Hughes John R
Department of Psychiatry, University of Vermont, UHC Campus, 1 South Prospect Street, Burlington, VT 05401, USA.
Drug Alcohol Depend. 2008 Dec 1;98(3):169-78. doi: 10.1016/j.drugalcdep.2008.06.003. Epub 2008 Aug 3.
This article provides a brief overview of the rationales, possible mechanisms and epidemiological data on the association of smoking, smoking cessation and cessation medications with suicide. Current smoking is reliably associated with suicide both in case-control and cohort studies. The three most plausible (but relatively untested) explanations for the association are that smokers have pre-existing conditions that increase their risk for suicide, smoking causes painful and debilitating conditions that might lead to suicide, and smoking decreases serotonin and monoamine oxidase levels. Stopping smoking appears to lead to major depression in some smokers; thus, it could induce suicide; however, smoking cessation has not been associated with suicide in the few studies available. Regulatory agencies have stated bupropion, rimonabant and varenicline appear to be associated with suicide; however, the data for these statements have not been presented in sufficient detail to assess their validity. Most prior data have come from post hoc analyses. Studies that a priori focus on understanding smoking and suicide are now needed.
本文简要概述了吸烟、戒烟及戒烟药物与自杀之间关联的理论依据、可能机制及流行病学数据。在病例对照研究和队列研究中，当前吸烟与自杀之间均存在可靠关联。对此关联最合理的三种（但相对未经证实）解释为：吸烟者存在使自杀风险增加的既往疾病；吸烟引发疼痛及使人衰弱的状况，可能导致自杀；吸烟会降低血清素和单胺氧化酶水平。戒烟似乎会在部分吸烟者中导致重度抑郁，因此可能诱发自杀；然而，在现有少数研究中，戒烟与自杀并无关联。监管机构称安非他酮、利莫那班和伐尼克兰似乎与自杀有关联；不过，支撑这些说法的数据并未详细呈现，无法评估其有效性。多数既往数据来自事后分析。现在需要开展事先着重于理解吸烟与自杀关系的研究。
