Tobacco Cessation Among Patients With Depression

The adverse health consequences of tobacco use have been well-known to the medical and lay community for the better part of the last 50 years. The first reports implicating cigarette smoking as a major risk factor for cancer of the lung were published in the 1950s 16 , 44 and since then, voluminous research has demonstrated that tobacco use is a leading cause or contributor to other major causes of medical illnesses and death in Western society. Much less understood, however, have been the nonphysical implications of chronic tobacco use. In the past 10 years, this topic has drawn the attention of researchers in both areas of nicotine dependence and psychiatry. As late as 30 years ago, when smoking was socially acceptable for men and, in many circles, for women also, it would have been difficult to demonstrate a relationship between the regular use of tobacco and a psychiatric condition. When many smokers quit smoking or attempted to do so in response to the negative information about tobacco use, dramatic differences in the rates of smoking according to the presence of a psychiatric disorder, including major depression, anxiety, schizophrenia, attention deficit disorders, and alcoholism and other drug dependence disorders have become apparent. Most of the evidence to date has been on major depression and depressed mood. This article presents research findings that have burgeoned during the past decade, indicating a complex association between depression and addiction to nicotine and tobacco. This literature has led to important new insights into the nature of chronic tobacco use. Drawing from the results of scientific investigations and clinical experience with several hundred addicted smokers, many of whom have been smokers with depressive disorders, this article also offers recommendations on how to treat nicotine dependence among patients with depression. This knowledge is important to primary care clinicians. Because nicotine dependence and depression are both highly prevalent conditions (estimated as 20% and 17%, respectively, in the adult population in the United States) 4 , 6 that also carry considerable medical consequences, 6 the primary care clinician is strategically positioned to provide the first line of medical care to those individuals who are dually afflicted by a severe addiction to smoking and a vulnerability to depressive disorder.