, 186:473 | Cite as

A decrease in the plasma DHEA to cortisol ratio during smoking abstinence may predict relapse: a preliminary study

  • Ann M. Rasmusson
  • Ran Wu
  • Prashni Paliwal
  • George M. Anderson
  • Suchitra Krishnan-Sarin
Original Investigation



Increases in depressive symptoms during smoking cessation have been associated with risk for relapse. Several studies have linked plasma levels of cortisol and dehydroepiandrosterone (DHEA) or DHEA-sulfate (DHEAS) to depressive symptoms.


To determine whether changes in plasma cortisol, DHEA, or DHEAS levels and emergence of depressive symptoms during smoking cessation are associated with smoking relapse.

Materials and methods

Subjects were healthy non-medicated men and women, aged 39±12 years, who smoked, on average, 22 cigarettes per day. Depressive symptoms, smoking withdrawal symptoms, and plasma steroid levels were measured before and after 8 days of verified smoking abstinence. Relapse status at day 15 was then determined.


In the full sample (n=63), there was a trend for changes in depressive symptoms to be associated with relapse. In the subset of 25 subjects with plasma neuroactive steroid data, there was a significant interaction between the change in the plasma DHEA/cortisol ratio from day 0 to day 8 and relapse status at day 15. This ratio was similar before abstinence, but lower at day 8 in relapsed, compared to abstinent, subjects. Changes in the DHEA/cortisol ratio tended to predict changes in depressive symptoms in the women only.


A decrease in the plasma DHEA/cortisol ratio during 8 days of smoking abstinence was associated with relapse over the following week. Further research is needed to fully characterize sex-specific relationships between abstinence-induced changes in neuroactive steroid levels, depressive or withdrawal symptoms, and relapse. Such research may lead to new interventions for refractory smoking dependence.


Smoking cessation Smoking relapse Cortisol Dehydroepiandrosterone DHEA DHEAS Sex differences Depression Nicotine Men Women 


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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Ann M. Rasmusson
    • 1
    • 2
    • 6
  • Ran Wu
    • 1
    • 3
  • Prashni Paliwal
    • 1
    • 4
  • George M. Anderson
    • 3
    • 5
  • Suchitra Krishnan-Sarin
    • 1
    • 3
  1. 1.Department of PsychiatryYale University School of MedicineNew HavenUSA
  2. 2.Clinical Neuroscience DivisionVA National Center for PTSDWest HavenUSA
  3. 3.Department of Laboratory Medicine and Transdisciplinary Tobacco Use Research CenterYale University School of MedicineNew HavenUSA
  4. 4.Division of Women’s Behavioral HealthYale University School of MedicineNew HavenUSA
  5. 5.Child Study CenterYale UniversityNew HavenUSA
  6. 6.Psychiatry Service/116AVA Connecticut Healthcare SystemWest HavenUSA

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