Tabaquismo

Tabaquismo y depresión

Smoking and depression

Ana Moreno Coutiño,1* María Elena Medina–Mora Icaza2

1 Facultad de Psicología de la Universidad Nacional Autónoma de México, UNAM.

2 Directora de la Dirección de Investigaciones Epidemiológicas y Psicosociales del Instituto Nacional de Psiquiatría Ramón de la Fuente.

*Correspondencia:

Dra. Ana Moreno Coutiño.

Av. Universidad 3004,

Copilco–Universidad,Coyoacán,

04510, México DF.

Tel. 5658 3911 Fax:5658 3744.

E–mail: moca99_99@yahoo.com

Recibido: 23 de abril de 2008

Aceptado: 27 de junio de 2008

Abstract

The objective of the present work is to review updated information about smoking and depression, based on a revision of PubMed Data Base to find articles with the words <<treatment>>, <<smoking>> and <<depression>> in the title, the summary, or the key words. The date of the most recent article reviewed was April of the 2008. An analysis of these articles was performed aiming to select the pertinent ones for the subject to treat in this summary. Additional articles were selected from references found in articles identified in the original revision. In addition, we offer a proposition about new research directions for depression and smoking, specially treatments for those patients who have simultaneously these disorders, since it's important to design and evaluate new treatments against tobacco smoking habits. Treatments must have an integral approach, contemplating the psychological as well as the pharmacological intervention in order to achieve for a complete treatment.

Smoking and depression constitute two important worldwide and national public health problems. Tobacco addiction is worldwide one of the main causes of deterioration of the quality of life and increased morbi–mortality. It causes 5000000 deaths per year (one out of ten deaths of adults).The World Health Organization (WHO) estimated that according to present tendencies, in the year 2020, smoking habits will be responsible for ten million deaths, of which, seven out of ten will take place in developing countries. For the year 2030 tobacco smoking will be the main cause of death around the world.

In Mexico, according to the latest National Survey of Addictions, there were 14 million smokers, 9.6 million were former smokers and around 60000 people die every year due to illnesses directly related to smoking habits.

In adittion, in the year 2002 the WHO informed that depression was the prevailing disorders in general population with 154012 cases, affecting primarily women (62%) (95023 cases). This disorder is already the main cause of disability in the world, with 121 million people living with the disease. The estimation for the year 2020 is that it will be the second cause of labor loss in developed countries. In Mexico, depression is one of the main causes of mortality and burden of disease nation wide. A study focused on early depression in Mexican population, reported that 2.0% has suffered depression at some point during childhood or adolescence, and will present an average of seven depression episodes throughout their life.

During the last years, studies have shown a strong relation between smoking and depression. Therefore, people with history of depression have a tendency to develop tobacco addiction. Also, this kind of patients reveal an important reduction in the severity of the depressive symptoms when consuming nicotine. In spite of the evidence of the high comorbidity between these two diseases, their treatment is generally provided from an independent perspective, making it urgent to recognize the importance of their integrate attention.

In a study performed in order to determine the probability of occurrence of substance dependency disorder when affection disorders coexist, it was reported that dependency disorders occur before the abuse or dependency of substances in 47% of men and in 26% of women. In relation specifically to tobacco smoking habits, it has been reported that smokers who consume more than one pack per day have three times more probability of presenting symptoms of depression compared to nonsmokers.

It has been shown that patients with depressive symptomatolgy smoke as a way of self medication against this disabiling disease. Until now there is not enough information to predict if former smokers with depression can attain long term tobacco abstinence, as well as which would be are the effects produced by abstinence over depressive symptomatology. Because smokers with history of depression have a great probability of experiencing symptoms of the disease during abstinence, more research regarding treatment with antidepressants after abstincence period has been proved necessary.

Reviews are discussed in terms of their theoretical and clinical implications for smoking cessation research. Treatment of patients with both disorders must contemplate psychological and pharmacological attention. The appropriate medical attention of comorbid diseases will surely increase the rehabilitation's rate of success.

Key words: Smoking, depression, treatment.

Resumen

La intención del presente trabajo es la de reseñar información actualizada sobre el tabaquismo y la depresión, a partir de una revisión de la base de datos PubMed. La fecha del artículo revisado más reciente fue abril del 2008. Se seleccionaron sólo los trabajos pertinentes al tema a tratar en este resumen. Artículos adicionales fueron seleccionados a partir de las referencias de los artículos de la revisión original. Asimismo, se plantea una propuesta sobre hacia dónde se debería dirigir la investigación para el tratamiento de aquellos pacientes que presentan de manera simultánea estos dos trastornos, contemplando tanto el aspecto psicológico como el farmacológico.

La adicción al tabaco es una de las principales causas de morbimortalidad y deterioro de la calidad de vida, y ocasiona cinco millones de muertes al año (una de cada diez defunciones de adultos en el mundo). La Organización Mundial de la Salud (OMS) estima que de mantenerse las tendencias actuales, para el año 2020 el tabaquismo será responsable de diez millones de defunciones, de las cuales siete de cada diez ocurrirán en los países en desarrollo.

En México, de acuerdo con la última Encuesta Nacional de Adicciones, existen 14 millones de fumadores y 9.6 millones de exfumadores (ENA, 2002). Alrededor de 60000 personas mueren al año por padecimientos vinculados con el tabaquismo.

Por otro lado, la depresión es ya la principal causa de invalidez en el mundo, siendo 121 millones de personas las que la padecen, y se

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