Cited by 157Nicotinic Acetylcholine Receptors StudySmoking Behavior and CessationNeuroscience and Neuropharmacology Research

The DOI matches its Crossref record; 150 of the 154 references it cites were found in a registry or an index; none of the 149 sources its claims cite is checked for support yet.

Mood and anxiety regulation by nicotinic acetylcholine receptors: A potential pathway to modulate aggression and related behavioral states

Open access
Picciotto, Marina R., Lewis, Alan S., van Schalkwyk, Gerrit I., Mineur, Yann S.·2015·Neuropharmacology

Abstract

The co-morbidity between smoking and mood disorders is striking. Preclinical and clinical studies of nicotinic effects on mood, anxiety, aggression, and related behaviors, such as irritability and agitation, suggest that smokers may use the nicotine in tobacco products as an attempt to self-medicate symptoms of affective disorders. The role of nicotinic acetylcholine receptors (nAChRs) in circuits regulating mood and anxiety are beginning to be elucidated in animal models, but the mechanisms underlying the effects of nicotine on aggression-related behavioral states (ARBS) are still not understood. Clinical trials of nicotine or nicotinic medications for neurological and psychiatric disorders have often found effects of nicotinic medications on ARBS, but few trials have studied these outcomes systematically. Similarly, the increase in ARBS resulting from smoking cessation can be resolved by nicotinic agents, but the effects of nicotinic medications on these types of mental states and behaviors in non-smokers are less well understood. Here we review the literature on the role of nAChRs in regulating mood and anxiety, and subsequently on the closely related construct of ARBS. We suggest avenues for future study to identify how nAChRs and nicotinic agents may play a role in these clinically important areas.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review synthesizes preclinical and clinical evidence that nicotinic acetylcholine receptors (nAChRs) regulate mood and anxiety and the closely related construct of aggression-related behavioral states (ARBS), suggesting smokers may use nicotine to self-medicate affective symptoms. It argues nicotinic agents may reduce ARBS across diagnoses, but mechanisms and whether agonists or antagonists are optimal remain unresolved.

Key findings

  • Preclinical work indicates that decreasing α4β2* nAChR signaling can improve depression-like behaviors, that nAChR antagonists or partial agonists can potentiate SSRI/NRI effects, and that β2* nAChRs are required for antidepressant efficacy of at least one antidepressant; nicotine reduces aggression in many rat paradigms, with effects blocked by mecamylamine but not peripheral blockade by hexamethonium, while mouse results vary by strain and paradigm.
  • Clinical imaging shows β2* nAChR availability is greatly decreased in actively depressed patients and intermediate in remitted subjects, suggesting a possible depression biomarker; nicotine can improve depressive symptoms even in non-smokers, and withdrawal is associated with anxiety, irritability, and aggression.
  • In a double-blind, placebo-controlled trial of transdermal nicotine in adult smokers with schizophrenia, agitation decreased 33% on the Agitated Behavior Scale versus 23% for placebo, with greater reductions on the PANSS excited component; in ADHD, a small study (n = 17) found no effect on agitation/aggression subscales, while a larger study (n = 40) found post-hoc significant improvement in irritability only.
  • A mecamylamine trial in Tourette’s syndrome (n = 61) found no overall symptom difference from placebo but a significant decrease in “sudden mood changes”; in an ICU prospective trial (n = 144), smokers had an almost doubled rate of agitation versus controls when nicotine replacement was not permitted.

Methods

  • Narrative review of preclinical and clinical literature on nAChRs in mood, anxiety, and ARBS; no primary data collection.
  • Evidence includes animal models (rodent and cat aggression paradigms, knockout mice, pharmacological studies) and human studies (clinical trials, case series, imaging, post-mortem, and nicotine withdrawal studies).
  • Main analysis is qualitative synthesis; no systematic search strategy, meta-analysis, or formal risk-of-bias assessment is described.

Limitations

  • The paper states that mechanisms underlying nicotine’s effects on ARBS are still not understood, that few clinical trials have studied ARBS outcomes systematically, that effects in non-smokers are less well understood, and that current clinical literature does little to clarify whether nicotinic agonists or antagonists are most helpful.
  • The paper notes that many supporting clinical studies are small and uncontrolled case series, and some findings are secondary, post-hoc, or anecdotal.
  • Evident from the text: as a narrative review, it cannot quantify pooled effects or systematically appraise study quality; species, strain, and sex differences complicate interpretation, as the paper itself states.

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Integrity signals

Registry

Crossref · 10.1016/j.neuropharm.2014.12.028

Cites

150 of 150 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

93 Not checked yet · 25 Own interpretation · 5 No basis given

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Show all 70 claims

  • Probably not a substantial claim. 14
  • It may state two separate claims as one. 43
53 of 53
  • The authors state this as an assumption.

    The mechanisms mediating the connection between smoking and mood alterations are not yet understood.

    “The underlying mechanisms mediating the connection between smoking and mood alterations are not yet understood, however.”
  • The authors state this as an assumption.

    The mechanisms underlying the effects of nicotine on aggression-related behavioral states are still not understood.

    “but the mechanisms underlying the effects of nicotine on aggression-related behavioral states (ARBS) are still not understood”
  • The authors state this as an assumption.

    The effects of nicotinic medications on ARBS in non-smokers are less well understood.

    “but the effects of nicotinic medications on these types of mental states and behaviors in non-smokers are less well understood”
  • The paper relies on this without support.

    Many conditions involving impulsive aggression are chronic disorders that require long-term treatment.

    “In addition, many conditions involving impulsive aggression are chronic disorders that require long-term treatment, such as neurodevelopmental or neurodegenerative disorders.”
  • The paper relies on this without support.

    There is a lack of currently available agents to effectively treat aggression, irritability, and agitation without significant side effects.

    “Despite the complexity, the lack of currently available agents to effectively treat aggression, irritability, and agitation without significant side effects means that further study in this promising area is strongly indicated.”
5 of 5

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Metadata

Authors
Picciotto, M. R., Lewis, A. S., van Schalkwyk, G. I., & Mineur, Y. S.
Affiliations
Yale University (US)
Corresponding author
Picciotto, Marina R.
Venue
Neuropharmacology
Publisher
Elsevier BV
Published
2015-09
Volume
96
Issue
Pt B
Pages
235-243
ISSN
0028-3908 (ISSN-L)
OpenAlex
W1969972941
Cited by
157
References
154
Citations by year
2026: 11 · 2025: 13 · 2024: 10 · 2023: 15 · 2022: 17 · 2021: 11 · 2020: 17 · 2019: 18 · 2018: 14 · 2017: 16 · 2016: 7 · 2015: 8
FWCI
1.45
Type
journal article
Language
en
Open access
Locations
  • Neuropharmacology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (MH077681, MH19961, MH014276, DA033945, DA14241)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
Keywords
nicotinic acetylcholine receptors, nicotine, mood regulation, anxiety regulation, irritability, agitation, self-medication, smoking cessation, nicotinic agonists, psychiatric comorbidity
MeSH terms
Affect, Aggression, Animals, Anxiety, Clinical Trials as Topic, Humans, Nicotine, Receptors, Nicotinic, Substance Withdrawal Syndrome, Tobacco Use Disorder, Nicotinic Agonists

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