Major depression following smoking cessation
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Abstract:
The authors examined the incidence and predictors of major depression following successful smoking cessation treatment, with special attention to the influence of past major depression.Three-month follow-up data were obtained from 126 subjects who successfully completed a 10-week smoking cessation program.The 3-month incidence of new major depression following treatment for nicotine dependence was 2%, 17%, and 30% among subjects with histories of no major depression, single major depression, and recurrent major depression, respectively. A history of major depression and persistent withdrawal symptoms independently predicted posttreatment major depression.Continued patient care beyond the 2-4-week period associated with the nicotine withdrawal syndrome is indicated when abstinence is attempted by smokers with prior major depression.Keywords:
Depression
History of depression
Nicotine withdrawal
Nicotine dependence
Nicotine withdrawal
Nicotine replacement therapy
Withdrawal syndrome
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Rationale
Decreasing withdrawal and craving during smoking cessation is a major aim of cessation medications. Prior studies have shown that Nicotine Replacement Therapy (NRT) decreases withdrawal symptom severity but have relied on retrospective reports and lacked robust measures of baseline symptoms or symptoms during unmedicated abstinence.
Objectives and methods
We tested the effect of high-dose (35 mg) nicotine patch on withdrawal and craving during abstinence using real-time assessment with electronic diaries during ad libitum smoking, a brief period of experimentally directed trial abstinence, and the first 3 days of cessation. Subjects were 324 smokers randomized to high-dose nicotine patches or placebo.
Results
Treatment with active patches reduced withdrawal and craving during cessation and completely eliminated deprivation-related changes in affect or concentration.
Conclusion
High-dose NRT reduces withdrawal symptoms and craving and can eliminate some symptoms entirely.
Nicotine withdrawal
Nicotine patch
Nicotine replacement therapy
Nicotine gum
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The present study evaluates the role of distinct components of nicotine dependence (craving, withdrawal, behavioural dependence) in comparison to smoking-related cognitions (attitudes, perceived social approval, self-efficacy) in adolescent smoking cessation. In the process towards smoking cessation, we distinguish between distinct behavioural transitions, respectively, short-term abstinence, reduction in smoking behaviour and prolonged cessation, to evaluate differences in cessation-related antecedents as a function of varying behavioural outcomes. A total of 850 adolescent smokers (age 14-16) participated in the present study. Smoking behaviour was assessed 1 year after baseline. Results showed that all dependence components had a distinct role in the prediction of behavioural change towards cessation. Furthermore, each behavioural transition was predicted by a distinct set of variables, indicating that contributions of cessation-related factors vary across the course towards cessation. Overall, our findings suggest that smoking-related cognitions are particularly relevant in the initiation of behavioural change, such as short-term abstinence, whereas nicotine dependence, craving in particular, becomes increasingly important in the prediction of maintained behavioural change, such as prolonged cessation. Implications encompass enhanced attention to the multidimensional nature of nicotine dependence and the value of comparing different behavioural outcomes in a comprehensive understanding of cessation-related factors.
Nicotine dependence
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Background: Smoking is among the most common preventable causes of early death in the world. Implementation of smoking cessation programs is among the effective strategies of tobacco control. More than half the smokers experience nicotine withdrawal syndrome after quitting and this could be one of the main reasons of unsuccessful smoking cessation. This study evaluated the severity of nicotine withdrawal symptoms 14 days after quitting (the last visit of smokers to the smoking cessation clinic).
Nicotine withdrawal
Withdrawal syndrome
Nicotine dependence
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Despite the critical role of withdrawal, craving, and positive affect (PA) and negative affect (NA) in smoking relapse, relatively little is known about the temporal and predictive relationship between these constructs within the first day of abstinence. This pilot study aims to characterize dynamic changes in withdrawal, craving, and affect over the course of early abstinence using ecological momentary assessment. Beginning immediately after smoking, moderate and heavy smoking participants (n = 15 per group) responded to hourly surveys assessing craving, withdrawal, NA, and PA. Univariate and multivariate multilevel random coefficient modeling was used to describe the progression of craving, withdrawal/NA, and PA and to test correlations between these constructs at the subject level over the course of early abstinence. Heavy smokers reported greater craving from 1-4 hr of abstinence and greater withdrawal/NA after 3 or more hours as compared with moderate smokers. Level of withdrawal/NA was strongly positively associated with craving, and PA was negatively correlated with craving; however, the temporal dynamics of these correlations differed substantially. The association between withdrawal/NA and craving decreased over early abstinence, whereas the reverse was observed for PA. These findings can inform experimental studies of nicotine abstinence as well as their clinical applications to smoking cessation efforts. In particular, these results help to elucidate the role of PA in nicotine abstinence by demonstrating its independent association with nicotine craving over and above withdrawal/NA. If supported by future studies, these findings can refine experimental methods and clinical approaches for smoking cessation.
Nicotine withdrawal
Affect
Cotinine
Nicotine dependence
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Nicotine withdrawal is cited by smokers as a principal reason for relapse and a significant barrier to sustained abstinence. Postcessation self-efficacy is established as a predictor of smoking cessation success but may be influenced by the impact of nicotine withdrawal symptoms. The objective of the current study was to determine if the relationship between nicotine withdrawal and relapse to smoking was mediated by diminished postcessation self-efficacy. Smokers (N = 266) ready to make a quit attempt completed measures of nicotine withdrawal, depressed mood and self-efficacy at Week 1 post-target quit date (TQD); smoking status was collected at Week 3 post-TQD. Both nicotine withdrawal (OR = 0.56, CI = 0.36-0.85, p <.01) and self-efficacy (OR = 1.50, CI = 1.09- 2.05, p <.05) predicted continuous abstinence at Week 3; depressed mood did not. Mediational analysis did not support the contention that self-efficacy mediated the role of nicotine withdrawal on abstinence.
Nicotine withdrawal
Nicotine dependence
Nicotine patch
Nicotine gum
Depressed mood
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Nicotine withdrawal
Nicotine dependence
Abstinence Syndrome
Intensity
Negative mood
Depressed mood
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Scientific evidence implicates anxiety sensitivity (AS) as a risk factor for poor smoking cessation outcomes. Integrated smoking cessation programs that target AS may lead to improved smoking cessation outcomes, potentially through AS reduction. Yet, little work has evaluated the efficacy of integrated smoking cessation treatment on smoking abstinence. The present study prospectively examined treatment effects of a novel AS reduction-smoking cessation intervention relative to a standard smoking cessation intervention on smoking abstinence.
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Anxiety sensitivity
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Nicotine withdrawal
Nicotine dependence
Withdrawal syndrome
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