Brain Responses to Cigarette-Related and Emotional Images in Smokers During Smoking Cessation: No Effect of Varenicline or Bupropion on the Late Positive Potential

• Published in: Nicotine & tobacco research 2019-01, Vol.21 (2), p.234-240
• Main Authors: Versace, Francesco, Stevens, Elise M, Robinson, Jason D, Cui, Yong, Deweese, Menton M, Engelmann, Jeffrey M, Green, Charles E, Karam-Hage, Maher, Lam, Cho Y, Minnix, Jennifer A, Wetter, David W, Cinciripini, Paul M
• Format: Article
• Language: English
• Subjects: Adult; Brain - drug effects; Brain - physiology; Bupropion - pharmacology; Bupropion - therapeutic use; Cigarette Smoking - physiopathology; Cigarette Smoking - psychology; Cigarette Smoking - therapy; Double-Blind Method; Emotions - physiology; Female; Humans; Male; Middle Aged; Original Investigations; Photic Stimulation - methods; Smokers - psychology; Smoking Cessation - methods; Smoking Cessation Agents - pharmacology; Smoking Cessation Agents - therapeutic use; Treatment Outcome; Varenicline - pharmacology; Varenicline - therapeutic use
• ISSN: 1462-2203; 1469-994X
• DOI: 10.1093/ntr/ntx264

Varenicline and bupropion are two effective smoking cessation pharmacotherapies. Researchers have hypothesized that they might be effective, in part, because they reduce cue reactivity and cue-induced cravings. Here, we used event-related potentials (ERPs) to directly measure brain responses to cigarette-related and other motivationally relevant images during a pharmacologically aided quit attempt. Smokers involved in a 12-week placebo-controlled double-blind clinical trial of smoking cessation medications (varenicline, bupropion, placebo) took part in the study. We assessed participants at two time points: 24 h (n = 140) and 4 weeks (n = 176) after the quit date. At both sessions, we measured the amplitude of the late positive potential (LPP), an ERP component reliably associated with motivational relevance, and self-reported tonic craving using the brief version of the Questionnaire of Smoking Urges (QSU-Brief). At both sessions, emotional and cigarette-related images evoked significantly larger LPPs than neutral images. Neither drug type nor smoking abstinence altered this effect at either session. At both sessions, varenicline and bupropion significantly reduced self-reported tonic craving relative to the placebo condition. While both varenicline and bupropion reduced self-reported tonic craving, neither medication altered the amplitude of the LPP to cigarette-related or emotional pictures in smokers attempting to quit. These medications may influence abstinence by means other than by reducing neuroaffective responses to cigarette-related cues. Smokers should be prepared for the likelihood that even after several weeks of successful abstinence, once treatment ends, cigarette-related cues may remain motivationally relevant and trigger cravings that might lead to relapse. Bupropion and varenicline do not alter electrophysiological responses, as measured by the LPP, to cigarette-related and emotional images. These findings help explain why cigarette-related cues can trigger relapse when smoking cessation medication treatments end.