Smoking and depression--a review

People with a lifetime history of depression are twice as likely to smoke as those who do not suffer from depression. Smoking is a major health issue in this population, but is often overlooked by health professionals.

This article examines the relationship between smoking and depression, and reviews the evidence for the use of specific therapies in general practice.

All patients with depression should be asked if they smoke. Smokers with depression have higher nicotine dependence and, after quitting, experience more severe negative moods and are at increased risk of major depression. However, they are motivated to quit and many achieve long term abstinence. Effective strategies for smoking cessation in this population include cognitive behavioural mood management, nicotine replacement therapy, varenicline and bupropion. Additional support and longer courses of treatment may be needed. Smokers with depression should be monitored for mood changes after quitting. Preventive antidepressants may have a role in high-risk cases, especially for those with recurrent depression.