New Treatment Approach Could Help Depressed Smokers Quit

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Author: Shernide Delva

Quitting smoking is hard. Quitting smoking when you’re depressed is even harder. That’s why researchers are testing a new smoking cessation treatment combining medication and behavioral activation therapy targeted at this particular population.

Researchers from Northwestern Medicine have pinpointed why quitting smoking is so difficult for depressed people. Now, they are testing a new treatment plan that will help make the quitting process easier.

The study offers a much deeper understanding of why nicotine withdrawal symptoms for people with depression make it so much harder to quit smoking. The research was published in the international journal Addiction.

“We’ve used this new theory of withdrawal in depressed smokers to develop the first targeted approach for smoking cessation in this underserved population,” said senior author Brian Hitsman.

Depressed smokers experience adverse withdrawal states that make it more likely for them to resume smoking. These symptoms include depressed mood, difficulty engaging in rewarding activities and impaired thinking/memory. While all who quit smoking experience similar symptoms, the symptoms are more severe for those with depression than for those without depression.  Also, depressed smokers tend to struggle with coping with the symptoms and the nicotine in cigarettes help mitigate these problems, which results in relapsing at a higher rate.

“Many smokers learn, ‘If I smoke in this situation, my mood gets better.’ But while smoking improves mood in the short term, it produces a long-term decline in mood,” said lead author Amanda Mathew, research assistant professor of preventive medicine at Feinberg and a licensed clinical psychologist.
“On the other hand, successfully quitting smoking is associated with improvements in mental health.”

The study also revealed that the smoker’s first response to quitting is a “low positive affect”  (low pleasure and engagement in rewarding activities, such as the socializing or physical activity) and “high negative affect” (feelings of anger, sadness, guilt or anxiety). The second adverse state is “cognitive impairment” (difficulty making decisions, focusing and memory).

Researchers have begun testing a treatment that targets the specific challenges depressed smokers face when they are quitting. However, those diagnosed with clinical depression were excluded from the clinical trials.  The FDA-approved medication Chantix is coupled with behavior therapy to improve smoker’s moods as they engaged in normally pleasurable activities with the goal of lowering the rate of relapse. Behavioral therapy is a common treatment for depression, but this is the first time this type of treatment is being combined with a smoking cessation program.

“People have thought for some time that depressed smokers have difficulty quitting because they experience a more pronounced withdrawal syndrome, but the evidence is scarce because depressed smokers are hard to recruit and consequently have not been as studied,” said coauthor Lee Hogarth, associate professor of psychology at the University of Exeter in England. “But now we have gathered together convincing empirical support for this theory, which can be used to justify new treatment approaches.”

Researchers are still seeking participants for the study. If shown effective, it could potentially transform the way depressed smokers tackle quitting smoking.  It is the combination of behavior therapy, and medication could be the right combo needed to drop the habit.

We know that smoking is not healthy in the long term. However, quitting can be tough, even impossible after smoking for so long. In recovery, it is important to evaluate ways you can improve your health. When you feel ready to quit smoking, there are so many resources that can assist you in the process.  Do not hesitate. The time is now. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-777-9588.