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

Abstract

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.

Intact goal‐directed control in treatment‐seeking drug users indexed by outcome‐devaluation and Pavlovian to instrumental transfer: critique of habit theory

“…However, the current paper has (a) suggested that human drug users have intact goal‐directed control, (b) critiqued published human evidence for impaired goal‐directed control in addiction and (c) reviewed evidence that human drug dependence is a form of excessive goal‐directed behaviour. These arguments suggest that neuro‐interventions for addiction should seek to dampen the encoding of expected drug value in the DMS (Murray et al ., ) and OFC (Everitt et al ., ; Valentin et al ., ; Hayashi et al ., ; Guillem & Ahmed, ; Guillem et al ., ), which arguably underpins excessive goal‐directed drug‐seeking (Mathew et al ., ). Future research in this field might prioritise characterisation of the computational and neurobiological mechanisms underpinning value‐based learning, drug valuation and outcome comparison, especially in the OFC, in order to develop neuro‐interventions for drug dependence (Rangel et al ., ; Hayashi et al ., ).…”

“…These data suggest that drug addiction might be driven by constitutional sensitivity to adverse motivational states (e.g. withdrawal, depression, stress) promoting goal‐directed drug‐seeking though incentive learning (Hogarth et al ., ; Mathew et al ., ; Hogarth & Hardy, ) rather than though excessive habit learning.…”

Current major depression is associated with greater sensitivity to the motivational effect of both negative mood induction and abstinence on tobacco-seeking behavior

“…One mechanistic explanation for this association is that depressed individuals are more sensitive to a cluster of correlated adverse interoceptive-emotional states which trigger drug use to cope, thus increasing the risk of dependence, persistence and relapse (Hussong et al, 2011; Mathew et al, 2016). This cluster of adverse triggers for drug use could include several distinct states such as rumination, anger, hostility, anxiety, stress, anhedonia, fatigue, or cognitive decline.…”

The role of physical activity enjoyment on the acute mood experience of exercise among smokers with elevated depressive symptoms

“…Smokers who are unable to quit are more likely to possess risk factors or characteristics that make it difficult to quit, such as psychiatric symptoms and disorders (Korhonen et al, 2011; Morrell et al, 2010; Pratt and Brody, 2010; Trosclair and Dube, 2010). Robust evidence indicates that elevated depressive symptoms are related to the maintenance of smoking and cessation failure (Audrain-McGovern et al, 2015; Mathew et al, 2016). As a result, there has been growing interest in the development and testing of smoking cessation interventions that can effectively target depressive symptoms to help promote smoking cessation (Weinberger et al, 2013).…”