Influence of depression in a smoking cessation program

Introduction: Smoking rates amongst depressed patients are higher than in general population. Treating depressed smokers is a challenge due to their dysfunctional emotional regulation and severe withdrawal symptoms. Aim: To understand how depression influenced a tobacco cessation program. Methods: Retrospective study of a cohort of 331 patients followed at our cessation program. Data were collected from revision of case notes. SPSS 21th version was used for statistical analysis. Results: 54.1% patients were male, mean age was 48.7 years; 22.7% of the patients were depressed and 12.3% had history of depression. Amongst depressed individuals, 64% were female. Median number of cigarettes per day was 20, without differences concerning depression status. Regarding Fagerstrom scale, 135 individuals had high nicotine addiction, with higher rates among depressed patients (56.8% vs 36.5%, p‹0.01). According to HADS, respectively 139 and 67 patients showed significant anxiety and depression. These rates were significantly higher (p‹0.01) amongst depressed individuals. 51 subjects had a high Richmond score (10) and this rate was significantly lower in the depressed group (8% vs 17.7%, p‹0.05). At 6 months, 105 individuals had quit smoking. This rate was significantly lower amongst depressed patients (16% vs 36.3%, p‹0.05), who were more likely (OR: 2.33, 95% CI:1.2-4.8) to continue smoking than non-depressed subjects (p‹0.05). In spite of depression status, varenicline was associated with higher quitting rates (p‹0.05). Similar associations were found in patients with past depression. Conclusion: Our results confirm the negative effect of, not only active depression, but also prior history of depression on tobacco quitting rates.