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Letters to the Editor   |    
Current Smoking, Hypoxia, and Suicide
Henri-Jean Aubin; Ivan Berlin; Michel Reynaud
Am J Psychiatry 2011;168:326-327. doi:10.1176/appi.ajp.2010.10101501
View Author and Article Information
Villejuif, France
Paris, France
Villejuif, France

This letter was accepted for publication in December 2010.

Dr. Aubin has received sponsorship to attend scientific meetings, speakers honoraria, and consultancy fees from Pfizer, McNeil, GlaxoSmithKline, Sanofi-Aventis, Lundbeck, and Merck-Serono.

Dr. Berlin has received sponsorships to attend scientific meetings, speakers honoraria, and consultancy fees from Pfizer Ltd.

Dr. Reynaud has received funding to attend scientific meetings, speakers honoraria, funding, and consultancy fees from Merck-Serono, Schering-Plough, Lundbeck, and Bristol-Myers Squibb.

Accepted December , 2010.

To the Editor: Recently Namkug Kim, Ph.D., et al. reported that altitude appears to be a significant independent risk factor for suicide, hypothesizing that hypoxia mediates this relationship (1). Cigarette smoking leads to increased carboxyhemoglobinemia, reduced hemoglobin availability for oxygen, resulting in impaired oxygen release to tissues (24). Thus, like altitude, smoking is likely to decrease oxygen availability in the brain.

Current cigarette smoking has been shown to be dose-dependently associated with increased rates of suicide, an association not found in ex-smokers (5). Whether this association can withstand adjustment for psychiatric and addiction confounding factors has also been debated (6, 7). Several mechanisms have been proposed to explain this association (57): the toxic effects of nicotine, monoamine oxidase activity inhibition, the high prevalence of psychiatric comorbidity and consequent suicide risk, and smoking-induced serious physical illness with pain and disability resulting in negative mood response. Smoking could also be an inadequate self-medication for psychological symptoms, themselves causing suicide, and finally the association could be due to a third underlying factor associated with both smoking and suicide. To our knowledge, hypoxia has not yet been hypothesized as a possible mechanism for the association of current smoking and suicide. The suggestion by Kim et al. (1) that hypoxemia may have a role in inducing suicide can particularly be applied for the current smoking-suicide relationship and would merit further investigations.

Kim  N;  Mickelson  JB;  Brenner  BE;  Haws  CA;  Yurgelun-Todd  DA;  Renshaw  PF:  Altitude, gun ownership, rural areas, and suicide.  Am J Psychiatry 2011; 168:49—54
[CrossRef] | [PubMed]
 
Benowitz  NL:  Cigarette smoking and cardiovascular disease: pathophysiology and implications for treatment.  Prog Cardiovasc Dis 2003; 46:91—111
[CrossRef] | [PubMed]
 
Jensen  JA;  Goodson  WH;  Hopf  HW;  Hunt  TK:  Cigarette smoking decreases tissue oxygen.  Arch Surg 1991; 126:1131—1134
[PubMed]
[CrossRef]
 
Sorensen  LT;  Jorgensen  S;  Petersen  LJ;  Hemmingsen  U;  Bulow  J;  Loft  S;  Gottrup  F:  Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis.  J Surg Res 2009; 152:224—230
[CrossRef] | [PubMed]
 
Hughes  JR:  Smoking and suicide: a brief overview.  Drug Alcohol Depend 2008; 98:169—178
[CrossRef] | [PubMed]
 
Boden  JM;  Fergusson  DM;  Horwood  LJ:  Cigarette smoking and suicidal behavior: results from a 25-year longitudinal study.  Psychol Med 2008; 38:433—439
[CrossRef] | [PubMed]
 
Kessler  RC;  Borges  G;  Sampson  N;  Miller  M;  Nock  MK:  The association between smoking and subsequent suicide-related outcomes in the National Comorbidity Survey panel sample.  Mol Psychiatry 2008; 14:1132—1142
[CrossRef] | [PubMed]
 
References Container
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References

Kim  N;  Mickelson  JB;  Brenner  BE;  Haws  CA;  Yurgelun-Todd  DA;  Renshaw  PF:  Altitude, gun ownership, rural areas, and suicide.  Am J Psychiatry 2011; 168:49—54
[CrossRef] | [PubMed]
 
Benowitz  NL:  Cigarette smoking and cardiovascular disease: pathophysiology and implications for treatment.  Prog Cardiovasc Dis 2003; 46:91—111
[CrossRef] | [PubMed]
 
Jensen  JA;  Goodson  WH;  Hopf  HW;  Hunt  TK:  Cigarette smoking decreases tissue oxygen.  Arch Surg 1991; 126:1131—1134
[PubMed]
[CrossRef]
 
Sorensen  LT;  Jorgensen  S;  Petersen  LJ;  Hemmingsen  U;  Bulow  J;  Loft  S;  Gottrup  F:  Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis.  J Surg Res 2009; 152:224—230
[CrossRef] | [PubMed]
 
Hughes  JR:  Smoking and suicide: a brief overview.  Drug Alcohol Depend 2008; 98:169—178
[CrossRef] | [PubMed]
 
Boden  JM;  Fergusson  DM;  Horwood  LJ:  Cigarette smoking and suicidal behavior: results from a 25-year longitudinal study.  Psychol Med 2008; 38:433—439
[CrossRef] | [PubMed]
 
Kessler  RC;  Borges  G;  Sampson  N;  Miller  M;  Nock  MK:  The association between smoking and subsequent suicide-related outcomes in the National Comorbidity Survey panel sample.  Mol Psychiatry 2008; 14:1132—1142
[CrossRef] | [PubMed]
 
References Container
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