Smoking and depression

The graph on the left shows that of the general
population, only a minority are smokers. In a population of those with a history of
depression, a propensity for recurrent depression a majority are smokers. And a few are using the presbyterian approach, you would say “well, this is because these
people have so much time on their hands, perhaps they don’t have the requisite skills
to get their ducks in a row the way other people might have. And it is the only pleasure that might remains
and we should you know “blah, blah, blah, blah, blah.” Which is again, I think an inappropriate perspective. When we begin thinking like clinicians and scientists and seek to deconstruct this relationship
and identify if there are contributing mechanisms. We begin to find some interesting facts. If you look at the slide on the left, which
is that of a non-smoker you see that something is lighting up the
kidneys, the liver, the heart and the brains of those who are non smokers. Something is absent in those same structures
in smokers and that something is Monoamine Oxidase. Most clinicians are completely unaware
that hundreds of times a day, smokers are self administering small doses
of Monoamine Oxidase inhibitors, and so as a consequence, they are self medicating,
if you will, and deriving some benefit in terms of their
depressive symptoms as a result of this phenomenon. Conversely, when individuals stop smoking,
when certain individuals stop smoking it is quite reasonable to suspect or predict
that symptoms of depression might emerge. Typically, when those symptoms do emerge,
the emergence of those symptoms has been attributed to the agent that has been used to help people
stop smoking. Clinicians all across this country know about
the relationship between grapefruit juice and metabolism of statins. Notwithstanding that you have got to drink
tanker-loads, well, not quite that much. But must clinicians, most family physicians
have no idea about some of these fundamental relationships. Why should we? Why should they have to know
about this? This is a habit, and if their patients were
just better organized, they would do something about it. And so, we have not felt any kind of investigative
or scientific responsibility in trying to understand some of these kinds of processes.

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