Smoking and suicide: a brief overview.
paper
Cited
Public
- Authors
- Hughes, John R
- Year
- 2008
- Journal
- Drug and alcohol dependence
- PMID
- 18676099
- DOI
- 10.1016/j.drugalcdep.2008.06.003
- PMCID
- PMC2585177
This article provides a brief overview of the rationales, possible mechanisms and epidemiological data on the association of smoking, smoking cessation and cessation medications with suicide. Current smoking is reliably associated with suicide both in case-control and cohort studies. The three most plausible (but relatively untested) explanations for the association are that smokers have pre-existing conditions that increase their risk for suicide, smoking causes painful and debilitating conditions that might lead to suicide, and smoking decreases serotonin and monoamine oxidase levels. Stopping smoking appears to lead to major depression in some smokers; thus, it could induce suicide; however, smoking cessation has not been associated with suicide in the few studies available. Regulatory agencies have stated bupropion, rimonabant and varenicline appear to be associated with suicide; however, the data for these statements have not been presented in sufficient detail to assess their validity. Most prior data have come from post hoc analyses. Studies that a priori focus on understanding smoking and suicide are now needed.
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| 20 | 3. Results β 3.3. Association of Suicide and Smoking Cessation β 3.3.1. Possible Theories and Mechanisms | In terms of actual data, many lines of evidence indicate smoking causes a physical dependence onβ¦ |
| 21 | 3. Results β 3.3. Association of Suicide and Smoking Cessation β 3.3.2. Epidemiological/Clinical Data | Whether smoking cessation increases the risk of suicide during the initial period of tobaccoβ¦ |
| 22 | 3. Results β 3.3. Association of Suicide and Smoking Cessation β 3.3.2. Epidemiological/Clinical Data | A recent meta-analysis provided a more rigorous test of whether cessation might change suicidalβ¦ |
| 23 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.1. Theories/Mechanisms | Two of the major medications for smoking cessation are full agonist nicotine replacement therapiesβ¦ |
| 24 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.1. Theories/Mechanisms | There are two proven non-nicotine smoking cessation medications; i.e. antidepressants (McEwen et al.β¦ |
| 25 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.1. Theories/Mechanisms | Rimonabant, a cannabanoid antagonist, is another non-nicotine medication being developed both as aβ¦ |
| 26 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.2. Epidemiological/Clinical Data β 3.4.2.1. Nicotine replacement therapy (NRT) | Proven NRTs are nicotine gum, inhaler, lozenge, microtab, nasal spray and patch (Fiore et al. 2008;β¦ |
| 27 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.2. Epidemiological/Clinical Data β 3.4.2.1. Nicotine replacement therapy (NRT) | vs control group. If anything, suicides appeared to be less common with gum; i.e., 2/3923 or 0.05%β¦ |
| 28 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.2. Epidemiological/Clinical Data β 3.4.2.2. Nicotine partial agonists | Among the 2183 smokers exposed to varenicline in published trials, several AEs were more common withβ¦ |
| 29 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.2. Epidemiological/Clinical Data β 3.4.2.2. Nicotine partial agonists | A non-peer reviewed study listed 227 reports of βsuicide/self-injuryβ including 28 cases ofβ¦ |
| 30 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.2. Epidemiological/Clinical Data β 3.4.2.2. Nicotine partial agonists | Cytisine is another partial nicotine agonist that has been tested in 10 trials but only three ofβ¦ |
| 31 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.3. Antidepressants | Bupropion has been tested in 40 RCTs and found efficacious (Hughes et al. 2007). The FDA warningβ¦ |
| 32 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.3. Antidepressants | Nortriptyline has been tested in eight trials and found efficacious (Hughes et al. 2007; Hughes etβ¦ |
| 33 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.3. Antidepressants | Finally, the doses and duration of use of bupropion and nortriptyline when used for smokingβ¦ |
| 34 | 3. Results β 3.4 Association of Suicide and the Use of Smoking Cessation Medications β 3.4.4. Cannabanoid Antagonist | A trial of rimonabant to decrease obesity and atherosclerosis reported more suicidal outcomes in theβ¦ |
| 35 | 4. Discussion β 4.1. Summary of Results | The above data indicate a) suicide is strongly associated with current smoking; however, whetherβ¦ |
| 36 | 4. Discussion β 4.2. Limitations of the Review | These conclusions must be tempered by several limitations with the above data. First, suicides andβ¦ |
| 37 | 4. Discussion β 4.2. Limitations of the Review | study, or may be lost-to-follow-up. Since participants in smoking studies are usually reportingβ¦ |
| 38 | 4. Discussion β 4.3. Suicide and Current Smoking | Before reading the literature, the author believed any association of current smoking andβ¦ |
| 39 | 4. Discussion β 4.4. Suicide and Smoking Cessation | Before this literature review, the author also thought that smoking cessation was likely to lead toβ¦ |
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