Co-morbid tobacco use disorder and depression: A re-evaluation of smoking cessation therapy in depressed smokers

Background and Objectives: To provide a critical evaluation of nicotine use disorder co-morbidity in persons with major depressive disorder (MDD) or its subsyndromal presentations. We focus on how a diagnosis of current or past MDD may shape access to smoking cessation therapy, and highlight the unique challenges that this group of smokers has to overcome to receive adequate treatment. Methods: A literature search was performed using PubMed for studies published between January 1995 and March 2015 using the following keywords and combination of keywords (co-morbidity, co-occurrence, and dual-diagnosis) and (nicotine dependence, cigarette smoking, tobacco dependence, tobacco use disorder) and (depression, major depression, unipolar mood disorders) and (self-medication). A total of 93 articles were identified. Of these, 31 studies were included in the analysis. Results: We found that: a) depressed smokers are motivated to quit; b) smoking cessation does not exacerbate symptoms of depression; c) depression does not have a negative impact on smoking cessation outcomes, and d) the self-medication hypothesis does not account for tobacco dependence and depression co-morbidity. Discussion and Conclusions: Our review of the relevant evidence suggests the importance and clinical significance of undertaking smoking cessation treatment for depressed smokers. Scientific Significance: Our findings support the need for increased attention to developing and implementing smoking cessation treatments for depressed smokers. Scientific Significance: Our findings support the need for increased attention to developing and implementing smoking cessation treatments for depressed smokers.