GUSHANSKAYA EKATERINA VLADIMIROVNA, PSYCHIATRIST, PSYCHOTHERAPIST, CANDIDATE OF MEDICAL SCIENCES, HEAD OF THE DEPARTMENT OF PSYCHIATRY AT THE PSYCHIATRIC HOSPITAL 13, ASSOCIATE PROFESSOR OF THE DEPARTMENT OF PSYCHIATRY, PSYCHOTHERAPY AND PSYCHOSOMATIC PATHOLOGY, FACULTY OF PSYCHIATRY, PSYCHOTHERAPY AND PSYCHOSOMATIC PATHOLOGY, RUDN MEDICAL INSTITUTE
Authors: Gushanskaya *Ekaterina Vladimirovna , Medvedev Vladimir Ernstovich 
Published: February 2025

Abstract

Background
According to the recent research the existence of a negative interference between psychopathological disorders and smoking has been proved. Smoking is cited as a factor that leads to depression. The possibility of developing clinical depression is two-three times higher than in those who have never smoked. Increased anxiety is discovered among smokers which is more than twice compared to nonsmokers. The proportion of those who smoke and suffer from mental illness is higher than in nonsmoking population. Patients with both depression and anxiety disorders start trying cigarettes at an early age, experience greater addiction, and have more difficulty in giving up.

Goals and Objectives
Studying the diagnostic importance of dynamic of cigarette consumption in patients with depressive and anxiety disorders against the background of psychopharmacotherapy.

Methods
The research included smoking patients of the age of 18 to 55 years with light or medium scale of depressive episodes (F32.0, F32.1), prolonged depressive reaction within adaptation disorders (F43.2) and anxiety-depressive disorder. Patients who took part in the research had stable somatic indexes and were on stable doses of somatotropic therapy given at least two weeks before the patients were included in the research. The therapy had been running with antidepressants from the SSRI group for 6 weeks (42 days) within the interval of permitted standard daily doses. The dynamics of patients' mental states was recorded during four visits. Planned visits were conducted every two weeks of therapy. The results were evaluated on the basis of the Fagerströ m Tolerance Questionnaire and standardized assessment scales (Hospital Anxiety and Depression Scale (HADS) and General Clinical Impression Scale (CGI)).

Results
Significant reversal development of depressive symptoms was recorded in a fortnight ( on the 14th day) of treatment (p&lt;0.05) and became more pronounced on the background of further therapy with constant improvement of indexes till to 42th day of the therapy (p&lt;0.001). By the end of the research, the level of anxiety had been decreased by 62% (from 17.9 to 6.8; p&lt;0.001), the depression - by 64.7% (from 13.9 to 4.9; p&lt;0.001) from the initial level.

Discussion and Conclusion
The reliable evidences of antidepressants’ efficacy of the group of SSRIs in the therapy of depressive and anxiety-depressive disorders of light or medium scale of smokers has been received. The medications in the majority of observations (39 (78%)) provide more rapid improvement of psychopathologic states at their shorter duration of the initial clinical cases. The equation of symptomatology along with improvement of patients' well-being is cited from the 14th day of therapy.
With the use of monotherapy in the studied group, SSRI has a favorable outcome of tolerability and safety. Higher and more stable consumption of tobacco may be a factor that reduces the efficacy and increases the possibility of unwanted consequences of antidepressant therapy. If a patient is not motivated to give up smoking, a "harm reduction" strategy might be used, which precisely goals on unmotivated patients who carry on smoking despite obvious and marked health negative outcomes.

References
1)Arstangalieva Z.J. Determinants of healthy lifestyle of elderly people. BMIC. 2013; 11:1309.
2)Podsvirova E.V., Romanova T.A., Tkacheva A.O., Gavrishova N.N. the influence of parental smoking on the state of health of newborn children. Actual problems of medicine. 2014; 11:182.
3)Fisin Y.M. Nicotine addiction and intelligence. CPJ. 2006;1.
4)Milic M., Gazibara T., Pekmezovic T., Kisic Tepavcevic D., Maric G., Popovic A., et al. Tobacco smoking and health-related quality of life among university students: Mediating effect of depression. PLoS ONE. 2020; 15(1): e0227042. https:// doi.org/10.1371/journal.pone.0227042