Project TEAM

Depression and Smoking

Health professionals face distinct and substantial obstacles in attempting to help smokers who are depressed to initiate an effort to quit smoking and follow through. Depression and smoking pose somewhat of a chicken-and-egg question, but determining which came first doesn't seem as important to researchers currently as determining the effects each has on the other and the effect depression has on quitting smoking. Major depression is more than twice as common among smokers as it is among nonsmokers, depressive mood is more common among smokers than among nonsmokers, and studies show that smokers who are depressed find it more difficult to quit than smokers who aren't.

In one study major depression was found in 6.6% smokers but only 2.9% of nonsmokers ; moreover, in a study of adolescents free of notable depressive symptoms at baseline, researchers found that 18% of "established" smokers reported depressive symptoms, whereas only about half as many— 9.8%—of nonsmokers reported such symptoms.

Depression and Tobacco Cessation Attempts

Investigators have found that depression is closely linked to nicotine-dependent smoking, that smokers with depressive symptoms are more likely to experience more severe withdrawal and withdrawal-induced depressive symptoms, and that such symptoms are associated with a decreased likelihood of success at quitting. In particular, Cinciripini and colleagues at The University of Texas M. D. Anderson Cancer Center found that having a depressed mood before attempting cessation was inversely related to successful six-month abstinence.

In effect, depression appears to short-circuit cessation efforts: only 22% of nondepressed women smoked on the first day of abstinence during a cessation attempt, but 48% of depressed women did. Furthermore, study subjects in another trial who were without symptoms of depression delayed relapse a median of 30 days, but subjects who had even one symptom of depression aborted their cessation attempt at a median of 3.5 days. However, the relationship between a history of major depression and cessation success has not always been clear-cut in clinical samples. Some studies have shown that having a history of depression does not necessarily lead to a poorer treatment outcome.

Negative affect is a term that refers to a composite of depression, dysphoria, irritability, nervousness, and other negative moods. Negative affect has been duly linked with smoking initiation and relapse. Researchers have found a positive correlation between the likelihood of being a smoker and rising levels of daily negative mood, whether it is depression, loneliness, boredom or other similarly negative mood that is experienced. Negative affect also been identified as a factor in more than 50% of all smoking cessation lapses, and as with depression alone, negative affect strongly predicts a failure to quit or a predilection to return to smoking after a short attempt at abstinence.

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