Anxiety and depressive disorders in tobacco dependence

The association between tobacco dependence and various forms of anxiety and depressive disorders is well established. The presence of these disorders constitutes a key cause of failure in subjects seeking to stop smoking. In addition to the clinically manifest forms of such anomalies, systematic screening for minor forms of these disorders was performed at the Centre for Tobacco Studies of Créteil, France; as well as the standard questionnaire concerning personal and familial history and current psychological well-being, subjects were asked to complete two self-questionnaires, the HAD (Hospital Anxiety Depression score) and the BDI (Beck Depression Inventory, abridged version) together with the MINI (structured mini-interview). In a series of 400 heavy smokers, sub-syndromes of such anxiety and depressive disorders were noted in 34% of subjects, and a combination of anxiety and depressive disorders was seen in 2/3 of these subjects, mainly general anxiety and social phobia, which were frequently preceded by depressive episodes. In these forms of tobacco dependence with anxiety and depressive disorder, relapse was very common in spite of nicotine substitution therapy (NST), usually as a result of a depressive episode that tended to subside very rapidly on resumption of cigarette smoking. Psychotropic therapy involving selective serotonin reuptake inhibitors (SSRIs) coupled with NST resulted in lasting success accompanied by an often unexpected and spectacular improvement in psychological status. These findings confirm the role of mood disorders in tobacco addiction in keeping with other types of addiction.