“Smokers who suffer from major depression should think twice before trying to quit”.
With all the bad press smoking has received regarding the health risks it poses, most of us are familiar with the hazards involved. We’ve heard the safety alerts, we’ve seen the statistics and we’re familiar with the warning labels that adorn each pack. One fact that you are unlikely to see printed on one of those labels anytime soon, however, is that smokers who suffer from major depression should think twice before trying to quit.
According to a study published in the American Journal of Psychiatry, smoking cessation poses unique risks to those suffering from depression. Studies have shown that quitting smoking is not only more difficult for people with major depression, it is also likely to exacerbate the condition. Research in America has shown that 75 percent of smokers with a history of depression develop a depressed mood within the first week of nicotine withdrawal, compared to only 30 percent of smokers without a history of depression. The withdrawal symptoms appear to be far more severe among those with a history of depression. In addition, according to the study, smoking cessation can cause major depression in some cases where no history of depression is present.
Nicotine has been proven to have certain anti-depressant effects. The US Department of Health has admitted to its ability to “relieve stress and improve mood”. Withdrawing from this anti-depressant can lead to a depressive episode. Concern has thus been raised over depression suffers wishing to quit smoking. American psychiatrist, Dr Alexander Glassman, has cautioned fellow doctors to be very careful when advising clients prone to depression to quit smoking because of the risks involved.
The anti-depressant effects of nicotine may very well account for why so many depression sufferers are also heavy smokers. According to statistics people diagnosed with depression are three times more likely than the general population to become smokers. Interestingly, the statistics also show that daily smokers are almost twice as likely to be diagnosed with depression. It seems then that smoking and depression go hand-in-hand for many people. The question then remains: Which comes first? Perhaps neither.
The accepted anti-depressant effects of nicotine would certainly suggest that in many cases smoking follows depression as a means to self-medicate. Studies do show, however, that smoking itself may lead to depression. One such study conducted at Johns Hopkins University in Maryland, looked at teenagers specifically and concluded that teenagers who smoke have an increased risk of depression. According to the National Research Council Survey in America, the prevention and control of cigarette smoking could be an important intervention against depression.
The research is not clear on whether depression causes smoking or vice versa. A new theory has been proposed that claims that neither causes the other, but that something else entirely can precipitate both – a genetic predisposition. Researchers in the field, such as the American scientist Kenneth Kendler, believe that they have found the gene that predisposes people to both developing depression and cigarette smoking. Kendler has conducted various studies looking at identical and non-identical twins and has found evidence of a genetic predisposition to both. What this means is that people born with this specific gene are more susceptible to suffering from depression and also to smoking cigarettes.
What does all of this tell us? It would seem, from the research available, that starting smoking may trigger depression. Depression may very well need to be added to the list of health risks smoking carries with it. Paradoxically though, smoking seems to alleviate the symptoms of depression when both occur together. This accounts for the concern among mental health professionals that quitting smoking can lead to a relapse in people suffering from depression. It would seem then that the starting and the quitting are the tricky areas. So the answer then is not to start smoking in the first place!
Where does that leave those who are smoking and who do suffer from depression? If you’re planning on quitting, here are a few things to remember:
Ø Consult with your psychiatrist, psychologist or GP and tell him/her of your intention to quit. Be aware that changes in your mood are normal, but the onset of a depressive episode is not. Monitor your mood and report any disturbing changes before they spiral into depression.
Ø Expect some withdrawal symptoms. They include dry mouth, scratchy throat, a feeling of “being on edge”, irritability and restlessness.
Ø Taper your smoking off gradually, don’t go “cold-turkey”. Tapering is less likely to shock your system and the withdrawal symptoms will be less severe.
Ø Express your intention to quit to family and friends. Draw on their support and encouragement.
Ø Engage in the activities you enjoy most, get plenty of exercise and eat healthily. Keep your mind otherwise occupied and you will have less time to think of cigarettes or ruminate on depressed thoughts.
Ø Draw on the help available to you. Acupuncture, hypnosis, quitting smoking programmes, patches and gum are various different cessation aids.
Ø If you’re feeling depressed and want someone to talk to, phone the Depression and Anxiety Support Group on (011) 783-1474/6 or (011) 884-1797 and speak to one of the counsellors. The group is open from 8am-7pm weekdays and 8am-5pm on Saturdays.