Smoking and mental health

This content mentions depression, which some people may find triggering.

Summary

• Why is smoking so addictive?
• Ways to help you quit

If you’re a smoker, there is now a lot of support available to help you quit. It’s never too late to give up, and you may find that quitting reduces your levels of stress, anxiety and depression.

Why is smoking so addictive?

When a person smokes, nicotine reaches the brain within about ten seconds. At first, nicotine improves mood and concentration, decreases anger and stress, relaxes muscles and reduces appetite.

Regular doses of nicotine lead to changes in the brain, which then lead to nicotine withdrawal symptoms when the supply of nicotine decreases. Smoking temporarily reduces these withdrawal symptoms and can therefore reinforce the habit. This cycle is how most smokers become nicotine dependent.

Smoking and stress

Some people smoke as ‘self-medication’ to ease feelings of stress. However, research has shown that smoking actually increases anxiety and tension. Nicotine creates an immediate sense of relaxation, so people smoke in the belief it reduces stress and anxiety. This feeling is temporary and soon gives way to withdrawal symptoms and increased cravings. Smoking reduces withdrawal symptoms but doesn’t reduce anxiety or deal with the reasons someone may feel that way.

Smoking and depression

Adults with depression are twice as likely to smoke as adults without depression. Most people start to smoke before showing signs of depression, so it’s unclear whether smoking leads to depression or depression encourages people to start smoking. It’s most likely that there is a complex relationship between the two.

Nicotine stimulates the release of the chemical dopamine in the brain. Dopamine is involved in triggering positive feelings. It is often found to be low in people with depression, who may then use cigarettes to temporarily increase their dopamine supply. However, smoking encourages the brain to switch off its mechanism for making dopamine, so in the long term, the supply decreases, which in turn prompts people to smoke more.

People with depression can have particular difficulty when they try to stop smoking and have more severe withdrawal symptoms. Remember, there’s lots of support available if you decide to quit. However – you don’t have to go through it alone.

Smoking and schizophrenia

People with schizophrenia are three times more likely to smoke than other people and tend to smoke more heavily. It’s likely this is because people with schizophrenia use smoking to control or manage some of the symptoms associated with their illness and reduce some of the side effects of their medication.

A recent study has shown smoking may increase the risk of developing schizophrenia. However, further research is needed to fully understand how the two are linked.

Ways to help you quit

Stopping smoking suddenly through willpower alone is the least effective way to quit. If you plan, have support and choose the right time to try, you’re more likely to be successful. If you’re feeling unstable, experiencing a crisis or undergoing significant changes in your life, you’re less likely to quit.

If you take antidepressants or antipsychotic medicines, talk to your GP or psychiatrist before you stop smoking. The dosage you take may need to be monitored, and the amount you need to take could be reduced. This is because smoking can reduce the levels of some medications in the blood, so you may need a lower dose when you quit.

Prepare for change

Think about your relationship with smoking. Write down what you will gain by not smoking, such as better physical health, fresher breath, improved concentration and more money to spend on other things.

Get support from family and friends

Stopping smoking can be easier with the support of family and friends. If you live with people who smoke, or have friends who smoke, suggest to them that you give up together. If other household members smoke, encourage them not to smoke around you or leave their cigarettes, ashtrays or lighters where you will see them.

Find other ways to cope with stress

If you use smoking to cope with stress, you’ll need to find other ways to deal with it. Some things people find helpful are meditation and breathing exercises, regular exercise, cutting down on alcohol, eating a well-balanced diet, acupuncture and hypnosis. Counselling or simply talking to a supportive friend, family member or religious or spiritual leader can also help.

Find a local stop-smoking service

You’re three times as likely to stop smoking successfully if you use a stop smoking service. They offer free one-to-one or group support along with stop-smoking medicines. You usually go for a few weeks before you quit, then once a week for four weeks after your last cigarette.

Talk to your GP

Many people don’t realise their GP can help them stop smoking. They may enrol you in a stop smoking clinic, prescribe nicotine replacement therapy, or stop smoking medicine.

Nicotine replacement therapy and medication

Nicotine replacement therapy (NRT), anti-depressants and other medication have all been shown to help smokers without mental health problems stop smoking. They may also be helpful for people with depression or schizophrenia. NRT appears to be more effective when combined with talking therapy.

You could also consider e-cigarettes. They’re much safer than cigarettes and can help people stop smoking.

Talk to your doctor, a pharmacist or a health visitor about which treatments might be suitable for you.

Talking therapies

Individual, group or telephone counselling can help people to stop smoking. Talking therapies can help people change their behaviour by thinking and acting more positively. Many counselling programmes use the techniques of cognitive behavioural therapy (CBT) and social skills development. Research has shown that CBT may be particularly effective in smokers with or without mental health problems.

Avoid triggers linked to smoking

Removing all tobacco products from your home can help lessen some of the cravings for nicotine withdrawal.

Learn to recognise your smoking triggers. Identify when you crave cigarettes, such as at a party or after a meal. Try to avoid those situations where possible, or plan ways to resist triggers you can’t avoid. Most cravings only last a few minutes. If you can ride them out, you’ll be closer to quitting for good.

Be prepared for withdrawal symptoms

You may experience headaches, nausea, irritability, anxiety, craving cigarettes, feeling miserable, difficulty concentrating, increased appetite and drowsiness. Drinking more fresh fruit juice or water, eating more high-fibre foods and reducing caffeine and refined sugar in your diet can all help you cope with withdrawal symptoms.

Don’t give up if you relapse

Many people who quit smoking will relapse at some point. Don’t be put off trying again. Use it as an opportunity to reflect on what went wrong, learn about yourself and figure out what will help you be more successful in future.

Further help and support

Call the National Smokefree Helpline in England on 0300 123 1044 or visit the NHS website. If English isn’t your first language, you can call the helpline and ask to speak to an interpreter for the language you need.

• In Wales, call 0808 250 2157 or visit Help Me Quit.
• In Northern Ireland, visit Stop Smoking NI.
• In Scotland, call 0800 84 84 84 or visit Quit Your Way Scotland.
• ASH (Action on Smoking and Health) - Campaigns to reduce the health problems caused by tobacco.

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* Last updated: 9 March 2021