Development of major depressive disorder during smoking-cessation treatment

Miriam Hospital, Division of Behavioral and Preventive Medicine, Providence, RI, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 12/1996; 57(11):534-8.
Source: PubMed


Several studies have shown an association between smoking and major depressive disorder (MDD), but few have prospectively examined subjects who develop MDD after quitting smoking. This descriptive study evaluated the development of MDD after smoking cessation, as assessed by a structured clinical interview at both baseline and the end of treatment.
Nondepressed participants (N = 114) in a trial investigating the effect of fluoxetine on smoking cessation were administered the Structured Clinical Interview for DSM-III-R at baseline and posttreatment to evaluate the impact of quitting smoking on the development of MDD. Depressive symptoms were additionally assessed with the Beck Depression Inventory and the Hamilton Rating Scale for Depression.
At baseline, 32% of the subjects reported a history of MDD. Sixty-nine subjects completed the SCID at baseline and posttreatment. At posttreatment, 5 subjects (7%) met threshold criteria for MDD; none were taking the highest dose of fluoxetine (60 mg), 4 were taking 30 mg, and 1 was taking placebo. All 5 had a history of MDD; 3 were women. Four had a history of substance abuse and attained at least 3 consecutive biochemically verified weeks of smoking abstinence. Those who developed MDD after treatment scored significantly higher on measures of depressed mood at baseline than those who did not develop MDD after smoking-cessation treatment.
The results from this descriptive study suggest that a subset of smokers may be at risk for developing MDD after smoking cessation.

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    • "Specifi cally, the observed relations between anhedonic depression symptoms and nicotine withdrawal symptoms would be moderated by anxiety sensitivity, such that anhedonic depression symptoms will be more strongly related to the individual components of withdrawal for those with high levels of anxiety sensitivity than for those with low levels of anxiety sensitivity. As mentioned above, individuals who are prone to experiencing anhedonic depression may be more likely to endorse a greater intensity of nicotine withdrawal during periods of smoking deprivation (Borrelli et al., 1996; Covey et al., 1990; Leventhal et al., 2009; Niaura et al., 1999; Pomerleau et al., 2000). Smokers characterized by high levels of anxiety sensitivity (compared with low levels of anxiety sensitivity) may be more reactive to aversive internal cues associated with withdrawal symptomatology, thereby paradoxically driving the affective and drug-state experiences (Zvolensky and Bernstein, 2005). "
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    ABSTRACT: Objective: The aim of the present investigation was to explore the main and interactive effects of anhedonic depressive symptoms and anxiety sensitivity in terms of the individual components of nicotine withdrawal symptoms experienced on quit day as well as throughout the initial 14 days of cessation. Method: Participants included 65 daily cigarette smokers (38 women; Mage = 46.08 years, SD = 9.12) undergoing psychosocial-pharmacological cessation treatment. Results: Results indicated that, after controlling for the effects of participant sex and nicotine dependence, anhedonic depression symptoms, but not anxiety sensitivity, significantly predicted quit day levels of mood-based nicotine withdrawal symptoms. Conversely, anxiety sensitivity, but not anhedonic depression symptoms, was significantly related to the change in most nicotine withdrawal symptoms over time. Finally, our results revealed a significant interaction between anxiety sensitivity and anhedonic depression symptoms related to the slope of certain withdrawal symptoms over time. Specifically, among participants with higher levels of anxiety sensitivity, greater levels of anhedonic depression symptoms were related to greater increases in withdrawal symptoms over time for two of the nine anxiety-relevant components of nicotine withdrawal (restlessness and frustration). Conclusions: Among high anxiety-sensitivity persons, compared with those low in anxiety sensitivity, anhedonic depression symptoms may be more relevant to the experience of some withdrawal symptoms being more intense and persistent during the early phases of quitting.
    Journal of studies on alcohol and drugs 05/2013; 74(3):469-478. DOI:10.15288/jsad.2013.74.469 · 2.76 Impact Factor
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    • "Nine studies have utilized an idiographic approach by identifying specific individuals who developed a diagnosis of depression during or after smoking cessation treatment (Borrelli et al., 1996; Covey, Glassman, & Stetner, 1997; Glassman, 1993; Glassman, Covey, Stetner, & Rivelli, 2001; Kahler et al., 2002; Killen, Fortmann, Schatzberg, Hayward, & Varady, 2003; Patten, Rummans, Croghan, Hurt, & Hays, 1999; Torres et al., 2010; Tsoh et al., 2000). Collectively, these studies indicate that <1%–7% of smokers develop depression between pre-and post-treatment and that 2.1–18% develop depression in the months following cessation treatment. "
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    ABSTRACT: Studies typically measure mood changes during smoking cessation treatment in two ways: (a) by tracking mean change in depression scores or (b) by tracking the incidence of major depression development using diagnostic assessments. However, tracking mean change does not capture variability in individual mood trajectories, and diagnosing participants at multiple time points is time and labor intensive. The current study proposes a method of assessing meaningful increases in depression without the use of diagnostic assessments by utilizing reliable and clinically significant change criteria. This method was applied to 212 participants in a smoking cessation trial to explore the relationship between smoking status and depressed mood, assessed at baseline, end-of-treatment, and 2-, 6-, and 12-month follow-ups. High rates of reliable (24-28%) and both reliable and clinically significant increases (23-24%) in depressed mood were observed across all participants, regardless of whether or not they achieved abstinence. However, when we calculated group mean change in depression during the trial, only decreases in depressed mood where observed across several intervals. Findings indicate that utilizing reliable and clinically significant change criteria to track symptoms of depression during smoking cessation treatment leads to different conclusions than simply tracking mean changes. We propose that a combination of reliable and clinically significant change criteria may serve as a useful proxy measure for the development of major depressive disorder during smoking cessation.
    Addictive behaviors 07/2011; 36(12):1228-32. DOI:10.1016/j.addbeh.2011.07.031 · 2.76 Impact Factor
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    • "Individuals who are vulnerable to depression may be more motivated to smoke in response to mood fluctuations than less vulnerable individuals. A depression history is associated with an increased likelihood of becoming a smoker, greater nicotine dependence, and greater difficulty quitting smoking (Anda et al., 1990; Borrelli et al., 1998 "
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    ABSTRACT: Stress and anxiety have been shown to increase smoking motivation. There is limited experimental data on depressed or sad mood and smoking. This study investigated the effects of two induced moods on smoking behavior. Depression scores were examined as a potential moderator and mood changes were tested as a potential mediator. Smokers (N = 121) were randomly assigned to receive either a sad induction or a neutral induction via standardized film clips. Among participants with higher depression scores, smoking duration and the number of cigarette puffs were greater in response to the sad condition. There was also a marginal interactive effect on the change in expired air carbon monoxide among this subsample; however, no differences in smoking latency or craving were observed. Changes in positive mood partially mediated the effect of condition on smoking behavior among participants with high depression scores. There was no modifying effect of gender or mediating effect of negative mood changes. The results provide preliminary support that decreases in positive mood may have a greater influence on smoking behavior among depression-prone smokers than less psychiatrically vulnerable smokers.
    Psychology of Addictive Behaviors 09/2009; 23(3):546-51. DOI:10.1037/a0016529 · 2.09 Impact Factor
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