title: Predicted Impact of Nicotine Reduction on Smokers with Affective Disorders.
abstract: OBJECTIVE
  In 2009 the FDA acquired the authority to reduce the nicotine content in cigarettes if appropriate for public health, prompting research to evaluate the implications of this policy scientifically. Studies in non-psychiatric populations show that reducing the nicotine content of cigarettes to non-addictive levels reduces smoking rates and nicotine dependence. However, few studies have examined this hypothesis in vulnerable populations.
  
  
  METHODS
  In this narrative review we examined the extant literature on the effects of nicotine reduction or cessation on symptoms of withdrawal, as well as psychiatric symptoms, among those with affective disorders.
  
  
  RESULTS
  Following initial withdrawal from nicotine, smokers with affective disorders experience more severe mood disruption than smokers without these disorders. Use of very low nicotine content (VLNC) cigarettes during abstinence may help mitigate the mood-disrupting effects of initial abstinence. Once the initial effects of nicotine withdrawal on mood have passed, longer-term abstinence is associated with psychiatric improvement rather than worsening.
  
  
  CONCLUSIONS
  These findings suggest that if a national nicotine reduction policy were to be implemented, smokers with affective disorders would need additional support to overcome initial withdrawal but that long-term outcomes would likely be positive.
authors.affiliation: Vermont Center of Behavior and Health, University of Vermont, Burlington VT.
authors.forename: Diann E
authors.initials: DE
authors.lastname: Gaalema
authors.affiliation: Center for Alcohol and Addictions Studies, Brown University, Providence RI.
authors.forename: Mollie E
authors.initials: ME
authors.lastname: Miller
authors.affiliation: Center for Alcohol and Addictions Studies, Brown University, Providence RI.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Tidey
keywords: PTSD; affective disorders; anxiety; comorbidity; depression; nicotine; withdrawal