According to the US Centers for Disease Control and Prevention (CDC) almost half (43%) of the people over the age of 20 who suffer with depression are also smokers. This confirms what clinicians who work to help smokers quit have long seen firsthand. The smoking rate for people with depression in all age groups, for both men and women, is twice that of people without depression. In fact, these are smoking rates similar to those found in the population as a whole back in 1964, when the U.S. Surgeon General first reported on the dangers of smoking. To compound matters, the CDC report also says that in their findings: “Adults with depression were less likely to quit smoking than those without depression.”

What’s going on here?

Could it be that depressed people smoke because cigarettes deliver an antidepressant effect which provides mood support? Let’s keep in mind, however, that these smokers are all still being categorized as depressed, even while they are smoking, so obviously smoking is not a cure-all for them. Is there more smoking in the depressed population because quitting smoking represents a higher hurdle for them than for the general population? Do depressed people become even more depressed from the challenges of quitting and so avoid even trying?

I have long observed that all smokers are not alike; some quit relatively easily on their own while others say it is the hardest thing they have ever done in their lives. The job of clinicians who want to help smokers quit is to understand these differences and to make quitting as easy and pain-free as possible for the different kinds of smokers.

Sigmund Freud gave us an early description of the pain of tobacco withdrawal and depression when he wrote of his own experience in 1894:

The misery of abstinence has been far greater than I ever imagined…suddenly there came a severe cardiac misery, greater than I ever had while smoking. The most violent arrhythmia, constant tension, pressure, burning in the heart region, shooting pains down my left arm…and with it a feeling of depression which took the forms of visions of death.

Freud tried to quit after he developed heart arrhythmia when he was 38, but was soon back to smoking 20 cigars a day. He found not smoking a “torture,” and believed smoking tobacco was the “stuff of work” and necessary for the “combat with life”. By the time he was 67, he had developed growths on his jaw and palate associated with heavy smoking. During this period he underwent 30 or more minor, and some major, operations to remove precancerous growths. Despite this, he continued to smoke and had a huge prosthesis inserted in his oral and nasal cavities which required repeated painful adjustments. Freud didn’t quit his famous cigars until the age 74.

In my new book, “Smoke Free in 30 Days,” I describe that many men and women believe, much like Freud, that they will not be as effective in their work without smoking; they believe they will lose their edge. I have treated many individuals who believe that smoking helps them concentrate and that they will lose their cognitive ability if they were to stop.

In all these cases, however, each person who used nicotine replacement therapy appropriately was able to resume a productive work life after he or she stopped smoking. Nicotine replacement can help make this transition much less difficult by relieving withdrawal symptoms. Another medicine, the antidepressant Wellbutrin, (marketed to smokers as Zyban), represents a great advance in providing smokers with mood support as well as relief from withdrawal symptoms. However, medicine alone is unlikely to solve the dilemma posed by addiction to smoking. There is a difference between stopping smoking under duress, and making a positive emotional adjustment to going smoke-free. Ultimately, to make peace with the addiction, and make a happier long-term adjustment, the smoker must challenge the belief that they need to smoke to cope with their lives.

How can we help the smoker who is depressed?

We have learned a great deal about smoking, quitting and depression in the more than 100 years since Freud first discussed it. But unfortunately, most of today’s smokers struggling with depression are not benefiting from these advances.

Based on my clinical experience, and my reading of the research literature, I am not convinced that smoking actually serves as a good antidepressant drug. I believe the antidepressant effects of smoking are often exaggerated and overstated. More likely smoking feeds on smoker’s mood problems, some of which are created or magnified by withdrawal symptoms. It will surprise you to learn that half of the symptoms of nicotine withdrawal are also symptoms of clinical depression. These include (1) dysphoric or depressed mood; (2) insomnia; (3) difficulty concentrating; (4) increased appetite or weight gain. In order to meet diagnostic criteria for depression these symptoms must cause clinically significant distress or impairment in social, domestic, occupational, or other important areas of functioning. Even the symptoms of nicotine withdrawal that do not overlap with depression involve emotional upset. They include: irritability, frustration, anger, anxiety and restlessness. Just to get an idea of how difficult these kinds of symptoms make it to quit smoking, in research studies two out of three times smokers relapse (slip back to smoking), they report being “triggered” by a negative or stressful emotional experience.

In my book I outline six different patterns of smoking addiction. One of these is “the Emotion-Triggered Smoker”. For these smokers, mood problems can not only magnify nicotine withdrawal, but also complicate the emotional adjustment after quitting. If smoking were truly such a great antidepressant, why do so many smokers say they feel better, not just physically but emotionally, after a period of time away from it? They expect to feel worse, but actually feel better without smoking, once they overcome the withdrawal. For many, especially depressed smokers, this requires some small but important shifts in their perceptions about smoking which can help them to completely lose interest in smoking. This shift involves learning to disconnect the automatic smoking response from the trigger of emotional discomfort.

One smoker, whom I will call Christine, quit smoking because, like Freud, she had developed a heart condition which caused her great anxiety. Her identity was wrapped up in smoking. She literally told me “I was born to smoke”! While she suffered from lifelong depression, she told me from the beginning that “anger is my issue,” and every time she got angry she automatically reached for a cigarette. When she quit smoking, the anger would begin to build up and over time the tension grew to the point where it eventually triggered her back to smoking. She repeated this pattern several times before she was able to disconnect her smoking addiction from her anger. How did she do this? By making a conscious effort to recognize that “Smoking never helped me solve a real life problem”. Once she discovered more productive and healthy ways to react to anger, she lost complete interest in smoking.

Cognitive-behavioral therapy (CBT) for smoking cessation focuses on this kind of shift in perspective and behavior. It turns out that quitting smoking is not only good for your physical health but also helps interrupt emotional patterns of unproductive coping which can keep people stuck in their depression.

The recent CDC report states that: “…studies that have examined ability to quit smoking in persons with depression have shown that with intensive treatment, persons with depression can quit smoking and remain abstinent. These intensive cessation services often use treatments that are also used for depression, including cognitive-behavioral therapy or antidepressant medications. Adults with depression and other mental illnesses are an important subgroup to target for tobacco cessation programs.”

Isn’t it time — more than a hundred years after Freud struggled unsuccessfully with this problem — that we offer these life saving, effective services at every accredited medical and health center and mental health clinic where smokers get their healt hcare?

depression, quit, smoking

Kelly Clarkson has set light to a feud after appearing in a billboard ad for cigarettes in Indonesia.

Protestors are livid to see the country’s most popular brand of fags, L.A. Lights is sponsoring the singer’s show in Jakarta.

Posters have been put up all around town with the ‘American Idol’ winner’s face next to the brand of smokes.

The marketing ploy comes just two years after Alicia Keys objected to a similar tobacco-fuelled sponsorship deal.

The ‘Empire State of Mind’ star insisted the logo was removed from all ads promoting her Jakarta gig.

Now U.S. based anti-smoking groups want Kelly, who’s currently touring Australia before heading to Asia, to do the same.

Matt Myers , the president of the Campaign for Tobacco-Free Kids, tells the Associated Press,

“If Kelly Clarkson goes ahead with the concert, she is by choice being a spokesman for the tobacco industry and helping them to market to children.

“She has the power now to turn this situation around and to send a clear message to Indonesian young people and, frankly, to the young people of the world.”

clarkson, feud, kelly, smoking

TORONTO

— The Ontario Medical Association is calling on the province to take steps to help smokers butt out and to prevent others from taking up the habit.

“There have been a number of initiatives implemented aimed at reducing the use of tobacco, and in particular the current government has been a leader in efforts to curb exposure to second-hand smoke. But there is more work to be done,” OMA president Dr. Suzanne Strasberg said Tuesday.

The doctors organization is urging the province to “relight the fight against tobacco” by:

• Creating a comprehensive smoking-cessation system to help people butt out;
• Drastically reducing the number of retail tobacco outlets;
• Placing a moratorium on the sale of new tobacco products;
• Immediately implementing a control strategy for contraband tobacco products, including sanctions against suppliers of raw materials to unlicensed manufacturers.

The availability of cheap, untaxed contraband tobacco products is expanding, the OMA said in a report released Tuesday, which noted that in 2009, an estimated one in five cigarettes smoked in Ontario was classified as contraband.

“It’s unfortunate, but the simple fact is there are still far too many people who smoke and who suffer from preventable tobacco-induced illness and it is having a significant impact on our health-care system,” Strasberg said in a statement.

association, medical, ontario, quit, smoking

Canada needs to implement a national program that both helps smokers quit and reduces the number of stores selling cigarettes if it wants to curb rising rates of tobacco use, according to a report released yesterday by the Ontario Medical Association.

The report – entitled Tobacco, Illness, and the Physician’s Perspective – says that smoking costs the Canadian health-care system $1.6 billion a year. It also accounts for 85 per cent of lung cancers and 30 per cent of cancer deaths.

According to the report, there are 2.3 million smokers in the country, up from 2.1 million smokers in the mid-1960s.

“The bottom line is there is still too many smokers … and they continue to be a tremendous drain on resources in our health-care system,” said Dr. Suzanne Stratsberg, president of the OMA.

Ontario Premier Dalton McGuinty agrees that smoking cessation is an important avenue to pursue in order to help lower rates, particularly among youth.

campaign, canada, reduction, smoking

A decree banning smoking in Syrian cafes, restaurants and other public spaces has entered into force.

The decree also outlaws smoking in educational institutions, health centres, sports halls, cinemas and theatres and on public transport.

Workers must not smoke during meetings and businesses need to provide well-ventilated areas for smokers.

The restrictions include the nargile, or hubble-bubble pipe, which is popular among locals and tourists.

The decree signed by President Bashar al-Assad, a qualified medical doctor, imposes a fine of up to $800 (£518) on those who break the ban.

Businesses hit

The BBC’s Lina Sinjab in Damascus says the ban has upset many in a country heavily addicted to nicotine.

In one of the city’s traditional cafes, Cafe Rawda, on the first day of the new rules, the inside area was deserted but the outdoor terrace was busy with customers smoking shisha pipes, she reports.

Empty inside room in Damascus cafe
Indoor rooms in some Damascus cafes were virtually deserted

Cafe owner Ismat Kosoros said he feared the ban would take a heavy toll on business.

“There are customers who have been coming here for forty years. And in hot summers, it is hard to have people sitting in courtyard, they need an air-conditioned area,” he said.

But there are members of the younger generation who welcome the decision as good for public health – even if they still smoke themselves – our correspondent reports.

The Syrian government has passed several laws restricting smoking in the last two decades.

A decree in 1996 banned tobacco advertising while a 2006 law outlawed smoking on public transport and in some public places, introducing fines for offenders. Under-18s are not allowed to buy tobacco.

The World Health Organization is unable to provide details on tobacco consumption in Syria, but levels of smoking in public is high across the Arab world, especially among men.

Last year Iraq’s cabinet agreed a draft law outlining similar measures, causing uproar amongst smokers.

ban, cafe, restaurants, smoking, syria

VANCOUVER, Canada — Smoking cigarettes in the parks and beaches of Canada’s third largest city is to be banned as of September 1, the Vancouver Park Board has decided.

The elected board voted Monday night to prohibit smoking in some 200 parks and along 18 kilometers (11 miles) of beaches, such as Vancouver’s famed Stanley Park, citing opinion surveys that suggest enormous support for the measure.

Board members also pointed to efforts to curb smoking by the World Health Organization and the Vancouver Coastal Health agency that claims smoking and exposure to second-hand smoke are the “leading” and “third leading cause of death” in the province, respectively.

But civil libertarians warned Tuesday that the prohibition could create more problems than any public health benefits would be worth.

Cigarette smoking has long been banned inside, and directly beside, public indoor venues in British Columbia — as well as in indoor public facilities in many other Canadian cities.

A contentious recent study linked major recent declines in hospital admissions for heart, stroke and respiratory conditions in Toronto to a 2001 ban on smoking in restaurants in that city.

But smoking outdoors was mostly unregulated in Canada until recently, when several British Columbia towns started imposing bans in parks.

Smoking bans for beaches and parks also exist in some US states, as well as in Australia and Hong Kong.

Libertarians said Vancouver’s outdoor smoking ban goes too far and argued that existing public nuisance bylaws would address smokers who bother others, or who litter.

The ban will be “unenforceable,” predicted a spokesman with the British Columbia Civil Liberties Association.

“There is no health effect” from the small amount of second-hand smoke that people are exposed to in outdoor parks, said medical professor Richard Mathias of the University of British Columbia, who described himself as “a relative libertarian.”

“What we’re dealing with here is a prohibitionist moral model that as far as I’m concerned is totally unacceptable,” Mathias told AFP.

He said that he does not smoke “and I don’t think anybody should smoke… but we’re demonizing them.”

“We have gone too far, particularly in British Columbia. We’ve already done everything we need to do from a regulatory perspective in reducing smoking,” said Mathias.

bans, beaches, parks, smoking, vancouver

Step 1
Create a plan and choose a quit date. If you are taking an antidepressant to help you quit, most doctors recommend that you take the medicine for two weeks before quitting.

Step 2
Tell everyone you know that you are going to quit and on what day. This will give them fair warning if you don’t seem yourself right after you quit, and it will encourage you to keep your word.

Step 3
Gather as much support as you can. Try to convince your spouse or partner or a friend to quit with you. Join a support group online or find one in your area.

Step 4
Remove all smoking paraphernalia on your quit day. Throw away any leftover cigarettes, ashtrays and lighters.

Step 5
Keep yourself occupied at all times for the first few days. Go to restaurants where smoking is not allowed, play a sport, work on hobbies. Remember that the cravings will be frequent, but they do not last that long.

Step 6

Celebrate quitting milestones. Promise yourself something new if you can go two days, a week, a month without smoking. Use the money you would have otherwise spent on cigarettes.

Step 7

Focus your attention on quitting smoking, not maintaining your weight. Diet before or after you have quit, but not for the first three months. Allow yourself the few extra pounds. They are healthier than the cigarettes.

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