Butler Hospital, The Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906, USA. david
Drug Alcohol Depend. 2010 Jun 1;109(1-3):90-5. doi: 10.1016/j.drugalcdep.2009.12.020. Epub 2010 Jan 13.
The strong relationship between persistent tobacco use and Major Depressive Disorder (MDD) has motivated clinical trials of specialized treatments targeting smokers with a history of MDD. Meta-analyses suggest positive responses to specialized treatments have been observed consistently among smokers with history of recurrent rather than a single episode of MDD. Approximately 15% of current US smokers have a history of recurrent MDD. Little is known about the risk factors that contribute to persistent smoking and differentiate these at-risk smokers, US.
The National Comorbidity Survey - Replication (NCS-R) included a survey of 1560 smokers participants aged 18 and older in the United States. Lifetime history of MDD was categorized according to chronicity: no history (No MDD), single episode (MDD-S) and recurrent depression (MDD-R). The relationship between the chronicity of MDD, smoking characteristics, cessation history, nicotine dependence, comorbidity with psychiatric disorders, and current functional impairments were examined.
MDD-R smokers reported fewer lifetime cessation efforts, smoked more cigarettes, had higher levels of nicotine dependence, had higher rates of comorbid psychiatric disorders and greater functional impairment than smokers with No MDD. MDD-S smokers were not consistently distinguished from No MDD smokers on cessation attempts, level of daily smoking, nicotine dependence or functional impairment indices.
The study highlights the importance of chronicity when characterizing depression-related risk of persistent smoking behavior. Although, clinical trials suggest MDD-R smokers specifically benefit from specialized behavioral treatments, these services are not widely available and more efforts are needed to engage MDD-R smokers in efficacious treatments.
持续吸烟与重度抑郁症（MDD）之间的密切关系促使临床医生针对有 MDD 病史的吸烟者进行专门的治疗试验。荟萃分析表明，在有反复发作而非单次 MDD 病史的吸烟者中，专门的治疗方法观察到了积极的反应。大约 15%的美国当前吸烟者有反复发作 MDD 的病史。目前，人们对导致持续吸烟的风险因素知之甚少，也无法区分这些有风险的吸烟者。
国家共病调查-复制（NCS-R）纳入了美国 1560 名年龄在 18 岁及以上的吸烟者参与者的一项调查。根据慢性程度将 MDD 的终生病史分为无病史（无 MDD）、单次发作（MDD-S）和复发性抑郁（MDD-R）。研究了 MDD 的慢性程度、吸烟特征、戒烟史、尼古丁依赖、与精神障碍的共病以及当前功能障碍之间的关系。
MDD-R 吸烟者报告的戒烟尝试次数较少，吸烟量较多，尼古丁依赖程度较高，共病精神障碍的比例较高，功能障碍的程度也较高，而与无 MDD 的吸烟者相比。MDD-S 吸烟者在戒烟尝试、每日吸烟量、尼古丁依赖或功能障碍指数方面并未与无 MDD 吸烟者始终区别开来。
该研究强调了在描述与抑郁相关的持续吸烟行为风险时，慢性程度的重要性。虽然临床试验表明，MDD-R 吸烟者特别受益于专门的行为治疗，但这些服务并不广泛，需要更多的努力让 MDD-R 吸烟者参与到有效的治疗中。
