Abstract
Cigarette smoking increases the likelihood of developing anxiety disorders, among them panic disorder (PD). While brain structures altered by smoking partly overlap with morphological changes identified in PD, the modulating impact of smoking as a potential confounder on structural alterations in PD has not yet been addressed. In total, 143 PD patients (71 smokers) and 178 healthy controls (62 smokers) participated in a multicenter magnetic resonance imaging (MRI) study. T1-weighted images were used to examine brain structural alterations using voxel-based morphometry in a priori defined regions of the defensive system network. PD was associated with gray matter volume reductions in the amygdala and hippocampus. This difference was driven by non-smokers and absent in smoking subjects. Bilateral amygdala volumes were reduced with increasing health burden (neither PD nor smoking > either PD or smoking > both PD and smoking). As smoking can narrow or diminish commonly observed structural abnormalities in PD, the effect of smoking should be considered in MRI studies focusing on patients with pathological forms of fear and anxiety. Future studies are needed to determine if smoking may increase the risk for subsequent psychopathology via brain functional or structural alterations.
Highlights
Smoking behavior is overrepresented in patients with mental disorders in general (Lasser et al, 2000; Cook et al, 2014) and in patients with anxiety disorders (Johnson et al, 2000)
We investigated the effect of smoking in healthy controls (HC) subjects on a whole-brain level ‘as well as in specific regions pertaining to the pathophysiology of smoking and panic disorder (PD)’ (HC/S < HC participants [116 non-smokers (HC/NS))
There was a difference regarding the years of education, with HC subjects showing more years of education than PD patients irrespective of their smoking status
Summary
Smoking behavior is overrepresented in patients with mental disorders in general (Lasser et al, 2000; Cook et al, 2014) and in patients with anxiety disorders (Johnson et al, 2000). Panic disorder (PD) is linked to cigarette smoking in many epidemiological investigations using cross-sectional designs (Goodwin and Hamilton, 2002; Lawrence et al, 2010). PD patients who smoke report significantly more intense anxiety symptoms and greater severity of panic symptoms than those who do not smoke (Zvolensky et al, 2005). They show increased problems to stop smoking compared to healthy smokers (Piper et al, 2010). While the link between smoking and PD is well established epidemiologically, its neurobiological basis remains mostly unclear
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