Why Depression Affects Smoking Cessation
By Bob Sherman
Those who are suffering from depression experience prolonged symptoms that interfere with their daily lives. The National Institute of Health indicates that common symptoms include:
- Persistent sad, anxious, or 'empty' mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Decreased energy, fatigue, being 'slowed down'
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight loss or overeating and weight gain
- Thoughts of death or suicide; suicide attempts
- Restlessness, irritability
- Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
Treatments for Depression
Depression treatments typically include medication and psychotherapy.
Antidepressant medication is used to normalize brain chemicals called neurotransmitters. These neurotransmitters include serotonin, norepinephrine and dopamine. Medicines such as fluoxetine (Prozac) and citalopram (Celexa) are among the most popular. Older antidepressants such as tricyclics and monoamine oxidase inhibitors (MAOIs) are also prescribed, but may have more side effects.
Psychotherapy including cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) have been successful in treating depression. CBT involves teaching new ways of thinking that helps change negative habits that contribute to depression. IPT helps people work through relationship problems or events that contribute to their depression.
How Cigarettes Self Medicate
Nicotine is a major ingredient of cigarette smoke. It acts as an addicting stimulant. Within seven seconds of taking a puff, nicotine enters the smoker's brain. Nicotine increases acetylcholine, norepinephrine, dopamine, and beta-endorphin levels in the brain. Other ingredients in tobacco smoke work to inhibit monoamine oxidase (MAO). In this way, the ingredients in tobacco smoke generate feelings of pleasure similar to antidepressant medications.
The chemicals in tobacco smoke cause feelings of relaxation, calmness, and alertness that smokers find appealing. Some indicate it produces a mildly euphoric state.
The effects of tobacco smoke's ingredients on the brain last from five minutes up to two hours. After this time, the good feelings diminish and the smoker has a natural desire to smoke again to restore the good feelings.
Cigarettes and tobacco smoke, then, performs much the same function as antidepressant medication. They both increase neurotransmitters like dopamine and inhibit monoamine oxidase (MOA). Both alter the mood of a person suffering from depression. Since cigarettes are readily available, they are an easy way for people with clinical depression to restore pleasurable feelings.
During smoking cessation, the option to restore pleasurable feelings with tobacco smoke is absent. Not only that, but within 24 hours of quitting, withdrawal symptoms begin to appear. Withdrawal symptoms include irritability, depression, restlessness, insomnia, anxiety, hunger, poor concentration and cigarette craving. Couple these cessation symptoms with normal discouragements of life and you can see the pressure you may be under. Desire to relieve the pressure and restore a pleasurable mood causes many people to use the most familiar coping technique they know: they resume smoking.
This is why it is difficult for people suffering from depression to quit smoking.
How Prone Are You to Depression?
Since those suffering with symptoms of depression find it harder to quit smoking, it would be wise for you to learn where you stand. The following questionnaire will help you learn if quitting will be difficult for you.
Most people who attempt to quit do not have this knowledge. They try to quit and fail. Then they have more reason than ever to ponder their failure and become increasingly depressed. This is an opportunity for you to come to a better understanding of your level of difficulty.
The Goldberg depression questionnaire consists of 18 questions about your feelings. Answer them as honestly as possible. And, remember that your attitudes can change somewhat from day to day.
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Goldberg Depression Questionnaire |
Studies indicate that the lower your depression score, the more likely you will be successful in quitting smoking.
If you are depressed prior to starting a smoking cessation program, you will need to ensure your antidepressant medications are up-to-date. Your doctor may also recommend bupropion because of its dopamine enhancing characteristics. You should learn new ways of coping with stress and embrace new views of tobacco use and health. In addition, you would benefit from one or more means of nicotine replacement therapy. NRT alternatives include transdermal patches, nicotine inhalers, sprays and nicotine gum. Consult your doctor for advice.
References
- Cagel, BB, A Review of Smoking Cessation Strategies, ADVANCE for Nurse Practitioners, 12(3) 61
- Berlin, I $ Covey LS, Pre-cessation depressive mood prediction failure to quit smoking: the roll of coping and personality traits, Addiction 101, 1814-1821
- Morrell, HER & Cohen LM, Cigarette Smoking, Anxiety, and Depression, Joural of Psychopathology and Behavioral Assessment 28(4) 283-297
- McChargue DE & Cook JW, Depression vulnerability within smoking research: How accurate are one-item screening items?, Addictive Behaviors 32 404-409
- Williams, JM & Ziedonis D, Addressing tobacco among individuals with mental illness or an addiction, Addictive Behaviors 29 1067-1083
- Spring B, Pagoto S, McChargue D, Craton J, Doran N, Cook JW, Bailey K & Hedeker D, Fluoxetine, Smoking, and History of Major Depression: A Randomized Controlled Trial, Journal of Consulting and Clinical Psychology 71(1) 85-94
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