No abstract

No abstract

The authors review recent literature that has demonstrated an association between cigarette smoking behavior and major depression. Persons with major depression are more likely to smoke and to have difficulty when they try to stop. When they manage to succeed in stopping, such persons are at increased risk of experiencing mild to severe states of depression, including full blown major depression. The period of vulnerability to a new depressive episode appears to vary from a few weeks to several months after cessation. This knowledge suggests a relationship between smoking and depression that is complex, pernicious, and potentially life-long. It is recommended that cessation treatments incorporate screening procedures that will identify those patients with a propensity to depression and monitor the emergence of postcessation depression, particularly in those with a history of depression.

Objective High smoking rates in adults with attention deficit hyperactivity disorder (ADHD) and nicotine’s amelioration of ADHD suggest that effective ADHD treatment might facilitate abstinence in smokers with ADHD. The present study evaluated if using osmotic release methylphenidate (OROS-MPH) to treat ADHD enhances response to smoking cessation treatment in smokers with ADHD. Method A randomized, double-blind, placebo-controlled, 11-week trial with a one month follow-up conducted at six clinical sites between December 2005 and January 2008. Adults (18–55), meeting DSM-IV criteria for ADHD and interested in quitting smoking were randomized to OROS-MPH titrated to 72 mg/day (n=127) or placebo (n=128). All participants received brief weekly individual smoking cessation counseling for 11 weeks and 21 mg/day nicotine patch starting on the smoking quit day (day 27) through study week 11. Outcome measures included prolonged smoking abstinence and DSM-IV ADHD Rating Scale (ADHD-RS) score. Results Of 255 randomized, 204 (80%) completed the trial. Prolonged abstinence rates, 43.3% and 42.2%, for the OROS-MPH and placebo groups, respectively, did not differ significantly (odds ratio, 1.1; 95% confidence interval, 0.63 – 1.79; p=0.81). OROS-MPH, relative to placebo, evidenced a greater reduction in DSM-IV ADHD-RS score (p<0.0001) and in cigarettes per day during the post-quit phase (p=.016). OROS-MPH, relative to placebo, increased blood pressure and heart rate to a statistically, but not clinically, significant degree; medication discontinuation did not differ significantly between treatments. Conclusions ADHD treatment did not improve smoking cessation success; OROS-MPH, relative to placebo, effectively treated ADHD and was safe and generally well tolerated in this healthy sample of adult ADHD smokers.

These results provide, at best, mild promise for naltrexone as a smoking cessation drug and provide another instance of a differential response to nicotine dependence treatment according to gender and depression history.

The association between depressive mood and cigarette smoking among adolescents was examined within a multivariate model. Subjects were 205 eleventh graders (123 boys and 82 girls) enrolled in a Northeast metropolitan public high school for scienceoriented students. Logistic regression analysis showed an indepen- IntroductionA host of factors have been investigated in numerous attempts to determine the antecedents of cigarette smoking among adolescents. Peer and family smoking behavior have been consistently implicated'-3; while less evidence has been demonstrated for the effects of psychological traits, knowledge and attitudes about smoking, school achievement, and demographic characteristics.'A prospective study involving 1,004 subjects found that depressive symptoms reported at ages 15-16 predicted the frequency and duration ofcigarette smoking nine years later.4 This association was not seen for future alcohol or drug use. Another study found higher scores on the Beck Depression Inventory among cigarette smokers than in nonsmokers in males.5 Both studies limited analysis to simple associations; neither controlled for the effect of other known risk factors. We have found no other attempts to examine the relation between depression and smoking among adolescents. In contrast, a recent paper cited seven studies that examined the relation between depressive disorders and drug and alcohol abuse.6The present study reports our investigation into the relation between depressive symptoms and cigarette smoking among adolescents within the context of a multifactorial model.

Measures of addiction and major depression predict treatment failure. Together they are stronger predictors of outcome than drug. Clonidine is a limited aid in cessation, and drug effects come primarily from women at high risk for treatment failure. An increased risk for psychiatric complications after smoking cessation was apparent among smokers with histories of major depression, particularly bipolar disease.

Aims This paper aims to identify appropriate criteria for tobacco dependence assessment, evaluate relevant research, and suggest revisions that may be incorporated into DSM-5. Methods Desirable conceptual and psychometric features of tobacco dependence assessments were identified, including the types of outcomes against which such assessment should be validated. DSM-IV criteria were matched against these criteria and compared with other dependence measures. Results DSM-IV criteria were found to be ambiguous, little used in tobacco research, and have relatively low predictive validity. Other dependence measures were found to have greater validity in the prediction of important dependence features such as relapse likelihood. Strength of urges to smoke on typical smoking days and during abstinence, markers of nicotine intake or frequency of smoking, and latency to smoke soon after waking were found to be useful dependence measures. Conclusion The use and utility of DSM-5 will be enhanced by eliminating most DSM-IV criteria and adding new ones based on smoking pattern, smoking heaviness, and the severity of craving during periods of smoking and withdrawal.