What is the association of nicotine addiction and postcessation depression?

Updated: Jul 16, 2018
  • Author: R Gregory Lande, DO, FACN; Chief Editor: Glen L Xiong, MD  more...
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An association between nicotine addiction and depression is well established. Previous studies also have demonstrated that dependent smokers have lower monoamine oxidase A and B activity than nonsmokers do. Smokers with a past history of major depression also were found to have significantly lower resting plasma norepinephrine levels. A history of depression also was found to be more frequent in female smokers.

Reports of severe major depressive episodes after smoking cessation indicate that the onset of severe depressive symptoms ranges from 2 days to 6 weeks after abstinence from smoking.

In some cases, depression after smoking cessation was resolved with the use of nicotine replacement therapy or the use of antidepressants; in others, depressive symptoms dissipated after a relapse to smoking. The significant predictors of major depressive episodes were as follows:

  • Having a history of major depression

  • Experiencing elevated withdrawal symptoms at the end of treatment

Obtaining information about any history of depressive symptoms is important, and when such a history is present, remaining alert to the possible onset of depression even weeks after smoking cessation treatment has ended is also important.

Antidepressants (eg, fluoxetine and sertraline) may be a useful cessation aid for smokers with prior major depression, and other authors have suggested that smokers with prior major depression benefit from mood management counseling and nortriptyline as cessation aids. Whether these treatments also prevent the onset of postcessation depression remains to be determined. It also remains to be seen whether effective management of withdrawal symptoms prevents postcessation depression.

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