Effects of smoking and paroxetine on stress-induced craving and withdrawal symptoms

Background: When smokers relapse, many cite stressful circumstances as the cause. Most smoking cessation medications do not prevent stress-induced increases in craving and withdrawal symptom severity; however, the effect of smoking prior to stress exposure on symptom severity is unclear. Methods: We examined how smoking a cigarette immediately prior to a stressful task affects craving and withdrawal symptom severity by analyzing data from a double-blind, crossover study assessing paroxetine’s effects on the physiological response to the combination of stress and smoking. Measures were obtained prior to and following smoking/stress exposure and following a subsequent 30-min period at two laboratory sessions (i.e., after 1 month each of paroxetine and placebo). Results: Among study completers (n = 63), severity of craving decreased from the beginning of the session to immediately following the smoking/stress exposure (p < 0.01) and severity of smoking urges decreased from the beginning to the end of the laboratory session (p < 0.001). Withdrawal symptoms were less severe while taking paroxetine vs. placebo (p < 0.05) but no treatment  × time effects were observed. Conclusions: Additional research is needed to identify interventions that could similarly decrease stress-induced craving in order to determine if smoking cessation rates can be increased.