It’s Complicated: The Relationship Between Depression and Smoking

Smoking relieves stress. Smoking calms you down. Smoking makes you feel better … right? 

Smoking and depression have a well-established and consistent link. According to the CDC, people with depression smoke at higher rates, smoke more, and are less likely to quit than people without depression. Data from the 2005-2008 National Health and Nutrition Examination reveals that 48% of women and 40% of men with severe depression smoke, compared to 17% and 25% of non-depressed women and men respectively. Researchers have long suggested that smoking is a form of self-medication for depressed people, who may find temporary relief from their symptoms in both the chemical and behavioral process of lighting up, and experience aggravated depressive symptoms when they try to stop.However, newer studies reveal that traditional thinking about the relationship between smoking and depression may not tell the whole story; while depression may cause you to smoke, smoking may also be causing your depression.

Researchers the University of Alabama at Birmingham observed 1,218 high school students over a period of 1.5 years. Depression and smoking were assessed every six months along with factors such as parental smoking, familial support, temperament, delinquency, alcohol and substance use, and peer alcohol and substance use. The results were clear: the subjects who began the study as heavy smokers were more likely to become depressed than those who did not smoke or smoked less, even when all other variables were controlled for. Simultaneously, the teens who began the study with depressive symptoms increased their nicotine consumption over time compared to those without depression.

The exact mechanism by which cigarettes contribute to depression is unknown, and the idea itself is at odds with how many depressed smokers perceive their smoking experience. After all, many people with depression incorporate smoking as a maladaptive self-care mechanism based on the emotional benefits they feel they are receiving; people smoke because it makes them feel better. Theoretically, this is logical, as smoking activates the pleasure centers in the brain, temporarily enhancing mood. As tolerance develops, more and more nicotine is needed to produce the same pleasurable effect, and smoking cessation leads to an emotional crash. However, the research is less clear. A study led by Dr. Bonnie Springs at Hines Hospital, VA Medical Center, gave depressed and non-depressed subjects either nicotinized or denicotinized cigarettes after introducing a “positive mood trigger” and found that “[s]elf-administering nicotine appears to improve depression-prone smokers’ emotional response to a pleasant stimulus.” To investigate further, researchers at the University of Pittsburgh studied whether or not cigarettes improve emotional response to stressful triggers such as preparing for public speaking, dealing with a difficult computer task, and seeing negative images. The findings were surprising; smoking nicotinized cigarettes only improved mood if the subjects had gone at least one day since their last cigarette and only led to modest mood improvement.

It may then be that smoking, in fact, does not chemically have the power to produce the positive emotional effects many people with depression perceive themselves as benefitting from. In fact, it may be the beliefthat you are going to feel better that makes you feel better. This is very promising news for depressed people; if the short-term relief you experience from smoking is generated by the power of your own mind, rather than the chemistry of a cigarette, that relief can be found even without smoking. In fact, smoking cessation itself can alleviate depressive and anxious symptoms. A study published in the British Medical Journal found that “smoking cessation is associated with reduced depression, anxiety, and stress, and improved positive mood and quality of life compared with continuing to smoke.” The benefits were particularly marked for those subjects currently being treated with antidepressants.

Depressed smokers often feel that they rely on cigarettes to provide relief from painful symptoms and experience a sense of powerlessness over their addiction. Your relationship with smoking may have become an integral part of how you cope with emotional distress, and you may see quitting as a profound loss; how will you handle stressors without a cigarette? But smoking isn’t what makes you feel better–you have been drawn into a self-destructive pattern that aggravates your depressive symptoms. Through comprehensive mental health treatment, you can break the cycle of depression and nicotine addiction and address the underlying issues that fuel your smoking, optimizing your chances of successful quitting. Taking control of your health–physical and psychological–empowers you to move forward with confidence and a sense of self-mastery. By developing healthy coping mechanisms that give you true and lasting relief, you can begin to heal from the emotional and physical effects of both mental illness and cigarette use, allowing you to live a life free from the devastation of depression and smoking.

Bridges to Recovery offers innovative, personalized treatment for depression in a comfortable residential setting. Contact us for more information about our program and how we can help you or your loved one suffering from a mental health disorder.