Nicotine Withdrawal and Depression: Clinical Studies-A Four-Factor Model for More Accurate Characterization

D. G. Gilbert, M. L. Pergadia

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

4 Scopus citations


Depressive vulnerability (eg, history of major depressive disorders, subclinical depressive symptoms, and anhedonia) is associated with greater smoking prevalence, relapse, and nicotine dependence; however, the relationship between such depression-related measures and withdrawal symptom severity and trajectories, or what may be described as mental health measures following reduction or cessation of smoking, is less well established because of methodological limitations of most relevant studies. Major limitations of studies to date are related to the failure to control for or to carefully assess four factors: (1) differential dropout: substantial nonrandom study dropout and relapse in individuals with depressive vulnerability and more generally in individuals with the most severe withdrawal symptoms and stressful life events; (2) testing effects: the strong tendency for scores on measures of negative affect and withdrawal symptoms to decrease substantially with repeated testing across time (given a constant environment stress-potential); (3) anticipatory quit stress: increased prequit anticipatory negative affect and withdrawal symptom scores in the week or so prior to quit attempts; and (4) long- and short-term chronodynamic life changes: to date, generally uncharacterized factors (generally disguised as error variance in statistical analyses) such as individual variability in short and long-term stressors, life circumstances, and biological functioning independent of or interacting with smoking abstinence effects and the decision to quit smoking at a given time. A model that addresses these four threats to accurate characterization of withdrawal symptoms is presented.

Original languageEnglish
Title of host publicationNegative Affective States and Cognitive Impairments in Nicotine Dependence
PublisherElsevier Inc.
Number of pages22
ISBN (Electronic)9780128026694
ISBN (Print)9780128025741
StatePublished - Jan 1 2017


  • Bias
  • Depression
  • Depressive vulnerability
  • Four-factor model of assessment limitations
  • Mood
  • Nicotine
  • Smoking
  • Testing effect
  • Withdrawal symptoms


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