The effects of smoking cessation on the progression of depressive disorders: A systematic review and meta analysis

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INTRODUCTIONSmoking and depression frequently co-occur, posing a major public health challenge.While the physical benefits of smoking cessation are well established, its impact on depressive disorders remains debated.Clarifying this relationship is essential for optimizing mental health interventions. METHODSWe conducted a systematic review and metaanalysis of randomized controlled trials and longitudinal cohort studies assessing changes in depressive symptoms following smoking cessation among adults (≥18 years) diagnosed with depressive disorders.In addition, the reference lists of three relevant meta-analyses were screened to identify additional eligible primary studies, but these meta-analyses were not counted as included studies.Searches were performed in PubMed, Scopus, Web of Science, and PsycINFO up to 30 April 2025.Risk of bias was assessed using the Cochrane RoB 2.0 tool for RCTs and the Newcastle-Ottawa Scale for cohort studies.Effect sizes were pooled using a random-effects (DerSimonian-Laird) model, and heterogeneity (I²) was evaluated.RESULTS A total of 22 primary studies (10 randomized controlled trials and 12 cohort studies; >30000 participants) met the inclusion criteria, and 18 contributed to the quantitative synthesis.The primary outcome -change in depressive symptom severity measured using validated scales (PHQ-9, BDI, CES-D, HAM-D) -showed a pooled standardized mean difference of -0.25 (95% CI: -0.37 --0.12; p<0.001), indicating a modest but significant reduction in depressive symptoms among abstainers.Findings were consistent across study designs and populations, with moderate heterogeneity (I² about 60%).CONCLUSIONS This review provides consistent evidence that smoking cessation is safe and beneficial for individuals with depressive disorders, improving depressive symptoms and psychological well-being.Although some individuals experience transient increases in symptoms post-cessation, structured support effectively mitigates these effects.Integrating cessation treatment within mental healthcare and developing scalable, tailored interventions should be prioritized in future research.

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