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Excerpts from: Kicking Habit Kicks Up Depression

By Neil Sherman, HealthScoutNews Reporter  Kicking Habit Kicks Up Depression    [06/19/01]

If you are subject to depression, you're much more likely to suffer the blues again
after you quit smoking, new research shows.

People who have had episodes of clinical depression may have a sixfold risk of having another bout of depression within six
months of kicking the habit, compared to quitters not prone to depression, the researchers say.

"There seems to be some truth in the notion that some of the people who smoke are self-medicating with nicotine to avoid
clinical depression," says lead author Dr. Alexander Glassman, chief of clinical psychopharmacology at Columbia University's
New York State Psychiatric Institute in New York City. "I think the logical step for those trying to quit -- and I emphasize this
has not been proven to be correct -- is that if you used an antidepressant like Zyban to stop smoking, don't stop the drug after
you've successfully quit."

Glassman says his six-month study followed 76 pack-a-day smokers with a history of major depression but who hadn't been
taking an antidepressant. All were enrollees in a smoking cessation program. The smokers were randomly assigned a regimen of
the antidepressant Zoloft or a placebo, and were told to pick a quit date 21 days after beginning the drug. The study was
funded by Pfizer, Zoloft's manufacturer, to see whether Zoloft could help those with clinical depression stop smoking.

Forty-two participants stopped smoking and 34 continued to smoke at the end of the program, Glassman says. "We followed
everybody after they finished the Zoloft and were off all medication, and we followed both the successes and the failures. The
Zoloft, by the way, did not help them with the smoking cessation."

Among the successful quitters, "more that 30 percent developed a new episode of clinical depression," Glassman says. "That's a
sixfold increase in the risk," he says.

Another implication this study reveals is that "nicotine acts like an antidepressant," Glassman says. "That could mean a whole
new arena for new antidepressant drugs. It's quite possible you could make derivatives of nicotine that wouldn't have the
medical complications of nicotine but could prove very useful in the treatment of clinical depression."

According to the Centers for Disease Control and Prevention, there are 48 million adult smokers in the United States, and at
least 16 million try to stop smoking for at least 24 hours each year. Another 2 million to 3 million try to quit but can't get through
a single day.

Almost 20 million Americans suffer from clinical depression, according to the National Institute of Mental Health. It is the single
most prevalent mood disorder in America today.

"The study really points out that some smokers trying to quit are really vulnerable to depression, much more than we thought,"
says Raymond Niaura, a professor of psychiatry at Brown Medical School in Providence, R.I. "We always knew that people
experience significant withdrawal symptoms when they quit smoking and among those are symptoms of depression, but we
never realized the magnitude of the effect."

Niaura says that anywhere "from 30 to 50 percent of the smokers we see in our smoking cessation clinics have a history of prior
depression."

Sticking to an antidepressant is the answer, Niaura says, if you're contemplating quitting. "We know that it's useful in quitting
smoking, but it may also have people avoid a relapse into depression."