Aubin Henri-Jean
Hôpital Emile Roux, Assistance Publique-Hôpitaux de Paris, Limeil-Brévannes, France.
Curr Med Res Opin. 2009 Feb;25(2):519-25. doi: 10.1185/03007990802707600.
Tobacco smoking is a major risk factor for cardiovascular disease, respiratory disease and cancer and, for current smokers, smoking cessation is one of the most effective therapeutic interventions for reducing the risk of all-cause morbidity and mortality. However, smoking cessation causes nicotine withdrawal syndrome, a condition with symptoms that overlap those of major depression and anxiety disorders.
The objective of this review was to examine the evidence that smoking cessation may be associated with new onset of psychiatric illness, particularly in individuals with no history of psychiatric disease, and to provide recommendations for the management of emergent psychiatric symptoms in smokers attempting cessation. Relevant articles were obtained from a MEDLINE search (articles indexed up to, and including, October 2008, with no historical date limit), and citation review of selected primary and review articles.
There is evidence that smoking cessation can result in new onset of major depressive disorder, even in individuals with no history of depression. It has also been suggested that nicotine may be used as a form of self-medication for depression, and that smoking cessation can reveal a previously undiagnosed condition. There is little evidence of an association between smoking cessation and increased risk for other types of psychiatric illness. The management of emergent psychiatric symptoms in smokers attempting abstinence is discussed.
The overall health benefits of quitting smoking undoubtedly outweigh any potential side-effects associated with nicotine withdrawal. However, a well-managed quit attempt must plan for the emergence of nicotine withdrawal, monitor for symptoms of depression and psychiatric disease, and manage these conditions appropriately should they present.
吸烟是心血管疾病、呼吸系统疾病和癌症的主要危险因素，对于当前吸烟者而言，戒烟是降低全因发病和死亡风险最有效的治疗干预措施之一。然而，戒烟会引发尼古丁戒断综合征，其症状与重度抑郁症和焦虑症的症状重叠。
本综述的目的是研究戒烟可能与新发精神疾病相关的证据，尤其是在无精神疾病史的个体中，并为试图戒烟的吸烟者出现的紧急精神症状的管理提供建议。通过医学文献数据库（MEDLINE）检索（检索截至2008年10月包括该月的索引文章，无历史日期限制）以及对选定的原始文章和综述文章进行引文回顾获取相关文章。
有证据表明戒烟可导致新发重度抑郁症，即使在无抑郁症病史的个体中也是如此。也有人提出尼古丁可能被用作一种治疗抑郁症的自我用药形式，且戒烟可能会揭示先前未被诊断出的病症。几乎没有证据表明戒烟与其他类型精神疾病风险增加之间存在关联。文中讨论了试图戒烟的吸烟者出现的紧急精神症状的管理。
戒烟对整体健康的益处无疑超过与尼古丁戒断相关的任何潜在副作用。然而，一次管理良好的戒烟尝试必须考虑到尼古丁戒断的出现，监测抑郁症和精神疾病的症状，并在这些症状出现时进行适当管理。
