Depression is a precipitating factor for smoking initiation. A general perception exists that patients with depression have more difficulty quitting. We studied patients with clinical depression enrolled in smoking cessation classes.
Six weekly sessions emphasized behavior modification and pharmacological interventions. Innovative therapies of humor, grief counseling, and guided imagery were utilized. Quit status verified at 1 month with exhaled carbon monoxide levels.
1027 patients total; 206 (76 males; 130 females) reported a history of depression and/or taking antidepressant medications. Mean age for patients reporting depression was different from those not reporting depression (50.4 vs. 46.8 p<0.001) as were the pack-years (40.0 vs. 33.2 p<0.001), number of previous quit attempts (3.7 vs. 3.0 p< 0.0001), and Fagerstrom scores (nicotine addiction scale 6.4 vs. 5.4 p<0.0001). Those with depression were 2 x more likely to have been hospitalized in the previous year. They were more likely to wake at night to smoke (27.70% vs. 18.0% p<0.02) and reported higher Epworth daytime sleepiness scores (7.9 vs. 6.3 p<0.0001). Patients with depression were more likely to report “stress relief” as an obstacle to quitting (76.6% vs. 54.8%; p<0.0001). Those with depression were more likely to have used bupropion in previous quit attempts(37.8% vs. 25.1% p<0.0004. Patients with depression were more likely to cite “recent change in health status” (31.3% vs. 13.5% p<0.0001) and “cigarettes control my life” (52.7% vs. 32.9 % p<0.0001) as reasons for quitting. Patients with depression reported lower “readiness-to-quit” scores (63.6% ready vs 75.0%, p<0.002), however, there was no difference in quit success of both groups (51.7% vs. 56.1%).
Depressed patients, eager to quit, suffer severe nicotine addiction and report ’stress relief’ as an obstacle to quitting smoking. Despite psychiatric co-morbidity, these patients are able to quit similarly to other smokers. Clinicians should not perceive history of depression as a barrier to successful quitting.
Comprehensive treatment for tobacco dependence is effective despite the presence of psychiatric co-morbidities and timely treatment can result in reduced healthcare expenditures.
V.C. Reichert, None.