Depression Can Make It Tougher to Stop Smoking
February 27th, 2009 | by admin |Smokers with a history of depression may have an especially difficult time kicking the tobacco habit, according to a study in the June 16 issue of Lancet. The findings confirm a long-held and distressing suspicion — that reaching for a cigarette may be an especially toxic way that some depressed individuals self-medicate their symptoms.
“It’s self-medication with terrible consequences,” says psychiatrist Alexander Glassman, MD, chief of clinical psychopharmacology at New York State Psychiatric Institute and professor of psychiatry at Columbia University College of Physicians and Surgeons, in New York.
But the flip side of the story is more encouraging. Glassman says the sites in the brain where nicotine may be acting to dampen the effects of depression could be targets for new drugs designed to have a similar action — without the harmful effects of smoking.
“It will result in a new class of antidepressant drugs,” he predicts.
In the study, 100 smokers with a history of major depression were enrolled in a two-month smoking-cessation trial. Of those, 76 were followed for six months after completion of the program to see if they had another occurrence of depression. Of 42 people who successfully quit smoking, 13 had an episode of major depression, while only two of the 34 people who continued smoking became depressed.
“The people who continued to smoke got depressed 5% of the time, but the people who stopped smoking got depressed over 30% of the time,” Glassman says. “It’s a really big difference.”
The study grew out of the widely observed phenomena that people with a history of depression are much more likely to smoke than nondepressed people, Glassman says. It was this observation that contributed to the approval of the antidepressant Wellbutrin for use as a smoking-cessation agent, under the new name Zyban.
Now, Glassman says, new studies will be undertaken to determine whether continued use of Zyban will prevent the recurrence of depression in people with a previous history of the illness. Those studies will be funded by the National Institute on Drug Abuse, he says.
Raymond Niaura, MD, who co-wrote an accompanying editorial to the study, calls the findings “striking,” and says they are the strongest confirmation yet of what professionals working in smoking-cessation programs have long suspected.
“There are probably even more people at risk of becoming depressed when they try to quit smoking than we had previously thought,” says Niaura, professor of psychiatry at Brown University Medical School, in Providence, R.I. “If people with a history of depression try to quit, they are going to have a harder time. They are in a tough place — they are quitting smoking to improve their health, but at greater risk for depression.”
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