title: A decrease in the plasma DHEA to cortisol ratio during smoking abstinence may predict relapse: a preliminary study.
abstract: BACKGROUND
  Increases in depressive symptoms during smoking cessation have been associated with risk for relapse. Several studies have linked plasma levels of cortisol and dehydroepiandrosterone (DHEA) or DHEA-sulfate (DHEAS) to depressive symptoms.
  
  
  OBJECTIVE
  To determine whether changes in plasma cortisol, DHEA, or DHEAS levels and emergence of depressive symptoms during smoking cessation are associated with smoking relapse.
  
  
  METHODS
  Subjects were healthy non-medicated men and women, aged 39+/-12 years, who smoked, on average, 22 cigarettes per day. Depressive symptoms, smoking withdrawal symptoms, and plasma steroid levels were measured before and after 8 days of verified smoking abstinence. Relapse status at day 15 was then determined.
  
  
  RESULTS
  In the full sample (n=63), there was a trend for changes in depressive symptoms to be associated with relapse. In the subset of 25 subjects with plasma neuroactive steroid data, there was a significant interaction between the change in the plasma DHEA/cortisol ratio from day 0 to day 8 and relapse status at day 15. This ratio was similar before abstinence, but lower at day 8 in relapsed, compared to abstinent, subjects. Changes in the DHEA/cortisol ratio tended to predict changes in depressive symptoms in the women only.
  
  
  CONCLUSIONS
  A decrease in the plasma DHEA/cortisol ratio during 8 days of smoking abstinence was associated with relapse over the following week. Further research is needed to fully characterize sex-specific relationships between abstinence-induced changes in neuroactive steroid levels, depressive or withdrawal symptoms, and relapse. Such research may lead to new interventions for refractory smoking dependence.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, and Clinical Neuroscience Division, VA National Center for PTSD, West Haven, CT 06516, USA. ann.rasmusson@yale.edu
authors.forename: Ann M
authors.initials: AM
authors.lastname: Rasmusson
authors.forename: Ran
authors.initials: R
authors.lastname: Wu
authors.forename: Prashni
authors.initials: P
authors.lastname: Paliwal
authors.forename: George M
authors.initials: GM
authors.lastname: Anderson
authors.forename: Suchitra
authors.initials: S
authors.lastname: Krishnan-Sarin
mesh_terms: D000328:Adult; D003687:Dehydroepiandrosterone / Q000097:blood*; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D003863:Depression / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D013375:Substance Withdrawal Syndrome / Q000097:blood*; D014029:Tobacco Use Disorder
chemical_list: D003687:Dehydroepiandrosterone; D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone