[Depression, tobacco dependence and nicotine]

Abstract

The purpose of the study was to illustrate, through an observation, the association between depression and smoking dependence, as well as the considered anti-depressive properties of nicotine. Fageström Test for Nicotine Dependence was confirmed by the urinary cotinine dosage, and the expired Carbon Monoxide assessed the nicotine dependence. The anxio-depressive co-morbidity was determined through the cross-examination associated to the HAD test (Hospital Anxiety Depression Scale); then, in case of anomaly, by the depression inventory of Beck (13 items) and the structured interview: the Mini International Neuro Psychiatric Interview (MINI). Our patient, born in 1938, with the personal history of manic-depressive psychosis and alcoholic dependence severed in 1987, came to consult in 1995, after several smoking cessation attempts, followed every time by an extended and severe depression. He smoked 40 cigarettes per day, with a very high dependence (score of Fagerström = 10). The HAD and the Beck tests being normals; smoking cessation program has begun with nicotine patches. At the end of three months, he fell in a severe and resistant depression that continued during 2 years. Then, he stopped completely smoking. In 1997, a progressive treatment by nicotine-gum (NG) was proposed. Since the second week, while taking 2 to 3 NG per day, and without having modified his ADT, his psychological state improved, and in 3 months he recovered his previous psychological form. Confronted to literature data, this observation underlines the association between anxio-depressive states and the high level of smoking dependence. In the same way, the improving psychological effects of nicotine replacement, confirms the nicotine anti-depressive properties.