Smoking may increase symptoms of depression in adolescents, especially those who use  cigarettes to feel better or to “self-medicate,” according to a new observational substudy from the Canadian Nicotine Dependence in Teens (NDIT) trial.

“It’s important to emphasize that depressive symptom scores were higher for the teenagers who reported emotional benefits from smoking after they began to smoke,” lead study author Michael Chaiton, PhD, research associate at the Ontario Tobacco Research Unit, affiliated with the Dalla Lana School of Public Health at the University of Toronto, Ontario, Canada, told Medscape Medical News.

“Before smoking, all the adolescents [in the study] had roughly the same level of depression symptoms, but after they started smoking, [the smokers'] depression levels were much higher,” added Dr. Chaiton.

He noted that this is “one of the few observational studies to examine the perceived emotional benefits of smoking” in adolescents and the first in this patient population to “demonstrate the long-term trend of perceived smoking-related psychobiological function on depressive symptoms over time.”

The researchers write that these perceived benefits may simply come from the “alleviation of symptoms of [nicotine] withdrawal and craving resulting from abstinence.

“This repeated cycle of craving-satisfaction-craving-satisfaction that can occur many times a day for kids may lead to a higher level of depression over time and to worse outcomes,” added Dr. Chaiton. Therefore, “self-medication scores may be useful in identifying a population who are susceptible to depression.”

He also voiced concerns for clinicians “who may recommend holding off on smoking cessation” when dealing with patients with depression or other mental health disorders or addictions. “It’s a dubious practice to rely on smoking as a self-medication tool.”

The study was published online July 23 in Addictive Behaviors.

Tags: adolescent smoking

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