Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

Major Depressive Disorder

Major Depressive Disorder

Major Depressive Disorder (MDD) is characterized by one or more depressive episodes: a period of at least two weeks when the person experiences a depressed mood or the loss of interest or pleasure in nearly all activities.1 Major Depressive Episodes can change a person’s sleeping and eating patterns as well as make them more irritable and agitated. Certain things may play a role in the initiation, the perpetuation, and the development of depression such as drug and alcohol abuse, certain medical conditions such as cancer, and stressful life events such as divorce or losing a job. People who are depressed are more likely to use alcohol or illegal substances.2 Frequently, people who experience MDD are suffering from another mental disorder such as Dysthymic Disorder and Panic Disorder. Developing MDD is twice as common for adolescent and adult females as for adolescent and adult males.

Diagnosed with Major Depressive DisorderPercentage
U.S. Population16.9
Current Smokers36.6
Lifetime Smokers59.0

Major Depressive Disorder and Smoking

For individuals diagnosed with MDD, this can be a very difficult and isolating disorder to live with. In the U.S. population, 16.9% have major depression and account for 36.6% of the population of current smokers. Some research has indicated that smoking helps calm some of the symptoms like restlessness, agitation, and irritability in MDD.  Perhaps these smokers are attempting to use smoking as a way to relieve themselves of the symptoms of their depression which could make it extremely difficult for the person to quit smoking. Research has indicated that having this diagnosis does present a challenge for quitting smoking.  Among smokers on a Quitline in California, a total of 24.2% of callers met criteria for major depression while an additional 16.5% met criteria for mild depression.3  In the same study, smokers with current major depression were much less likely to have quit for at least 30 days at the time of the 2-month evaluation, compared to those with minimal depressive symptoms (18.5% vs 28.4%).3

It is not all bleak for those diagnosed with MDD who wish to quit smoking, 18.5 % of those with major depression were able to quit for at least 30 days. In another study it was found that exposure to smoking is associated with a 1.46-fold increase in the odds for major depressive disorder.4 It is difficult for those who are smoking to cope with the symptoms of depression, making it less likely they believe they can quit.  As a provider, it is important to understand the function of smoking for the individual diagnosed with MDD.  If it is to help themselves manage their symptoms of depression, then this is a good place to start in addressing other coping skills.  For other treatment suggestions and treatments in more detail, please click here.  Ultimately, it is equally important for those experiencing a major depressive disorder to seek help for both smoking cessation and managing their disorder as well as for health care providers to assess for tobacco use in their patients who are diagnosed with MDD.

References: 

1 American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author

A.D.A.M. Medical Encyclopedia. (2011, March 15). Major Depression. PubMed. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/

3Hebert, K. K., Cummins, S. E., Hernández, S., Tedeschi, G. J., & Zhu, S. (2011). Current major depression among smokers using a state quitline. American Journal of Preventive Medicine, 40(1), 47-53.

4Pasco, J. A., Williams, L. J., Jacka, F. N., Ng, F., Henry, M. J., Nicholson, G. C., & Berk, M. (2008). Tobacco smoking as a risk factor for major depressive disorder: Population-based study. British Journal of Psychiatry, 193(4), 322-326.