Development of major depressive disorder during smoking-cessation treatment

Massachusetts General Hospital, Boston, Massachusetts, United States
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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    • "Some research indicates that smoking cessation could result in an increase in depressive (Borrelli et al. 1996; Stage et al. 1996; Killen et al. 2003; Hughes, 2007) or anxiety symptoms (West & Hajek, 1997; Becoña et al. 2002) which in turn influences smoker's ability or motivation to quit (Shiffman, 1982; Covey et al. 1990; Hall et al. 1993; Bock et al. 1996; Glassman et al. 2001; Burgess et al. 2002). Studies vary in their reports on the risk for developing major depressive disorder following smoking cessation, with ranges from 0% to ~30% with the higher rates reported among smokers with a history of major depressive disorder (Borrelli et al. 1996; Covey et al. 1997; Killen et al. 2003; Glassman et al. 2001; Hughes, 2007). On the contrary and irrespective of cessation treatment, additional studies have found that smoking cessation is seldom associated with worsening mental health functioning (Leistikow & Shipley, 1999; Tsoh et al. 2000; Hall et al. 2006; Klungsoyr et al. 2006; McFall et al. 2006; Munafò et al. 2008; Prochaska et al. 2008; Shahab & West, 2009; Hajek et al. 2010; Torres et al. 2010; Shahab, 2012; Donald et al. 2013; Mathew et al. 2013). "
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    ABSTRACT: Background: The psychological outcomes that accompany smoking cessation are not yet conclusive but positive outcomes could help to persuade quitting. Method: We used data from the longitudinal National Epidemiological Study of Alcohol and Related Conditions. Logistic regression was used to examine associations between cigarette smoking reduction and Wave 2 status of addiction/mental health disorder among daily smokers at Wave 1, stratified by status of the diagnosis of interest at Wave 1. We adjusted for differences in baseline covariates between smokers with different levels of smoking reduction between Wave 1 and Wave 2 using propensity score regression adjustment. Results: After adjusting for propensity scores and other mental health/addiction co-morbidities at Wave 2, among daily smokers who had current or lifetime history diagnosis of the outcome of interest at Wave 1, quitting by Wave 2 predicted a decreased risk of mood/anxiety disorder [adjusted odds ratio (aOR) 0.6, 95% confidence interval (CI) 0.4-0.9] and alcohol disorder (aOR 0.7, 95% CI 0.5-0.99) at Wave 2. Among daily smokers with no lifetime history diagnosis of the outcome of interest at Wave 1, quitting smoking by Wave 2 predicted a decreased risk of drug use disorder at Wave 2 (aOR 0.3, 95% CI 0.1-0.9). Conclusions: There is no support in our data for the concern that smoking cessation would result in smokers' increased risk of some mental disorders. To the contrary, our data suggest that smoking cessation is associated with risk reduction for mood/anxiety or alcohol use disorder, even among smokers who have had a pre-existing disorder.
    No preview · Article · Sep 2014 · Psychological Medicine
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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.
    Full-text · Article · May 2013 · Journal of studies on alcohol and drugs
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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.
    Full-text · Article · Jul 2011 · Addictive behaviors
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