Depressed Smokers with CHD Less Likely to Quit

Smokers who are depressed at the time of a coronary heart disease (CHD) diagnosis are less likely to have quit smoking at follow-up, a new study finds.

To investigate the link between depression and poorer outcomes in coronary heart disease, researchers from the Royal College of Surgeons in Ireland conducted a meta-analysis of studies on smoking cessation in depressed patients with CHD.
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In all 19 studies the investigators analyzed, patients who smoked when CHD was diagnosed, and who were noted to be depressed, were less likely at follow-up to have quit smoking than non-depressed patients (overall standardized mean difference, −0.39). According to researchers, effect sizes for the association between depression and not quitting were generally small.

However, in 2 studies that defined depression as receiving antidepressants or sedatives, effect sizes were 2 and 3 times greater, the study authors noted, adding that these findings may help explain some of the reported associations between depression and greater cardiovascular morbidity and mortality.

The investigators also point out that studies specifying antidepressant or sedative treatment may have enrolled patients significantly more depressed than the patients in other studies, or some patients may have received antidepressants or sedatives for other reasons, such as pain or insomnia.

Nevertheless, patients who quit smoking reduce their CHD-associated mortality by 36 percent to 50 percent, the authors added, noting that treating depression alone in patients with CHD does not lower smoking rates. Therefore, clinicians treating depressed smokers should specifically focus on getting them to quit smoking using pharmacological, behavioral, and other psychotherapeutic methods, while concurrently attending to the depression.

“I think the [study’s] relevance for primary care practitioners is that, if patients with CHD do not quit smoking, the physician should be extra-vigilant for depression,” says Frank Doyle, PhD, a psychologist in the division of population health sciences at the Royal College of Surgeons, and the study’s lead author.

“All these patients should be offered support to quit, and [support should be] repeatedly offered if necessary,” continues Doyle. “Pharmacological treatments for cessation should be titrated carefully, and repeated follow-up is probably required.”

—Mark McGraw

Reference

Doyle F, Rohde D, et al. Systematic review and meta-analysis of the impact of depression on subsequent smoking cessation in patients with coronary heart disease: 1990 to 2013. Psychosomatic Medicine. 2014.