Quite a lot of smokers don't quit smoking after hospitalization for cardiovascular disease, even though they've received every encouragement to do so. As depression is not uncommon during such hospitalization, Boston researchers decided to see whether it played a role in the failure of smokers to quit under such circumstances. They've published their results in the Archives of Internal Medicine.

Data came from a placebo-controlled study of bupropion (Zyban®) in 245 smokers hospitalized for acute cardiovascular disease. Depression was measured during hospitalization using the Beck Depression Inventory.

22% of the smokers had moderate to severe depression during their time in hospital. These smokers were2.4 times as likely to resume smoking within 4 weeks of leaving hospital. Those smokers with low depression scores were significantly more likely to remain smoke-free at 3 months and 1 year follow-up. Clearly, depression was closely linked to rapid relapse after discharge and lower rates of quitting at long-term follow-up. The researchers believe the effect was due to stronger nicotine withdrawal symptoms in those with high depressive symptom scores.

Whatever the mechanism behind the association, the important thing for health professionals to remember is that after a heart attack there may be depression, and stopping smoking will be even harder for these patients. Families and friends should give all the support they can.