Smokers Use Nicotine To Manage Depression, Other Disorders

August 06, 1997

Hard Core Smokers May Use Nicotine To Manage Depression, ADHD, Anxiety Or Bulimia

ANN ARBOR---You still see them huddled over their cigarettes in public doorways, despite 30 years of increasing social pressure and education about health risks. Why can't they quit?

"There is mounting evidence that smoking is becoming increasingly concentrated in people at-risk for major depressive disorders, adult attention deficit hyperactivity disorder (ADHD), anxiety disorders and bulimia or binge-eating. People with these conditions or co-factors often use nicotine to help manage their symptoms," according to Cynthia S. Pomerleau, a researcher with the University of Michigan Substance Abuse Research Center and the Nicotine Research Laboratory in the U-M Department of Psychiatry.

"Many of those who have given up smoking in the past appear to have been the 'easy quits' or casual adult smokers," she added. "Health practitioners interested in helping patients with co-factors to quit need to develop new kinds of smoking interventions tailored to the special needs of these difficult-to-treat, at-risk populations." Pomerleau's findings are reported in a literature review in the April issue of Addiction.

Smoking has dropped in the U.S. adult population from 40 percent in 1965 to less than 29 percent in 1990. Despite the decline, Pomerleau said that smoking rates may level out at about 15 percent to 20 percent of the adult population.

"Nicotine produces temporary, small but reliable adjustments in a wide variety of cognitive and behavioral functions. Administered via smoking, nicotine quickly enters the brain where it affects neural regulators such as norepinephine, dopamine and serotonin, and can either sedate or stimulate depending on the timing, dosage and other factors," Pomerleau explained.

When smokers with co-factors such as depression or binge-eating try to quit, their symptoms are exacerbated or unmasked by the absence of nicotine and persist well beyond the usual two- to three-day nicotine withdrawal period. Consequently, they are more likely to relapse than smokers with no co-factors.

Pomerleau cited a substantial accumulation of research to support her conclusions, including:

Health professionals helping smokers with co-factors to quit smoking may have to treat the depression, anxiety, ADHD or binge-eating behaviors first or simultaneously, Pomerleau said. "A 1995 study found that Prozac helped smokers with depression to quit but it had no effect on smokers who were not depressed," she said. "It is possible that some of these patients wouldn't need nicotine replacement treatment once they received appropriate medications or psychotherapy for their underlying conditions."

Pomerleau also suggested that more research be conducted regarding the potential therapeutic use of nicotine products---transdermal patches, nasal sprays or gum---to treat ADHD and conditions such as Parkinson's and Alzheimer's diseases. "We need more data on the possible toxic effects of nicotine to weigh against its possible therapeutic effects.

"Finally, we need to consider the potential needs of children of smokers with co-factors," she said. "Recent twin studies suggest that the heritability of smoking is at least as high as that of alcohol, with significant genetic contributions to initiation, age of onset, amount smoked and likelihood of quitting. It may be that some families are predisposed to both smoking and depression.

"There also is good evidence of assortative mating in smokers---the tendency to find each other, marry and have children, with the nature and severity of problems experienced by smokers with co-factors being magnified in succeeding generations. Prevention efforts and early identification and treatment of the co-factor itself may be needed in these children."

University of Michigan

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