GUS (Gave Up Smoking) is a community support diary for Kossacks in the midst of quitting smoking. Any supportive comments, suggestions or positive distractions are appreciated. If you are quitting or thinking of quitting, please -- join us! We kindly ask that politics be set aside.
You can also click the GUS tag to view all diary posts, or access the GUS Library at dKosopedia for a great list of stop-smoking links. Check it out!
I wrestled with the title of tonight's GUS diary.
For a while, it was going to be "GUS: Tell Us Something We DON'T Know," because the link between nicotine addiction and depression is all too familiar for many of us. After all, nicotine is the #1 way that most people self-medicate for symptoms of depression. For most people with a co-occurring mental health and substance abuse diagnosis, nicotine -- not alcohol or marijuana or diverted prescription drugs -- was their gateway drug. It's often the first thing they try, and it's usually the last thing to go.
Now, we've got even more proof that the two go hand-in-hand.
Adults who suffer from depression are twice as likely to smoke and also smoke more heavily than adults who are not depressed, a study released Wednesday shows.
Forty-three percent of all adults aged 20 and older who suffer from depression smoked cigarettes, compared with 22 percent of adults who were not depressed, data compiled by the US National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention show. (AFP)
Well, dang. Those are pretty significant numbers.
And if this weren't bad enough, the AFP article quoted also includes this little gem:
Smokers with depression also had more difficulty kicking the habit.
Okay, that's a bummer.
Seriously, I'm not being flip here. I'm one of the legion of people prone to depressive illness who spent many years self-medicating with nicotine. I know how difficult it is to struggle against the numb, hopeless feelings that depression can engender. I know how tough it is to summon the will to just get throught the day sometimes, never mind the kind of effort it can take rise to the occasion when more than that is required.
To embark on a life-altering behavior modification program and simultaneously -- and knowingly -- alter your brain chemistry by depriving it of a substance it has become accustomed to relying on? That's huge.
It's also kind of scary.
And for many of us, it shouldn't even be attempted without medical supervision.
The study isn't all bad news, though. From a Reuters article referencing the same study, we get this little glimmer of hope:
Patients with depression who want to kick the habit can be helped, but it is difficult, said Laura Pratt and Debra Brody of the National Center for Health Statistics, who conducted the study.
"The few studies that have examined ability to quit smoking in persons with depression have shown that with intensive treatment, persons with depression can quit smoking and remain abstinent," they wrote.
"These intensive cessation services often use treatments that are also used for depression, including cognitive-behavioral therapy or antidepressant medications."
So where does this leave us? What can GUS (or anyone else) do for you if you're one of those folks who are wrestling with some funky brain chemistry in addition to your nicotine jones?
For all of our well-meaning advice and support here at GUS, most of us are not medical or counseling professionals (though a few are) and NOBODY should be looking to the internet for all of their medical advice! We aren't qualified to diagnose you or recommend a specific method of quitting, never mind suggest a course of treatment you might want to pursue.
But what we can do is tell you our experiences and listen to yours, provide positive reinforcement and support, tell you what you're going through is normal (or perhaps not-so-normal), and describe what worked (or didn't work) for us. We can't diagnose you or provide specific treatment advice regarding your quit; this is especially true if you are experiencing mood changes that seem to fall outside of the usual "bad first few weeks" of a typical quit. That's where we have to step aside and let the medical professionals take over.
I knew I might have some trouble with this aspect of quitting, as I'd experienced an episode of major depression in the past. Although I went cold turkey and the impact on my mood was abrupt (to say the least), I was able to mitigate my symptoms with St. John's Wort and letting go of my need to appear to have everything under control, at least at first. I had a few emotionally rocky weeks and I was back on track.
My Dad, on the other hand (who quit a 50+ year chain-smoking habit using the patch) found that his underlying depression required medication. He went to his Doctor and was prescribed Welbutrin (same drug, different formulation as the currently-popular-for-smoking-cessation Zyban), and the combination ended up working well for him.
This is one of those classic Your Milage May Vary scenarios. For example, some people swear by Chantix; in others, that drug triggered severe health issues. Some people can tolerate the patch indefinitely; others have difficulty with it from day one. Some are good to go on with their lives as soon as the nicotine has cleared their system and a few behavioral modification techniques have taken root; others struggle with the psychological and behavioral conditioning common to ex-smokers for months or even years.
The upshot of all this is that there are a lot of paths to the same destination. You may end up trying more than one of them, and you may have some interesting, GUS-fueled detours along the way, but only your Doctor can really give you directions if you find yourself a little lost.
This isn't the first GUS diary I've written about smoking and depression, and fair warning, it may not be the last. I return to this topic every so often because it's one I think bears repeating, and because I know it impacts a larger group of people than many of us realize.
The relationship between smoking and depression (with or without an accompanying anxiety disorder) is one aspect of smoking cessation that's sometimes overlooked. Downplaying or ignoring the link between the two can be very dangerous for those whose smoking masked an underlying depressive illness they may not be aware of. Some folks do experience their first full-blown bout of depression, or find that their existing depression has intensified, when they quit for the first time. To that end, I'm going to reiterate some of what I wrote in my earlier diary.
If you recently quit, or are in the process of quitting, you should be aware of any major changes in mood that persist for more than a couple of weeks. It can be very dangerous to leave depression untreated, and it's not necessary to suffer through an episode of depression when so many avenues of treatment are available.
If you are experiencing a prolonged bout of depression, please arrange to see a medical professional as soon as possible. Medical privacy and anti-discrimination laws being what they are these days, you can choose to keep treatment for depression private if you worry that it might jeopardize your job. If you are uninsured or unemployed (or underemployed) and worried about treatment costs, most public health clinics can refer you to a behavioral health professional either free of charge or charge you on a sliding fee scale (it will most likely cost you less than your cigarettes did).
And if you don't even know where to begin to find help, you can always just CALL 2-1-1. It's like calling 9-1-1, but you will get health care and counseling assistance (as well as related help - housing, employment, basically anything in the social services umbrella).
If you think that quitting smoking may have triggered a depressive episode, there's help available to you. If you are fearful of quitting because you think it may trigger (or intensify) underlying depression, please ask for help from a medical professional in planning your quit -- "I might get depressed, or get more depressed" are not great excuses to keep smoking, trust me! If you have already quit and feel depressed as a result, the correct response is to seek treatment (not go back to smoking as a "fix" for the problem).
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