Van der Meer et al.'s [1] study of the efficacy of a mood management intervention as an addition to telephone counseling for smokers with a history of major depressive disorder (MDD) is intriguing. First, van der Meer et al. [1] have shown that, in the context of telephone counseling, adding the mood management intervention to a standard intervention, increases smoking treatment effectiveness for this specific group of high-risk patients. The results of this study, and that of Munoz et al. [2] who used mail, are consistent with those of investigators who have provided the treatment via more expensive face-to-face methods [3,4]. Given the relative cost-effectiveness of telephone treatment [5,6], this study reports yet another way of providing a sophisticated treatment for a high-risk population in a cost-effective manner. Given the over-representation of such individuals within the population of those who smoke [7,8], the replication of these results in doubly important.

Thus, the results of this study parallel those in studies using different delivery methods. This leads to a second contribution of this study. From a model-building perspective, the consistency of the results despite differing methods of delivery provides convergent validity for the usefulness of mood management interventions with smokers with a history of MDD.

Third, at least one study providing a mood management intervention in a traditional face-to-face setting found no difference in changes in mood as an effect of mood management [9]; another found no differences in the rate of recurrence of depressive symptoms as a function of provision of mood management treatment [10]. Van der Meer et al.'s had findings were similar. Their results lend support to the notion that mood management works for depressive smokers by some mechanism other than modulating negative mood. Like the earlier literature, there are no data or measures in the current study to suggest what that mechanism might be. The authors argue that it is not simple increased attention as a function of extra sessions devoted to mood management. Nevertheless, there is some evidence that additional attention might explain at least some proportion of the increased efficacy observed. One study [2] found differential effectiveness of mood management for smokers with a history of depression in one study where the mood management intervention was provided in 10 sessions, and the control condition provided in five, but failed to replicate this effect when control and mood management sessions were equivalent in time and therapeutic contact [9]. Conversely, Brown et al. [3] found differential efficacy for mood management over standard treatment for depressive history smokers when session times were equivalent, but only for those smokers with recurrent episodes of MDD.

It is possible that the differential efficacy is due primarily to having available skills that can be used during periods of poor mood, even if these skills do not produce measureable differences in the occurrence of these moods. There is also the possibility of lack of adequate measurement devices, or less than optimal timing of measurement of mood changes. Clearly, further work is needed to elucidate the efficacy of the mechanism of change.

In the current study, as in studies using traditional provision of mood management interventions, smokers with current major depression were excluded, as were smokers on antidepressants. Replication of these results with both of these groups would be of great interest to the field, and might help to answer those yet-to-be-answered questions about the behavioral mechanism dictating the effectiveness of mood management with depressive history smokers.

It is also interesting that approximately one-quarter of the applicants to the program who were excluded were taking anti-depressant drugs, and that more than 40% had alcohol problems. Other investigators have also noted a similar high rate of antidepressant use among smoking treatment program applicants, even when the study was not designed for individuals with a history of depression [11]. The meaning of this high rate, how it compares to the general population of the same age, gender and socio-economic status, is not known, but is intriguing.


  1. Top of page
  2. Declaration of interest
  3. References
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