Is there a link between cigarettes and depression? (in french)
People often feel depressed when they are in the process of stopping smoking. But how and why are smoking and depression linked? This article is about studies which have shown that smokers make up the majority of depression patients, and have offered possible explanations for this link. You will also find a mood test and links to help and information about depression.
Just feeling down, or depressed?
The line between feeling blue and being depressed can be blurry. The test below from an external site allows you to quickly assess your mood:
|Test CES-D sur la dépression (in french)|
Need help? +41 22 305 45 45 (local call – Switzerland only)
A telephone line which provides information, advice and support is open to take your calls from Monday to Friday between 2 pm and 6 pm (in Switzerland only).
Who is it for?
The phone line is aimed at people who show signs of depression, as well as their family and friends, and also people who simply want more information about this illness. It can also be used by doctors and medical professionals who are treating fragile patients dealing with depression.
Why do I feel depressed when I stop smoking?
As a general rule, depression is a frequent withdrawal symptom. Indeed, cigarettes are known for their “antidepressant” effect, because tobacco smoke contains both nicotine and Monoamine Oxidase inhibitors (harmane and norharmane). These substances favor the release of chemical messengers such as dopamine, serotonin and noradrenaline, which play a role in pleasure and producing a feeling of wellbeing. By encouraging the release of these neurotransmitters, tobacco produces an artificial sense of wellbeing which lifts the smoker’s mood. Smokers sometimes rely on cigarettes as an “antidepressant” which comforts them and cheers them up. When they stop smoking, it’s natural that they miss the good feeling and begin to feel a little down.
A link can therefore be established between tobacco withdrawal, or more specifically nicotine withdrawal, and feeling depressed. These feelings generally ease after between 10 and 30 days, and disappear after two months. Occasionally, post-cessation depression persists for longer – in this case, it is highly recommended that you see your doctor.
Still, these feelings are not experienced by everyone and can be lessened or even eliminated by measures such as substitute treatments, behavioral techniques, peer support, professional support, etc.
Do more depressed people smoke or do more smokers become depressed?
Beyond the dip in mood that often follows when you quit smoking, is there a link between depression and smoking? Epidemiological studies have shown that on the whole, people who suffer from mental health problems are twice as likely to smoke as the general population. Specifically, some studies have shown a higher instance of depression among smokers (McClave et al., 2009; Fergusson et al., 2003).
All the same, we must bear in mind when we look at these results that it is not always easy to distinguish between anxiety and mood problems. There are bound to be more smokers who suffer from anxiety, and if these studies find a link between depression and smoking, it could be that the depression is linked not to smoking but to anxiety itself (Mykletun et al., 2007).
This research has not yet discovered a causal link. Do more smokers than non-smokers get depressed, given that smoking encourages feelings of depression, or do more depressed people smoke, given that depression can lead to a desire to smoke? This question has not yet been answered. It will undoubtedly produce wide-reaching implications because we are dealing with complex, interconnected factors. People who are vulnerable to depression are also vulnerable to smoking, as smoking and its associated withdrawal symptoms can lead to mood problems. People sometimes refer to this as a two-way link. For instance, Chaiton and colleagues (2009) found in a review of 15 longitudinal studies on teenagers, published between 1990 and 2008, that depression symptoms often anticipated smoking and vice versa. A literature review by Paperwalla and colleagues (2004) focused on this two-way causal link and recommends that we consider the following points:
- The scientific data that has been gathered leads us to believe that the links between smoking and depression are just as behavioral as they are neurobiological.
- Depression can be a vulnerability factor which encourages teenagers to start smoking.
- Failing to quit smoking can cause symptoms of depression, or even lead to the onset of a period of depression, especially among people who have had depression before.
- If depression goes untreated it can reduce a smoker’s likelihood of being able to quit and worsen their withdrawal symptoms.
- Health professionals should be aware of the issue of depression when helping people to stop smoking.
Do more smokers than non-smokers suffer from mental health problems?
Dr. Thomas Rathelot, Medical Director of the Addictology Unit, Geneva University Hospitals (HUG), gives his response: (french)
The use of antidepressants in smoking cessation
Antidepressants can sometimes be useful in aiding smoking cessation for three reasons (Hughes et al., 2007):
- Nicotine withdrawal can produce symptoms of depression, or even in the worst cases lead to major depression.
- The "antidepressant" effect of nicotine is one of the factors that encourage people to keep on smoking. Because smokers lack nicotine and feel depressed when they do not smoke, they start again to make themselves feel better. The antidepressant replaces this effect of the nicotine.
- Antidepressants act on the nervous system and receptors in the brain whose link to nicotine addiction has been demonstrated.
The first two theories have not been proved. It is possible, on the contrary, that the success of bupropion in aiding smoking cessation is independent from its “antidepressant” effect.
|Information on bupropion (Zyban®), an antidepressant used as an aid to smoking cessation|
Reviews and meta-analysis
- Ameringer KJ, Leventhal AM. (2010). Applying the Tripartite Model of Anxiety and Depression to Cigarette Smoking: An Integrative Review. Nicotine Tob Res. 2010 Oct 29.
- Chaiton, MO., Cohen, JE., O'Loughlin, J., Rehm, J. (2009). A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Public Health, 22 (9):356.
- Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub3
- Paperwalla KN, Levin TT, Weiner J, Saravay SM. (2004). Smoking and depression. Med Clin North Am., 88(6):1483-94, x-xi.
Fergusson, D.M., Goodwin, R.D., Horwood, L.J. (2003). Major depression and cigarette smoking: results of a 21-year longitudinal study. Psychological Medicine, 33(8): 1357-1367.
- Lasser, K., Boyd, J.W., Woolhandler, S., Himmelstein, D.U., McCormick, D., Bor, D.H. (2000). Smoking and mental illness: a population-based prevalence study. Jama, 284(20):2606e10.
McClave, A.K., Dube, S.R., Strine, T.W., Kroenke, K., Caraballo, R.S., Mokdad, A.H. (2009). Associations between smoking cessation and anxiety and depression among U.S. adults. Addict Behav., 34(6-7): 491-7.
Mykletuna, A., Overlanda, S., Aarøa, L.E., Liabøa, A-M., Stewartb, R. (2008). Smoking in relation to anxiety and depression: Evidence from a large population survey: The HUNT study. European Psychiatry, 23(2): 77-84.
Wiesbeck, G.A., Kuhl, H.-C., Yaldizli, Ö., Wurst, F.M. (2008). Tobacco Smoking and Depression – Results from the WHO/ISBRA Study. Neuropsychobiology, 57: 26-31.
Auteur: Grégoire Monney