New research provides a detailed explanation of why it is so hard for depressed individuals to stop smoking.
In the study, an international team of researchers explain the unique nicotine withdrawal symptoms that people with depression must confront as they try to kick the habit.
Investigators note that smoking cessation is often accompanied by withdrawal states that contribute to resumption of smoking, including low mood, difficulty engaging in rewarding activities, and impaired thinking/memory.
Depressed individuals often have compromised coping skills to manage these issues and often relapse to nicotine as a way of dealing with the new stress.
As result of the findings, researchers are now testing a new smoking cessation treatment, combining medication and behavioral activation therapy targeted at this population.
The study appears in the journal Addiction.
Co-author Dr. Lee Hogarth of the University of Exeter said, “People have thought for some time that depressed smokers have difficulty quitting because they experience a more pronounced withdrawal syndrome, but the evidence is scarce because depressed smokers are hard to recruit and consequently have not been as studied.
“But now we have gathered together convincing empirical support for this theory, which can be used to justify new treatment approaches.”
Senior author Dr. Brian Hitsman of the Northwestern University Feinberg School of Medicine said, “We’ve used this theory of withdrawal in depressed smokers to develop the first targeted approach for smoking cessation in this underserved population.”
Depressed smokers experience adverse withdrawal states that contribute to resumption of smoking, including low mood, difficulty engaging in rewarding activities, and impaired thinking/memory, the paper reports.
These symptoms are more severe for people with depression than for those without depression. In addition, depressed smokers tend to have fewer ways to cope with the symptoms and the nicotine in cigarettes helps to mitigate these problems, which is why depressed people tend to relapse at higher rates.
“Many smokers learn, ‘If I smoke in this situation, my mood gets better.’ But while smoking improves mood in the short term, it produces a long-term decline in mood,” said lead author Dr. Amanda Mathew, a research assistant professor and a licensed clinical psychologist.
“On the other hand, successfully quitting smoking is associated with improvements in mental health.”
The review found that depressed smokers’ first adverse state while trying to quit is a combination of “low positive affect” (low pleasure and engagement in rewarding activities, such as socializing or physical activity) and “high negative affect” (feelings of anger, sadness, guilt, or anxiety).
The second adverse state is “cognitive impairment” (difficulty making decisions, focusing, and memory).
The study’s researchers have begun testing a treatment that targets the specific challenges depressed smokers face when they’re quitting. People who have clinical depression have typically been excluded from smoking cessation clinical trials.
The FDA-approved medication Chantix is coupled with a type of behavior therapy called “behavioral activation” to treat the depressed smokers.
Researchers are investigating whether Chantix reverses thinking and memory problems that depressed smokers experience during withdrawal, and whether the behavioral activation improves smokers’ moods so they engage in normal pleasurable activities, and thus have less desire to smoke and are able to resist relapsing.
Investigators note that behavioral activation is an effective treatment for depression, but this is the first time it is being used as a treatment for smoking cessation among depressed smokers.
Source: University of Exeter/EurekAlert