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Effect of Clinical Depression on Smokers Undergoing Treatment For Tobacco Dependence

Center For Tobacco Control, NS-LIJ Health System, Great Neck, NY

PURPOSE: 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.

METHODS: 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.

RESULTS: 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%).

CONCLUSION: 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.

CLINICAL IMPLICATIONS: Comprehensive treatment for tobacco dependence is effective despite the presence of psychiatric co-morbidities and timely treatment can result in reduced healthcare expenditures.

DISCLOSURE: V.C. Reichert, None.