Smoking Cessation and Depression

Quitting smoking is very hard because cigarettes are highly addictive, and withdrawal for most smokers is complicated by depressive symptoms. As a result, most smokers never achieve lasting abstinence and half die prematurely of smoking-related disease. In the United States less than 10 percent of the nearly 20 million people who quit smoking for a day remain abstinent one year later. With only 2 percent to 3 percent of smokers succeeding in smoking cessation, nicotine is considered among the most addictive drugs.

Smokers are almost twice as likely as nonsmokers to have depression at some point. And smokers with a history of depression are less likely to succeed in smoking cessation compared to smokers without depression. Clinicians have also noted that some smokers appear to self-medicate depressive symptoms by heavy smoking.

The relationship between depression and smoking has been poorly understood. The implication for smokers who are contemplating quitting, or have given up due to repeated failed attempts, is enormous.

Most smokers want to quit

The Centers for Disease Control and Prevention reports that 70 percent of current smokers want to quit but cannot. The good news is that public health education efforts have had a positive impact on adult perception and attitudes about smoking. The bad news is that we lack the medical and psychological sophistication to effectively treat those who want to quit.

What happens when you quit smoking?

When an addicted smoker abruptly quits smoking he experiences marked changes in his brain chemistry. Neurotransmitters that help regulate mood are disrupted, causing symptoms of irritability, confusion, agitation, insomnia, concentration problems, lethargy and yawning that can persist for a week or more. These symptoms are reversed by simply smoking a few cigarettes.

Treatment considerations

Because of changes in the brain’s chemistry, smokers are at high risk of relapse. Conversely, they require persistent, compelling reasons to remain abstinent. Accordingly, effective treatment should integrate brief supportive therapy and medication. The type, amount and frequency of support can be determined by addressing the following issues:

• specific interest in quitting and current motivation to do so

• level of attachment to smoking

• health risks

• effects on family and cost

• benefits of cessation

• cessation process

• craving

• withdrawal syndrome

• social/family support

• depressive symptoms

• smoking patterns and behaviors

• previous quitting experience and withdrawal symptoms

• short-term obstacles to treatment

Additionally, a brief, self-scored depression questionnaire provides a baseline snapshot of mood that can help determine the presence or level of depression or depressive symptoms.

Medication can blunt withdrawal symptoms, stabilize mood

In 1997 the U.S. Food and Drug Administration approved the antidepressant bupropion (Zyban®) as the first non-nicotine medication for nicotine dependence. Under double-blind conditions the efficacy of bupropion was clinically significant in decreasing the urge to smoke (craving) and in the number of days of continuous abstinence. Recent research suggests that a dual-medicine approach—utilizing nicotine replacement to blunt withdrawal symptoms in combination with bupropion to reduce craving and stabilize mood—is an effective treatment strategy.

If you are interested in smoking cessation or concerned about depression, talk with your doctor or employee assistance professional. Remember that nicotine dependence and depression are highly treatable with proper assessment and professional help.

By Drew Edwards, EdD, MS
© 2004 Achieve Solutions