Feature Article

Clinical aspects of nicotine dependence and depression

Kay Wilhelm, Robyn Richmond, Alex D Wodak



Smokers who have a history of depression are at increased risk of problems related to smoking and have more difficulty in quitting. GPs have an important role in identifying these patients and helping them to stop smoking.

Key Points

  • Although improved smoking cessation techniques have contributed to a decrease in the prevalence of tobacco smoking, a group of smokers dependent on nicotine remains.
  • Smokers who are dependent on nicotine are more likely than nonsmokers to have tobacco-related health problems that compound the risk of depression and the complexity of these subjects’ medical and psychological management.
  • When attempting to quit smoking, people with a history of depression have problems with more frequent, severe and prolonged withdrawal episodes and more depressive symptoms, anger and irritability.
  • For smokers who are both nicotine dependent and have a history of depression, nicotine replacement therapy and psychological approaches usually require supplementation with an antidepressant, started at least a week before the quit date.
  • Nicotine dependent patients who have a history of depression should be monitored for several months after quitting to ensure mood stability.