A lot of people take up smoking because they think it will boost their mood. For a while, they might be right. But in the long run, smokers could end up feeling hopeless or terribly sad. That’s because there appears to be a link between smoking and depression, and new research backs up this claim.

Although which comes first remains controversial, a Vancouver addictions specialist says the association only exacerbates the consequences of nicotine.

“This makes the hazards of smoking even greater,” says Ray Baker, medical director of HealthQuest, a Richmond clinic that helps people suffering from substance-use disorders who often have other medical problems, like chronic pain or psychiatric illnesses.

“We’ve always known that in the short term, nicotine acts like an antidepressant,” Baker explains. “We’ve always thought that people with depression are more likely to smoke because they’re self-medicating. When they try to stop, often a side effect is depression. But when their depression is concurrent, they have a much tougher time quitting. The depression gets worse, and so they have the urge to smoke.

“This is why we have to address the whole person: we have to look at the depression and we have to look at the addiction,” Baker adds. “It’s part of the whole recovery process.”

The World Health Organization and the International Society for Biomedical Research on Alcoholism recently released results from a joint study involving more than 1,800 men and women. Published in Neuropsychobiology in June, the study found that the highest rate of depression—almost 24 percent—was found in current smokers, while the lowest rate existed in people who had never smoked (about six percent). About 15 percent of participants who had quit smoking were depressed.

The WHO/ISBRA findings are just the latest of many that support the association between smoking and depression. Researchers from the University of Navarra, for instance, followed more than 8,500 university graduates with an average age of 42 during a six-year period. They concluded in a study published in the Spanish journal Medicina Clí­nica in March that the risk of suffering from depression increased by 41 percent in smokers compared to nonsmokers.

And a joint study by the Norwegian Institute of Public Health, the University of Bergen, and King’s College in London, which involved 60,000 people aged 20 to 89, found that depression as well as anxiety were most common in current smokers, followed by those who had quit and then people who never smoked. The study, published in February’s European Psychiatry, also concluded that the link between smoking and depression and anxiety was highest among women and young people.

In as little as seven seconds, a puff of nicotine can start to calm a smoker’s brain, according to ActNow B.C. The U.S. National Institute on Drug Abuse states that nicotine, like other addictive substances, attaches to core neurons of the brain’s reward system. That’s where certain beneficial behaviours (such as drinking water when you’re thirsty) are rewarded and reinforced. The neurons trigger the release of dopamine, a neurotransmitter, which floods the brain, producing pleasure and encouraging a repeat of the behaviours that caused the sense of well-being. That pleasure, and the need for it, drive the process of addiction.

The link between tobacco-smoking and depression also exists in teens.

In adolescents, Baker says, research suggests those with a nicotine dependence are more likely than nonsmokers to develop depression, while those with depression are not necessarily more likely than those without to become smokers.

The University of Kentucky published a study in 2006 in Addiction Behavior that included nearly 15,000 adolescents and found that those who took up smoking were 1.5 times as likely than those who never smoked to be depressed; those who started smoking and then quit were 1.4 times more likely to be depressed than those who never smoked; and those who maintained smoking were twice as likely to be depressed than nonsmokers.

A University of Alabama at Birmingham study found that smoking and depression affect each other reciprocally in adolescents, leading to a self-perpetuating pattern of unhealthy behaviour and negative consequences.

So what are some tips for people who want to quit smoking but are also depressed and are all too aware that giving up cigarettes could plunge them further into melancholy?

“When you quit smoking, you are likely to feel irritable, grumpy, or even dysphoric,” Baker says. “Most symptoms of dysphoria”¦are time-limited and pass with ongoing abstinence from nicotine. If you think you might have depression”¦then see your physician or other health or mental-health professional.”

Signs of depression include: persistent sadness; feelings of hopelessness; a sense of failure, guilt, disappointment, or self-loathing; excessive tearfulness or even the inability to cry; loss of interest in other people; difficulty making decisions; serious and new worries about your health or your appearance; fatigue and lethargy; difficulties sleeping; changes in appetite; loss of interest in sex; and thoughts of death or suicide.

Treatment often includes psychotherapy, such as cognitive behavioural therapy, Baker says. Then there is the use of antidepressants like buproprion, which also controls nicotine cravings in some people.

The U.S. National Cancer Institute suggests coping strategies like writing down things that are upsetting as well as solutions for them, increasing physical activity, breathing deeply, planning your next vacation, and establishing goals.

QuitNow, an on-line stop-smoking resource (www.quitnow.ca/), advises keeping busy and changing habits that you associate with smoking.

The physical benefits of quitting smoking don’t take long to kick in. ActNow B.C. states that after eight hours, the level of carbon monoxide in the body drops. After about three days, lung capacity increases. After two weeks, circulation improves. Within six to nine months, people experience less coughing, fatigue, and shortness of breath.