Self Help

Today little information suggests that nicotine use directly causes depression. Most evidence indicates that it is nicotine withdrawal that provokes depression. A young adolescent with depressive symptoms would likely be tempted to use nicotine as a self-medication. This could explain why people who are depressed take up smoking at a higher rate than others. An alternative possibility is that regular nicotine use increases the likelihood of major depressive disorder. A third prospect is that some genetic trait independently increases the risk for both depression and smoking.

Medical literature strongly suggests that there is an association between cigarette smoking and both alcoholism and major depression. But, although smokers regularly report that nicotine diminishes anxiety, it has been difficult to prove this anti-anxiety effect of nicotine experimentally. Studies using laboratory animals fail to show a strong anti-anxiety effect for nicotine. However, nicotine dependence in these animals increases when they are under stress.

Regardless of the role of anxiety, there is little question that major depression is associated with cigarette smoking. The question is, what specifically is responsible for this? Are smoking and lifetime major depression associated because (1) one directly causes the other, (2) common social or environmental factors indirectly link them, or (3) the same genes increase the vulnerability to both conditions? Studies conclude that smoking does not cause depression, nor does depression cause smoking. The two are associated largely or entirely because of genetic factors that influence one’s tendency toward both conditions.

It is important to recognize that the ability to see a link between smoking and major depression depends on social issues. If everyone smoked, there would be no association between smoking and any psychiatric illness. However, social pressures have ceased community rates of smoking to fall. So individuals who can more easily quit do so. Those with greater vulnerability to nicotine are more likely to continue. As a result, as the social pressure to stop smoking grows, the association between smoking and depression becomes more apparent.

Do smokers with a previous experience of major depression develop depression during nicotine withdrawal? Studies of a group of placebo-treated smokers with a past history of depression show that 75 percent of the subjects reported developing depressed moods during the first week of withdrawal from nicotine, whereas 30 percent of smokers without such a history made a similar report. Thus, withdrawal was more severe in those smokers with a history of major depression. Their development of depression during the first week of withdrawal was associated with failure to succeed in giving up tobacco. A controlled study of smokers with histories of major depression has shown that they were much more successful in quitting smoking when given antidepressant medication in addition to health education.