Heart Health

05 February 2008

Sad smokers won't quit

Smokers who have depressive symptoms during hospitalisation for a heart attack will have a harder time kicking the habit, a new study shows.

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Smokers who have depressive symptoms during hospitalisation for a heart attack will have a harder time kicking the habit, a new study shows.

Depression is common among heart-attack patients, Dr Anne N. Thorndike of Massachusetts General Hospital and Harvard Medical School in Boston, the study's lead author said, and the findings show "those issues have to be addressed before you can really make much progress with their smoking."

Furthermore, they must be addressed early, Thorndike added, as most of the depressed smokers who picked up the habit again did so within four weeks.

Quitting sharply reduces the death rate among smokers with heart disease, but at least 40 percent of smokers have started again within a year of having a heart attack, Thorndike and her colleagues note in their report in the Archives of Internal Medicine.

Meanwhile, heart attack patients with depressive symptoms are known to have trouble following recommendations for reducing their risk of future cardiac events.

How the study was done
To investigate the relationship between smoking cessation success and depressive symptoms, Thorndike and her team followed 245 smokers who had been hospitalised for a heart attack or unstable angina, an unpredictable type of chest pain that signals coronary heart disease and a high likelihood of having a full-blown heart attack.

All of the patients received smoking cessation counselling in the hospital and for 12 weeks afterwards, and were randomly assigned to treatment with either bupropion hydrochloride (an anti-smoking medication sold as Zyban) or an inactive placebo.

Twenty-two percent of the patients had moderate to severe depressive symptoms. These individuals had worse craving and withdrawal symptoms, and also scored higher on a test of their nicotine dependence. They also felt less confident that they would be able to quit smoking.

The depressed patients were 2.4 times more likely than their non-depressed peers to start smoking again, the researchers found.

What the study showed
Among the depressed patients, 19 percent on bupropion were able to quit, compared to three percent on placebo. For non-depressed patients, by comparison, quit rates were 27 percent for those on placebo and 27 percent for those on the drug. However, Thorndike cautioned, the difference in the effect of Zyban and placebo on the depressed patients wasn't significant from a statistical standpoint.

Based on the findings, smokers and their families should understand just how tough it can be to quit after a heart attack, and be on the lookout for depressive symptoms that could make quitting even more difficult, Thorndike said.

"If you tell somebody that's in the hospital with heart disease, 'stop smoking' and give them the medication and they're depressed, it's probably not going to have much effect on them," she said. Smokers in the current study, she noted, got several weeks of counselling, significantly more smoking cessation support than would be offered with usual care. – (Reuters Health)

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