In April 2010, the U.S. National Center for Health Statistics (NCHS) published a report detailing their findings about the association between depression and smoking. The report showed that 43% of Americans who report being depressed are current smokers. The report further demonstrated that depression was most severe in the heaviest of smokers. (Pratt LA, Brody, DJ. Depression and Smoking in the U.S. Household Population Aged 20 and Over, 2005-2008. NCHS Data Brief. 2010 April; (34)1-8).
Overall, depression among adults over the age of 20 is only reported by 7% of the total U.S. adult population, but that still represents over 15 million people. By comparison, the total number of confirmed COPD cases in the U.S. is around 13 million people so depression is clearly a significant societal issue.
The NCHS-reported 43% depression rate among current smokers implies that approximately 6.5 million of the 15 million people in our country suffering from depression are current smokers. Since there are approximately 43 million current smokers in the U.S., the 6.5 million smokers reporting depression represent about 15% of total current U.S. adult smokers.
Among the other significant findings reported by NCHS is the fact that 51% of smokers who light up their first cigarette of the day within 5 minutes of waking up report depression. By contrast, only 23% of smokers who waited over 30 minutes before consuming their first cigarette of the day reported depression. In addition, those who smoked the most (2 packs a day or more) reported the most severe depressive symptoms.
The report authors speculate that current smokers’ depression is largely related to frustration about the inability to quit smoking. We agree with that speculation and would further add concern/frustration among smokers about other elements of their health status (poor diet, breathlessness, and other conditions such as hypertension, heart disease and diabetes).
Is there a way out for smokers who are clinically depressed?
Most doctors will focus first and foremost on recommending smoking cessation. However, as most smokers who’ve attempted to quit in the past (successfully or unsuccessfully) can attest – it is excruciatingly difficult to do. A slew of research continues to search for aids to help improve smoking cessation success but thus far the “successful” results are modest at best. Though smoking cessation statistics vary by source quoted, it is safe to say that of the 43 million current smokers in our country, approximately 70% report a desire to quit each year, 35-40% actually try in a given year, and about 5-15% of the people who try are successful in abstaining for more than 1 year.
A common treatment option for depressive symptoms among smokers is to prescribe anti-depressant drugs such as Chantix. While these drugs taken alone, or combined with nicotine replacement can boost cessation success rates, they also have scary potential side effects.
But if you’re in a situation where you either have tried to stop smoking and can’t, or you are just not ready to try quitting, what do you do?
We think it is worth considering exercise. Now, you may chuckle at this suggestion but there have been a number of studies showing exercise’s benefits for smokers in the following ways:
- Slowing the progression of lung disease (click here to read more)
- Improving physical conditioning, reducing shortness of breath, and Improving sense of well being/quality of life (click here to read more)
- Enhancing smoking cessation success rates (click here to read more)
- Reducing the incidence of lung cancer (click here to read more)
In addition, there is evidence that exercise among people who exhibit depressive symptoms does modestly improve sense of well being though this review of depression/exercise studies does not specifically evaluate depression among smokers. (Mead GE, et al. Exercise for depression. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD004366)
We’re not saying exercise will cure depression but we think it may help. Specifically, we are saying that if your depression stems from frustration that you can’t seem to quit smoking and you’re not ready to try again right now, there is a viable option to consider beyond prescription anti-depressants (exercise). Further, we are saying that there is evidence that improving your physical conditioning prior to smoking cessation or in conjunction with smoking cessation can boost success rates (ala the links to other articles we’ve written on these topics).
It also makes intuitive sense to us – if you’re in a position where you feel you are not in control of your health (i.e. you want to quit smoking but can’t seem to do it), taking any positive steps to improve your health improves your sense of well being. Improving your sense of well being sounds like relieving depression to us, and if exercise can improve your physical conditioning and sense of well being, it’s quite possible that it will be easier for you to consider stopping smoking.
If you want to begin an exercise program, where do you start? Well, the most likely concern about beginning an exercise program if you are a current smoker is the high likelihood you will experience an uncomfortable degree of breathlessness. That’s where the principles of pulmonary rehabilitation come into play. Exercise programs in pulmonary rehab are specifically designed to help people who suffer from chronic shortness of breath start out at a manageable level and then increase the intensity and duration of exercise over time in an effort to lessen the likelihood and severity of shortness of breath attacks (known as dyspnea). For most smokers though, gaining entry to a pulmonary rehab program without completing a smoking cessation program first is almost unheard of. There is a strong bias against offering current smokers entry even though physicians agree smokers can significantly benefit from this valuable treatment option (a chicken and egg problem of modern pulmonary medicine).
That is one of the reasons why we developed the Breathe Better for Life guidebook and companion CD-ROM. We scoured the research, visited pulmonary rehab centers, and consulted leading respiratory care professionals to construct an at-home or fitness center based exercise program for people who suffer from chronic shortness of breath (whether you quit smoking first or not). To learn more about purchasing Breathe Better for Life, visit www.breathebetterforlife.com.
Whether you consider our exercise program in consultation with your physician, or begin one recommended by your physician, it is highly worth your time to give exercise a shot. There is so much health benefit upside for current smokers from an active, ongoing exercise program and in our opinion, it may make a significant difference about how you feel about yourself, your prospects, and ultimately your ability to stop smoking.
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