Tobacco smoking rates are decreasing in people with major depression and substance use disorder

Significant reductions in cigarette use were found among U.S. adults with major depression, substance use disorder, or both from 2006 to 2019, according to a new analysis of nationally representative survey data published today in JAMA. 

Smoking is a modifiable risk factor for cardiovascular disease and 73% of African American adults who smoke want to quit,

The study was conducted by researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the Substance Abuse and Mental Health Services Administration (SAMHSA).

These findings suggest that groups at higher risk of cigarette smoking can be reached by, and may have benefitted from, tobacco use prevention and cessation efforts that have led to significant declines in tobacco use in the general population. At the same time, the findings highlight remaining disparities, documenting higher smoking rates in people with psychiatric disorders than in those without.

“This study shows us that, at a population-level, reductions in tobacco use are achievable for people with psychiatric conditions, and smoking cessation should be prioritized along with treatments for substance use, depression, and other mental health disorders for people who experience them,” said Nora Volkow, M.D., director of NIDA and co-author of the study. “Therapies to help people stop smoking are safe, effective, and may even enhance the long-term success of concurrent treatments for more severe mental health symptoms in individuals with psychiatric disorders by lowering stress, anxiety, depression, and by improving overall mood and quality of life.”

Cigarette smoking, the leading preventable cause of disease, disability and death in the U.S., has been declining. Experts attribute this in part to increases in available treatments, insurance coverage of these treatments, cigarette prices, smoke-free and tobacco-free policies, mass media and educational campaigns and other evidence-based strategies to help people avoid or quit using cigarettes that have been implemented in recent decades.

Quitting cigarette smoking and tobacco use reduces the risk of cancer, heart disease, stroke and lung diseases. Studies have also found that smoking cessation in people with psychiatric disorders can help decrease anxiety, depression and stress; lower likelihood of a new-onset substance use disorder; and improve quality of life.

Past studies have documented that smoking rates remained essentially unchanged in people with substance use disorders, major depression or other psychiatric disorders. Now, analyzing data from more than 558,000 individuals aged 18 and older who participated in the 2006 to 2019 National Surveys on Drug Use and Health (NSDUH), researchers found that while people with major depression, substance use disorder or both were more likely to smoke cigarettes than people without these disorders; improvements in smoking cessation were seen among those with these psychiatric disorders during the 14-year period. The NSDUH, conducted annually by SAMHSA, provides nationally representative data on cigarette smoking, tobacco use, major depressive episode and substance (alcohol or drug) use disorders among the US civilian, non-institutionalized adult population. Among the population studied here, roughly 53% were women, 41% were aged 18 to 25 and 62% were non-Hispanic white.

After controlling for factors such as age, sex, race/ethnicity, education and family income, the researchers found that past-month smoking rates declined by 13.1% from 2006 to 2019 among adults with a past-year major depressive episode and by 8.2% from 2006 to 2019 among adults without. The difference in past-month cigarette smoking among those with versus without past-year major depressive episode significantly narrowed from 11.5% in 2006 to 6.6% in 2019.

Similarly, past-month cigarette smoking declined by 10.9% from 2006 to 2019 among adults with past-year substance use disorder and by 7.8% among adults without. For people with co-occurring substance use disorder and major depression, past-month smoking rates decreased by 13.7% during this 14-year period and by 7.6% among adults without these disorders.

“These declines tell a public health success story,” said Wilson Compton, M.D., NIDA’s Deputy Director and the senior author of the study. “However, there’s still a lot of work to be done to ensure tobacco use in patients with substance use disorder, depression, or other psychiatric conditions continue to decrease. It is crucial that healthcare providers treat all the health issues that a patient experiences, not just their depression or drug use disorder at a given point in time. To do this, smoking cessation therapies need to be integrated into existing behavioral health treatments. The result will be longer and healthier lives for all people.”

During 2006 to 2019, among adults with past-year major depressive episodes or substance use disorder, past-month cigarette smoking declined significantly across every examined age, sex, and racial and ethnic subgroup, except that among non-Hispanic American Indian or Alaska Native adults smoking rates did not decline. Given that American Indian and Alaska Native communities face the highest smoking and lowest quitting rates among racial and ethnic subgroups in the United States, this highlights the need to channel additional prevention and treatment efforts into these communities.

In future work, the researchers note the need to include data on certain populations at high risk of psychiatric disorders and cigarette smoking, such as institutionalized individuals or those experiencing homelessness without living in a shelter. More work is also needed to continue to monitor national trends in differences in tobacco use and nicotine vaping among adults with or without psychiatric conditions – including substance use disorder – during the COVID-19 pandemic.

Determining Depression

Everybody experiences feeling down from time to time; it is an entirely normal part of life. However, sometimes the feelings of hopelessness and despair seem to stick around as an almost permanent fixture, and this could be a telling sign that someone is struggling with depression.

Depression is undoubtedly more than simply feeling sad about setbacks – it changes how people think, feel, responds, and function in their everyday lives. Major depression can have a negative impact on work, schooling, eating, sleeping, and socializing. 

Unfortunately, there is no such thing as a simple depression test, and individuals experience this mental health issue in highly different ways. Some may feel like they are lifeless or apathetic. Others get an impending sense of doom. However depression is experienced by the person, if it is left untreated, it can become a life-threatening health condition. 

It is important to remember that depression isn’t the reality of the situation, and it can be treated with innovative medical processes and therapy sessions. The most important thing is knowing how to recognize the signs of depression so that you, or a loved one, can seek help at the earliest opportunity.

Symptoms of Depression

Photo credit: Harvard Health

As mentioned, everyone experiences depression in their own way. The signs of depression will also vary according to how severe it is. In general, however, these are the most commons signs to keep an eye out for:

1. Feelings of Hopelessness
2. Complete Loss of Interest
3. Changes in Sleep Patterns
4. Anxiety or Restlessness
5. Appetite and Weight Changes
6. Anger and Irritability
7. Uncontrollable Emotions
8. Reckless Behaviors
9. Physical Pain and Discomfort, and
10. Self-Harm or Talking About Death

Variations of Depression Symptoms

Of course, depression is something that people experience in completely different ways. However, there is a link between the signs of depression and how people of different ages and genders experience them:

• Men: Men who struggle with depression are less likely to acknowledge emotional aspects like self-loathing or hopelessness. Instead, they generally show signs such as irritability, sleep issues, loss of interest, and they are more likely to act out aggressively or engage in reckless behaviors like substance abuse.

• Women: Women tend to struggle with excessive self-guilt or loathing. Weight changes are incredibly common, with overeating and weight gain being particularly symptomatic of depression. Of course, depression is also impacted by the extreme hormonal changes women go through during menstruation, pregnancy, and menopause.

• Teens: Irritability, moodiness, and excessive sleeping are common in teens with depression. They may complain of physical symptoms like stomach and headaches to get out of activities like sports and school. They could also isolate themselves from friends and family.

• Older Adults: Older adults generally struggle more with physical symptoms. Aches, pains, fatigue, and memory problems are common. They could also begin to neglect personal hygiene, appearance, and health.

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The article is published courtesy of Addiction Rehab Treatment

Too much dietary fat in the brain may impact mental health

A team of researchers from the University of Glasgow in the United Kingdom and the Gladstone Institutes, in San Francisco, CA, has recently studied how eating a diet high in saturated fats might make depression more likely, using mouse models to do so.

The investigators — led by Prof. George Baillie, from the University of Glasgow — note that this is a particularly important research topic, as obesity-related depression seems to happen via different mechanisms from depression in otherwise healthy individuals.

In its study paper, which appears in the journal Translational Psychiatry, the research team explains that many people with obesity and depression, who doctors treat with regular antidepressants, do not see any benefits from the treatment.

At the same time, people with obesity and depression also do not experience some of the side effects that people typically associate with those antidepressants, such as further weight gain.

“When compared with patients of normal body weight, overweight and obese patients showed a substantially slower response to antidepressant treatment, less improvement in neuroendocrinology and cognitive processing, and less antidepressant-induced weight gain,” the researchers write.

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Credit: MedicalNewsToday

Every 40 seconds, someone dies by suicide – WHO Report

Every year close to 800 000 people take their own life and there are many more people who attempt suicide, while every 40 seconds, someone dies by suicide, according to the World Health Organization (WHO).

Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind. Suicide occurs throughout the lifespan and was the second leading cause of death among 15–29-year-olds globally in 2016.

• Close to 800 000 people die due to suicide every year.
• For every suicide there are many more people who attempt suicide every year. A prior suicide attempt is the single most important risk factor for suicide in the general population.
• Suicide is the second leading cause of death among 15–29-year-olds.
• 79% of global suicides occur in low- and middle-income countries.
• Ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally.

Suicide does not just occur in high-income countries, but is a global phenomenon in all regions of the world. In fact, over 79% of global suicides occurred in low- and middle-income countries in 2016.

Suicide is a serious public health problem; however, suicides are preventable with timely, evidence-based and often low-cost interventions. For national responses to be effective, a comprehensive multisectoral suicide prevention strategy is needed.

Who is at risk?

While the link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.

In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour. Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners. By far the strongest risk factor for suicide is a previous suicide attempt.

Methods of suicide

It is estimated that around 20% of global suicides are due to pesticide self-poisoning, most of which occur in rural agricultural areas in low- and middle-income countries. Other common methods of suicide are hanging and firearms.

Knowledge of the most commonly used suicide methods is important to devise prevention strategies which have shown to be effective, such as restriction of access to means of suicide.

Prevention and control

Suicides are preventable. There are a number of measures that can be taken at population, sub-population and individual levels to prevent suicide and suicide attempts. These include:

• reducing access to the means of suicide (e.g. pesticides, firearms, certain medications);
• reporting by media in a responsible way;
• introducing alcohol policies to reduce the harmful use of alcohol;
• early identification, treatment and care of people with mental and substance use disorders, chronic pain and acute emotional distress;
• training of non-specialized health workers in the assessment and management of suicidal behaviour;
• follow-up care for people who attempted suicide and provision of community support.

Suicide is a complex issue and therefore suicide prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labour, agriculture, business, justice, law, defense, politics, and the media. These efforts must be comprehensive and integrated as no single approach alone can make an impact on an issue as complex as suicide.

Challenges and obstacles

Stigma and taboo

Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need. The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it. To date, only a few countries have included suicide prevention among their health priorities and only 38 countries report having a national suicide prevention strategy.

Raising community awareness and breaking down the taboo is important for countries to make progress in preventing suicide.

Data quality

Globally, the availability and quality of data on suicide and suicide attempts is poor. Only 60 Member States have good-quality vital registration data that can be used directly to estimate suicide rates. This problem of poor-quality mortality data is not unique to suicide, but given the sensitivity of suicide – and the illegality of suicidal behaviour in some countries – it is likely that under-reporting and misclassification are greater problems for suicide than for most other causes of death.

Improved surveillance and monitoring of suicide and suicide attempts is required for effective suicide prevention strategies. Cross-national differences in the patterns of suicide, and changes in the rates, characteristics and methods of suicide highlight the need for each country to improve the comprehensiveness, quality and timeliness of their suicide-related data. This includes vital registration of suicide, hospital-based registries of suicide attempts and nationally representative surveys collecting information about self-reported suicide attempts.

WHO response

WHO recognizes suicide as a public health priority. The first WHO World Suicide Report “Preventing suicide: a global imperative” published in 2014, aims to increase the awareness of the public health significance of suicide and suicide attempts and to make suicide prevention a high priority on the global public health agenda. It also aims to encourage and support countries to develop or strengthen comprehensive suicide prevention strategies in a multisectoral public health approach.

Suicide is one of the priority conditions in the WHO Mental Health Gap Action Programme (mhGAP) launched in 2008, which provides evidence-based technical guidance to scale up service provision and care in countries for mental, neurological and substance use disorders. In the WHO Mental Health Action Plan 2013–2020, WHO Member States have committed themselves to working towards the global target of reducing the suicide rate in countries by 10% by 2020.

In addition, the suicide mortality rate is an indicator of target 3.4 of the Sustainable Development Goals: by 2030, to reduce by one third premature mortality from noncommunicable diseases through prevention and treatment, and promote mental health and well-being.

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Published courtesy of the WHO

Male depression may lower pregnancy chances among infertile couples, NIH study suggests

Among couples being treated for infertility, depression in the male partner was linked to lower pregnancy chances, while depression in the female partner was not found to influence the rate of live birth, according to a study funded by the National Institutes of Health.

Study also links women’s use of non-SSRI antidepressants to early pregnancy loss.

The study, which appears in Fertility and Sterility, also linked a class of antidepressants known as non-selective serotonin reuptake inhibitors (non-SSRIs) to a higher risk of early pregnancy loss among females being treated for infertility. SSRIs, another class of antidepressants, were not linked to pregnancy loss. Neither depression in the female partner nor use of any other class of antidepressant were linked to lower pregnancy rates.

“Our study provides infertility patients and their physicians with new information to consider when making treatment decisions,” said study author Esther Eisenberg, M.D., of the Fertility and Infertility Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which funded the study.

Citing previous studies, the authors noted that 41 percent of women seeking fertility treatments have symptoms of depression. In addition, a study of men seeking IVF treatments found that nearly 50 percent experienced depression. The authors conducted the current study to evaluate the potential influence of depression in couples seeking non-IVF treatments.

The researchers combined data from two previous studies funded by NICHD’s Reproductive Medicine Network. One study compared the effectiveness of two ovulation-inducing drugs for establishment of pregnancy and live birth in women with polycystic ovary syndrome. The other study compared the effectiveness of three ovulation-inducing drugs at achieving pregnancy and live birth in couples with unexplained infertility. In each study, men and women responded to a questionnaire designed to screen for depression. Only the women were asked whether they were taking any antidepressants.

From the two studies, the researchers analyzed data for 1,650 women and 1,608 men. Among the women, 5.96 percent were rated as having active major depression, compared to 2.28 percent of the men.

Women using non-SSRIs were roughly 3.5 times as likely to have a first trimester pregnancy loss, compared to those not using antidepressants. Couples in which the male partner had major depression were 60 percent less likely to conceive and have a live birth than those in which the male partner did not have major depression.

The study did not include couples who underwent in vitro fertilization because the authors thought that this procedure could potentially overcome some possible effects of depression, such as reduced sexual desire and lower sperm quality.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD conducts and supports research in the United States and throughout the world on fetal, infant and child development; maternal, child and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit https://www.nichd.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.