Neural Bases of Pharmacological Treatment of Nicotine Dependence - Insights from Functional Brain Imaging: A Systematic Review

• Published in: CNS drugs 2013-11, Vol.27 (11), p.921-941
• Main Authors: Menossi, Henrique Soila, Goudriaan, Anna E., de Azevedo-Marques Périco, Cintia, Nicastri, Sérgio, de Andrade, Arthur Guerra, D’Elia, Gilberto, Li, Chiang-Shan R., Castaldelli-Maia, João Mauricio
• Format: Article
• Language: English
• Subjects: Brain - physiopathology; Cigarettes; Dependence; Drug Discovery; Health care; Humans; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Neurology; Neurosciences; Nicotine; NMR; Nuclear magnetic resonance; Pharmacotherapy; Psychiatry; Psychopharmacology; Public access; Randomized Controlled Trials as Topic; Smoking cessation; Smoking Cessation - psychology; Studies; Substance Withdrawal Syndrome - physiopathology; Substance Withdrawal Syndrome - psychology; Systematic Review; Tobacco; Tobacco Use Disorder - drug therapy; Tobacco Use Disorder - physiopathology; Tobacco Use Disorder - psychology
• ISSN: 1172-7047; 1179-1934
• DOI: 10.1007/s40263-013-0092-8

Background Nicotine dependence is difficult to treat, and the biological mechanisms that are involved are not entirely clear. There is an urgent need to develop better drugs and more effective treatments for clinical practice. A critical step towards accelerating progress in medication development is to understand the neurobehavioral effects of pharmacotherapies on clinical characteristics associated with nicotine dependence. Objectives This review sought to summarize the functional magnetic resonance imaging (fMRI) literature on smoking cessation with the aim to better understand the neural processes underlying the effects of nicotinic and non-nicotinic pharmacological smoking cessation treatments on specific symptoms of nicotine dependence and withdrawal. Data Sources We conducted a search in Pubmed, Web of Science and PsycINFO databases with the keywords ‘fMRI’ or ‘functional magnetic resonance imaging’ and ‘tobacco’ or ‘nicotine’ or ‘smok*’. The date of the most recent search was May 2012. Study Eligibility Criteria, Participants and Interventions The original studies that were included were those of smokers or nicotine-dependent individuals, published in the English language, with pharmacological treatment for nicotine dependence and use of fMRI with blood oxygen level-dependent (BOLD) imaging or continuous arterial spin labelling (CASL). No date limit was applied. Study Appraisal and Synthesis Methods Two of the authors read the abstracts of all studies found in the search ( n  = 1,260). The inclusion and exclusion criteria were applied, and 1,224 articles were excluded. In a second step, the same authors read the remaining 36 studies. Nineteen of the 36 articles were excluded. The results were tabulated by the number of individuals and their mean age, the main sample characteristics, smoking status, study type and methodology, and the main fMRI findings. Results Seventeen original fMRI studies involving pharmacological treatment of smokers were selected. The anterior and posterior cingulate cortex, medial and lateral orbitofrontal cortex, ventral striatum, amygdala, thalamus and insula are heavily involved in the maintenance of smoking and nicotine withdrawal. The effects of varenicline and bupropion in alleviating withdrawal symptoms and decreasing smoking correlated with modulation of the activities of these areas. Nicotine replacement therapy seems to improve cognitive symptoms related to withdrawal especially by modulating activities of the defa