Anxiety and Depressed Mood Decline Following Smoking Abstinence in Adult Smokers with Attention Deficit Hyperactivity Disorder

• The preponderance of prior evidence indicates mood improvement following abstinence.
• Data from a smoking cessation trial were investigated to determine if that overall trend applies to smokers with ADHD.
• This secondary analysis on 255 smokers with ADHD treated with nicotine patch and randomized to receive adjunctive slow release methylphenidate or placebo found that anxiety and depression declined over the entire sample following smoking abstinence.
• The decline in anxiety and depressed mood following a target quit day was significantly greater in abstainers than non-abstainers and, in delayed manner, among those treated with methylphenidate than placebo.
• Instances of worsened mood following abstinence (4/255) were rare.

IntroductionA preponderance of relevant research has indicated reduction in anxiety and depressive symptoms following smoking abstinence. This secondary analysis investigated whether the phenomenon extends to smokers with attention deficit hyperactivity disorder (ADHD).MethodsThe study setting was an 11-Week double-blind placebo-controlled randomized trial of osmotic release oral system methylphenidate (OROS-MPH) as a cessation aid when added to nicotine patch and counseling. Participants were 255 adult smokers with ADHD. The study outcomes are: anxiety (Beck Anxiety Inventory (BAI)) and depressed mood (Beck Depression Inventory II (BDI)) measured one Week and six Weeks after a target quit day (TQD). The main predictor is point-prevalence abstinence measured at Weeks 1 and 6 after TQD. Covariates are treatment (OROS-MPH vs placebo), past major depression, past anxiety disorder, number of cigarettes smoked daily, demographics (age, gender, education, marital status) and baseline scores on the BAI, BDI, and the DSM-IV ADHD Rating Scale.ResultsAbstinence was significantly associated with lower anxiety ratings throughout the post-quit period (p < 0.001). Depressed mood was lower for abstainers than non-abstainers at Week 1 (p < 0.05), but no longer at Week 6 (p = 0.83). Treatment with OROS-MPH relative to placebo showed significant reductions at Week 6 after TQD for both anxiety (p < 0.05) and depressed mood (p < 0.001), but not at Week 1. Differential abstinence effects of gender were observed. Anxiety and depression ratings at baseline predicted increased ratings of corresponding measures during the post-quit period.ConclusionStopping smoking yielded reductions in anxiety and depressed mood in smokers with ADHD treated with nicotine patch and counseling. Treatment with OROS-MPH yielded mood reductions in delayed manner.