New Treatment for Depressed Smokers Trying to Quit

Summary: Researchers have pinpointed why quitting smoking is more difficult for people who are depressed.

Source: University of Exeter.

Researchers pinpoint why depressed smokers have a harder time resisting relapses.

An international team of researchers have pinpointed why quitting smoking is particularly difficult for depressed people and are now testing a new smoking cessation treatment, combining medication and behavioural activation therapy targeted at this population.

The paper, an extensive review of current research, offers a much deeper understanding of why nicotine withdrawal symptoms for people with depression make it much more difficult to quit smoking.

Co-author of the paper, Professor Lee Hogarth of the University of Exeter’s Psychology department, said: “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.

“But now we have gathered together convincing empirical support for this theory, which can be used to justify new treatment approaches.”

Senior author, Professor Brian Hitsman of the Northwestern University Feinberg School of Medicine said: “We’ve used this theory of withdrawal in depressed smokers to develop the first targeted approach for smoking cessation in this underserved population.”

Depressed smokers experience adverse withdrawal states that contribute to resumption of smoking, including low mood, difficulty engaging in rewarding activities and impaired thinking/memory, the paper reports. These symptoms are more severe for people with depression than for those without depression. In addition, depressed smokers tend to have fewer ways to cope with the symptoms and the nicotine in cigarettes helps to mitigate these problems, which is why depressed people tend to relapse at higher rates.

“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 in preventive medicine at Feinberg and a licensed clinical psychologist. “On the other hand, successfully quitting smoking is associated with improvements in mental health.”

The review found that depressed smokers’ first adverse state while trying to quit is a combination of “low positive affect” (low pleasure and engagement in rewarding activities, such as 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).

Image shows a cigarette in an ash tray.
Depressed smokers experience adverse withdrawal states that contribute to resumption of smoking, including low mood, difficulty engaging in rewarding activities and impaired thinking/memory, the paper reports. NeuroscienceNews.com image is for illustrative purposes only.

The study’s researchers have begun testing a treatment that targets the specific challenges depressed smokers face when they’re quitting. People who have clinical depression have typically been excluded from smoking cessation clinical trials.

The FDA-approved medication Chantix is coupled with a type of behavior therapy called “behavioral activation” to treat the depressed smokers. Researchers are investigating whether Chantix reverses thinking and memory problems that depressed smokers experience during withdrawal, and whether the behavioral activation improves smokers’ moods so they engage in normal pleasurable activities, and thus have less desire to smoke and are able to resist relapsing.

Behavioral activation is an effective treatment for depression, but this is the first time it is being used as a treatment for smoking cessation among depressed smokers.

About this psychology research article

The clinical study is being conducted at Northwestern Memorial Hospital and the University of Pennsylvania and is currently accepting participants.

Funding: The study is funded by the National Cancer Institute grant number R01 CA184211 of the National Institutes of Health.

Competing Interests: The authors have declared that no competing interests exist.

Source: Duncan Sandes – University of Exeter
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Abstract for “Cigarette smoking and depression comorbidity: systematic review & proposed theoretical model” by Amanda R. Mathew, Lee Hogarth, Adam M. Leventhal, Jessica W. Cook, and Brian Hitsman in Addiction. Published online Septermber 15 2016 doi:10.1111/add.13604

Cite This NeuroscienceNews.com Article

[cbtabs][cbtab title=”MLA”]University of Exeter “New Treatment for Depressed Smokers Trying to Quit.” NeuroscienceNews. NeuroscienceNews, 3 October 2016.
<https://neurosciencenews.com/depression-quit-smoking-5187/>.[/cbtab][cbtab title=”APA”]University of Exeter (2016, October 3). New Treatment for Depressed Smokers Trying to Quit. NeuroscienceNew. Retrieved October 3, 2016 from https://neurosciencenews.com/depression-quit-smoking-5187/[/cbtab][cbtab title=”Chicago”]University of Exeter “New Treatment for Depressed Smokers Trying to Quit.” https://neurosciencenews.com/depression-quit-smoking-5187/ (accessed October 3, 2016).[/cbtab][/cbtabs]


Abstract

Cigarette smoking and depression comorbidity: systematic review & proposed theoretical model

Background and aims

Despite decades of research on co-occurring smoking and depression, cessation rates remain consistently lower for depressed smokers than for smokers in the general population, highlighting the need for theory-driven models of smoking and depression. This paper provides a systematic review with a particular focus on psychological states that disproportionately motivate smoking in depression, and frame an incentive learning theory account of smoking-depression co-occurrence.

Methods

We searched PubMed, Scopus, PsychINFO, and CINAHL through December 2014, which yielded 852 articles. Using pre-established eligibility criteria, we identified papers focused on clinical issues and motivational mechanisms underlying smoking in established, adult smokers (i.e., maintenance, quit attempts, and cessation/relapse) with elevated symptoms of depression. Two reviewers independently determined whether articles met review criteria. We included 297 articles in qualitative synthesis.

Results

Our review identified three primary mechanisms that underlie persistent smoking among depressed smokers: low positive affect, high negative affect, and cognitive impairment. We propose a novel application of incentive learning theory which posits that depressed smokers experience greater increases in the expected value of smoking in the face of these three motivational states, which promotes goal-directed choice of smoking behavior over alternative actions.

Conclusions

The incentive learning theory accounts for current evidence on how depression primes smoking behavior and provides a unique framework for conceptualizing psychological mechanisms of smoking maintenance among depressed smokers. Treatment should focus on correcting adverse internal states, and beliefs about the high value of smoking in those states, to improve cessation outcomes for depressed smokers.

“Cigarette smoking and depression comorbidity: systematic review & proposed theoretical model” by Amanda R. Mathew, Lee Hogarth, Adam M. Leventhal, Jessica W. Cook, and Brian Hitsman in Addiction. Published online Septermber 15 2016 doi:10.1111/add.13604

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