period following quitting shows a pattern of associations with other variables (ie, treatment, tobacco dependence, negative affect, and craving) that is consistent with anhedonia being a tobacco withdrawal symptom.

Methods: As part of a randomized controlled trial of smoking cessation therapies, 1122 adults (58% female) were assigned to: placebo (n = 131), bupropion (alone or with nicotine lozenge; n = 401), or nicotine replacement therapy (NRT; lozenge, patch, both; n = 590). Participants completed 4 ecological momentary assessments per day for 10 days postquit, resulting in 22 575 assessments.

Results: Time-varying effect modeling showed that anhedonia was significantly greater among those high in dependence relative to lower dependent smokers out to day 9 postquit. The placebo group showed elevated anhedonia immediately postquit, which fell to levels similar to the treatment groups by day 7. NRT effectively reduced anhedonia and its time-varying association with craving early in the quit attempt. The positive association between negative affect and anhedonia was moderate and stable over time for both active treatment groups.

Conclusions: These results provide additional support that anhedonia following quitting smoking is a manifestation of the tobacco withdrawal syndrome.

Implications: This study supported the hypothesis that diminished responsivity to nondrug rewards (ie, anhedonia) is a symptom of the tobacco withdrawal syndrome. Results showed that anhedonia: (1) was significantly associated with dependence, especially during the early postquit period when withdrawal was at its peak intensity; (2) showed significant time-varying associations with other withdrawal symptoms, especially craving; and (3) was significantly suppressed by agonist administration as was its association with craving over time.

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Figures

Figure 1.
Figure 1.
(a) Time-varying mean anhedonia and corresponding 95% confidence interval during 10 days after cessation, by dependence level. (b) Time-varying mean anhedonia during 10 days after cessation, by treatment group. Square denotes region of time during which placebo and NRT groups had significantly different mean anhedonia.
Figure 2.
Figure 2.
(a) Overall time-varying effect of craving on anhedonia and corresponding 95% confidence interval during 10 days after cessation. (b) Time-varying effect of craving on anhedonia during 10 days after cessation, by treatment group. Square denotes region of time during which the association between craving and anhedonia was significantly different from zero.
Figure 3.
Figure 3.
(a) Overall time-varying effect of negative affect on anhedonia and corresponding 95% confidence interval during 10 days after cessation. (b) Time-varying effect of negative affect on anhedonia during 10 days after cessation, by treatment group. Square denotes region of time during which the association between negative affect and anhedonia was significantly different from zero.
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References

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