Tag Archives: Psychiatric

Improved Mental Health Tied to Quitting Smoking

In a new study from Washington University, researchers find that quitting smoking does more than improve physical health as stopping the habit also improves mental health.

Typically, health professionals who treat people with psychiatric problems often overlook their patients’ smoking habits, assuming it’s best to tackle depression, anxiety, or substance abuse problems first.

However, the new study shows that people who struggle with mood problems, or addiction can safely quit smoking and that kicking the habit is associated with improved mental health.

The study is published online in the journal Psychological Medicine.

“Clinicians tend to treat the depression, alcohol dependence or drug problem first and allow patients to ‘self-medicate’ with cigarettes if necessary,” said lead investigator Patricia A. Cavazos-Rehg, Ph.D.

“The assumption is that psychiatric problems are more challenging to treat and that quitting smoking may interfere with treatment.”

In the study, Cavazos-Rehg discovered that quitting, or significantly cutting back on cigarette smoking was linked to improved mental health outcomes.

Specifically, quitting altogether or reducing by half the number of cigarettes smoked daily was associated with lower risk for mood disorders like depression, as well as a lower likelihood of alcohol and drug problems.

“We don’t know if their mental health improves first and then they are more motivated to quit smoking or if quitting smoking leads to an improvement in mental health,” Cavazos-Rehg said.

“But either way, our findings show a strong link between quitting and a better psychiatric outlook.”

Naturally, the serious health risks associated with smoking make it important for doctors to work with their patients to quit, regardless of other psychiatric problems.

“About half of all smokers die from emphysema, cancer, or other problems related to smoking, so we need to remember that as complicated as it can be to treat mental health issues, smoking cigarettes also causes very serious illnesses that can lead to death,” she said.

Researchers analyzed questionnaires gathered as part of the National Epidemiologic Study on Alcohol and Related Conditions.

This survey was administered in the early 2000’s and just under 35,000 people were surveyed. As part of the study, participants answered questions about drinking, smoking, and mental health in two interviews conducted three years apart.

The researchers focused on data from 4,800 daily smokers. Those who had an addiction or other psychiatric problems at the time of the first survey were less likely to have those same problems three years later if they had quit smoking.

And those who hadn’t had psychiatric problems at the initial survey were less likely to develop those problems later if they already had quit.

At the time of the first interview, about 40 percent of daily smokers suffered mood or anxiety disorders or had a history of these problems. In addition, about 50 percent of daily smokers had alcohol problems, and some 24 percent had drug problems.

Forty-two percent of those who had continued smoking during the years between the two surveys suffered mood disorders, compared with 29 percent of those who quit smoking.

Alcohol problems affected 18 percent of those who had quit smoking versus 28 percent who had continued smoking.

And drug abuse problems affected only 5 percent of those who had quit smoking compared with 16 percent of those who had continued smoking.

“We really need to spread the word and encourage doctors and patients to tackle these problems,” Cavazos-Rehg said.

“When a patient is ready to focus on other mental health issues, it may be an ideal time to address smoking cessation, too.”

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We need to move firmly beyond the misinformed views that depression is a “psychiatric invention”.

The World Federation for Mental Health proposes that depression is a global crisis because it affects more than 300 million people around the world, that it is associated with profound social and economic consequences, and that despite the fact that it is “treatable” most people around the world do not receive these treatments. But there are many who question this evidence, with the most strident critique challenging the very notion of depression as a disorder in the first place and equating its application across cultures with psychiatric imperialism: one commentator has famously referred to the globalization of the concept of depression as the “Americanization of mental illness”. (http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?pagewanted=all).

These dissenting voices argue that what constitutes depression is, in fact, a perfectly normal human response to adversity in one’s life (for example, losing someone you love or your job), and that applying a medical label wrongly transforms this response into a sickness. Worse, applying such labels primarily furthers the pernicious agendas of the professional mental health sectors and its bed-fellows in the pharmaceutical industry. As Horwitz and Wakefield, two American mental health professionals argue, there is a real danger of the “loss of sadness” (http://www.amazon.com/Loss-Sadness-Psychiatry-Transformed-Depressive/dp/0195313046), an emotional experience which is as common as happiness, through the over-use and abuse of the diagnostic label of depression and antidepressant medicines.

What do we make of these contrasting views? Is depression a real disorder? Does it really occur in non-western settings? How do we distinguish despair from disorder?

There seems little doubt in my mind that depression, in particular at the severe end of the experience of this condition, is as real a disorder as diabetes is at the severe end of blood glucose levels. I could invoke the hundreds of studies carried out in scores of countries around the world which demonstrate not only that the core features of this condition can be identified in all cultures, but also that the condition is very common and disabling. I could invoke the fact that my own mother who grew up and lived her life in India, suffered from severe depression from which she made a full recovery with treatment. But I think the most compelling evidence to support the existence of this condition comes from the annals of the history of medical knowledge: indigenous systems of medicine from times immemorial, including our own in India, have described a syndrome akin to what we refer to as depression (albeit with different names and different explanations). Depression has existed as long as mankind itself, and certainly well before psychiatry, antidepressant medication or the nation of America itself came into being.

However, it is equally true that, we have a real problem is distinguishing depression as an illness from the despair of everyday life. Defining a disorder, at least from a clinical point of view, necessitates that we do identify such a dividing line. While the problem of defining the dividing line is also encountered in many other medical conditions such as hypertension (what is the exact dividing line between “normal” and “abnormal” blood pressure?), at least in those cases we can fall back on some objective indicator or measure (such as a blood pressure reading) to determine whether a person has the condition. In the absence of such an objective indicator of the disorder, psychiatry has defined a “case” on the basis of various characteristics of the self-reported experiences of depression (for example, their duration) and the impact of these experiences on social or occupational functioning. There is an obvious element of subjectivity and arbitrariness in making such distinctions and thus the inherent risk of mistaking despair for disorder, particularly at the milder end of the spectrum.

In the end, I do not think we will find the neat boundary between “normal sadness” and “clinical depression” if only because mood is an innate human characteristic, like weight or the length of our hair. However, to reject the very notion of depression as an illness on account of these difficulties is throwing the baby out with the bathwater. In my mind, depression is, like all non-communicable diseases, a physiologically expressed condition which is profoundly influenced by our social and cultural environments. Depression is a global crisis not only because it is common and universal, but because the vast majority of affected people suffer in silence or receive inappropriate care. We need to move firmly beyond the misinformed views that depression is a “psychiatric invention” to investing more on understanding its nature, finding more accurate ways of distinguishing when a person with the condition may benefit from medical care, and improving access to the full range of treatments (medicines and psychosocial) for such persons.

– The Hindu.

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