The Relationship between Smoking and Depression Post-Acute Coronary Syndrome

The purpose of the current article is to review research on the relationship between smoking cessation and depressed mood post-acute coronary syndrome (ACS; myocardial infarction or unstable angina). Emerging evidence regarding the effect of anhedonia-a specific subcomponent of mood disturbance characterized by reduced pleasure-on post-ACS outcomes is also discussed. There is strong evidence that depression prospectively predicts post-ACS relapse to smoking. Weaker evidence suggests that smoking at the time of ACS is related to post-ACS depression. Bupropion is a particularly promising treatment for this population because of its smoking cessation and anti-depressant effects. Future research should focus on the relative risk of using nicotine replacement therapies post-ACS, the efficacy of bupropion for smoking cessation and depression reduction in postACS patients, the role of anhedonia in post-ACS smoking cessation, and the development and testing of integrated behavioral treatments (smoking cessation plus interventions targeting mood management) for ACS patients.