Why depressed people find it harder to quit smoking


It is not easy to quit smoking, and this is especially true for depressed people. Recent studies shows that the cessation rates are consistently lower for depressed smokers than for smokers in the general population.

But why is that? What motivates depressed people smoke? What relation exists between smoking and depression?

To answer these questions, researchers from Northwestern University, University of Southern California, and University of Wisconsin-Madison conducted a deep, systematic review of the previous findings about smoking and depression. The review is published in Addiction.

Researchers included 297 studies published by December 2014 in their review. Paper search was done on several large academic databases, including PubMed, Scopus, PsychINFO, and CINAHL.

All selected studies focused on clinical issues and motivations of smoking in adult smokers with symptoms of depression. These adult smokers had willingness to quite and might show cessation or relapse.

The result showed that depressed smokers often experienced distress, and they tended to use cigarettes to feel better. In fact, there was a positive relation between distress level and nicotine dependence: the more they feel distressed, the more they smoke, and the more they relapse.

This is very bad because as nicotine dependence increases, distress in depressed smokers can reinforce a higher value of smoking. To people who cannot feel pleasure, smoking is like a reward to gain happiness. This is a strong motivation behind smoking.

Another reason causing depressed smokers hard to quit smoking is cognitive impairments. People with depression can have deficits in attention, memory, executive control function, and processing speed.

Smoking can help them maintain these functions, whereas quitting smoking may make the deficits worse. Therefore, depressed smokers usually keep smoking, particularly in cognitively demanding tasks.

Researchers suggest that in future treatment, doctors should try to improve depressed smokers’ positive emotions and change their beliefs about the high value of smoking. In that way, they can improve cessation outcomes for these smokers.

Citation: Mathew AR, et al. (2016). Cigarette smoking and depression comorbidity: systematic review & proposed theoretical model. Addiction, published online. doi: 10.1111/add.13604
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