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Evil Twins: Smoking and Mental Illness, Part 2

by Mike on October 14, 2008 · 51 comments

cigarette ashtray sm Evil Twins: Smoking and Mental Illness, Part 2There are all sorts of reasons for people to quit smoking, and for people with mental illnesses, there are even more.

Smokers with mental illnesses are at an accelerated risk of diabetes, heart attacks, and stroke. In addition, smoking has adverse effects on many of the most common psychiatric drugs. The negative effects of nicotine and other substances in tobacco smoke are little understood, but research is turning up many ways in which they are thought to be harmful to the body and mind.

Evidence is rapidly emerging that smoking may actually cause mental illnesses such as depression and Anxiety Disorders. It can greatly multiply the risk of panic attacks and other common mental conditions.

This post is the second in a 2-part series concerning smoking and mental illness. Part 1 discussed why people with mental illnesses smoke up to four times the rate of the general populace, along with findings about the higher rate of mental illness among smokers. This part deals with the following topics:

  • Why Should Someone With a Mental Illness Quit Smoking?
  • Can smoking cause mental illness?
  • In Summary

Why Should Someone With a Mental Illness Quit Smoking?

Smoking risks are greater for mentally ill smokers

The health reasons for quitting smoking have been well-known for years. But for the mentally ill, there are even more urgent reasons, including cigarettes’ effects on medication, and even more serious health risks than the general populace. Kristen Moeller-Saxone from the University of Melbourne’s Melbourne School of Population Health, says,    

Smoking compounds many of the health problems already experienced by people with mental illnesses. Combined with drug therapies that often make them overweight, they are at even greater risk of diabetes, heart attacks and strokes if they smoke. … The biggest cause of death among people with mental illness is not suicide, it is cardiovascular disease.

Many mental health professionals find that those with a mental illness find it particularly difficult to stop smoking. There is ample anecdotal evidence that says the same thing; it is well known that members of Alcoholics Anonymous find it more difficult to quit smoking than to quit drinking. Besides giving up the benefits of smoking listed under “Why Do People With Mental Illness Smoke?” in part 1, the elimination of nicotine produces emotions that many of the mentally ill find difficult to cope with.  Schmitz, Kruse, and Kugler say,

[P]eople who have difficulty coping with stress, anxiety, and depression are more vulnerable to dependency (somehow [nicotine] allows them to escape emotionally); that dependency may cause a vicious cycle — not being able to quit is stressful, which can increase anxiety.

In addition to the usual reasons for quitting smoking, there are additional reasons that are particularly important to people with a mental illness. Negative effects of smoking for people with mental illness include the following:

  • Premature death rates are higher for people with mental illness than for the general population, even after suicides are discounted. Many of these deaths are due to cardiovascular and respiratory problems that have smoking as a major contributor.
  • Substances found in tar in cigarettes stimulate enzymes in the liver, which increase the metabolism of some antipsychotics, such as clozapine, fluphenazine, haloperidol and olanzapine. This results in higher doses being needed for them to be effective.
  • There is some evidence to suggest that smoking may increase some side effects of many antipsychotic medications, including akathesia (restlessness) and tardive dyskinesia (involuntary movements of the face and mouth).
  • Smoking puts a heavy financial burden on mentally ill smokers, many of whom live on a low income.
  • Heavy smokers may find it difficult to participate in some activities where smoking is not allowed. This adds to the social exclusion experienced and may aggravate symptoms of mental illnesses such as Social Phobia, depression and other Anxiety Disorders.

Can smoking cause mental illness?

Studies show causal link between mental illness and smoking

Traditionally, it has been held that one is mentally ill first, and a smoker second. People with a mental illness start smoking, and smoke more, because nicotine relieves their symptoms and makes them feel better. In addition, they may be more psychologically vulnerable to nicotine addiction or the allure of tobacco advertising.

There are a growing number of studies that suggest that mental illness, including common conditions such as Anxiety Disorders and depression, can actually be caused by smoking. For example, a University of Cincinnati study of 8,704 teenagers found that mentally healthy teenagers who start smoking are four times more likely to develop depression than their nonsmoking peers.

Harvard University researchers studied cigarette smoking and mental health in 4,500 adolescents and adults. Mentally healthy teenagers who smoked at least one pack a day had a:

  • Sixteen times greater risk of developing panic attacks.
  • Seven times greater risk of developing serious phobias.
  • Five times greater risk of Anxiety attacks.

How could cigarette smoking cause mental illness? Experts don’t know. There are several plausible theories, including:

  • Nicotine and other chemicals in cigarette smoke may damage or change the normal activity of brain cells. 
  • Nicotine and high levels of carbon monoxide in cigarette smoke work together to cause symptoms of psychological illness.
  • Nicotine’s stimulant action keeps smokers in a state of heightened alertness similar to the “fight or flight” response. People in this state are more likely to overreact to body sensations and situations in the environment.
  • Carbon monoxide may cause breathing disorders responsible for one sensation — a false sense of suffocation — that triggers many panic attacks. One panic attack then engenders fear of others and the avoidance of triggering situations, and causes changes in behavior.

In summary

Smoking and mental illness: chicken and egg?

Whether smoking is the chicken or the egg, its association with mental illness cannot be denied. Those with mental illnesses are more likely to smoke and smoke more than those without a mental illness. Smokers have more mental illnesses, particularly the common ones such as Anxiety Disorders and depression.

Although it is much harder for a person with a mental illness to quit smoking, the reasons are all the more compelling: accelerated susceptibility to diabetes, heart disease and strokes; and the fact that smoking reduces and/or changes the effectiveness of psychiatric medications.

What do you think?

Uncomfortable truths

This article was difficult to write, because it tells some uncomfortable truths about smoking and mental illness. I am a smoker who took up the habit as a teenager, long before I was diagnosed with any mental illnesses. In retrospect, I was already having symptoms when I started smoking, but it is possible that smoking caused these and other symptoms to become worse. 

I have learned that I have what I call “an addictive personality,” so I gave up drinking alcohol a number of years back because it was beginning to become intrusive in my life. But I have not been able to give up my smoking addiction despite numerous attempts, both with and without medication. I know it’s just a matter of time before I will be forced to give up smoking for one reason or another, yet I find quitting as hard as anything I have ever done in my life.

  • Are you a smoker? Do you have any of the more common mental illnesses?
  • Do you smoke more than a person without a mental disorder?
  • Have you quit smoking? Will you share your experience or advice?

As always, your comments are welcome!

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Resources used in this post:

Arehart-Treichel, Joan. (2003, October 3). Smoking and Mental Illness: Which One’s the Chicken? Retrieved October 9, 2008 from Psychiatric News Web site:

Centers for Disease Control and Prevention. (2006, October 27). Tobacco Use Among Adults — United States, 2005. Retrieved October 13, 2008 from Centers for Disease Control and Prevention Web site:

el-Guebaly, N.; Cathcart, J.; Currie, S.; Brown, D.; Gloster, S. (2002). Smoking Cessation Approaches for Persons With Mental Illness or Addictive Disorders. Retrieved October 9, 2008 from Psychiatric Services (American Psychiatric Association) Web site:

National Business Review. (2008, October 8). Those with mental illness smoke four times more than average. Retrieved October 9, 2008 from National Business Review Web site:

Nauert, Rick. (2008, October 9). Smoking Accompanies Mental Illness. Retrieved October 9, 2008 from Psych Central Web site:

Rethink. (2008). Smoking and Mental Illness. Retrieved October 9, 2008 from eNotAlone Web site:

Schmitz, N.; Kruse, J.; Kugler, J. (2003, September). Disabilities, Quality of Life, and Mental Disorders Associated with Smoking and Nicotine Dependence. Retrieved October 10, 2008 from American Journal of Psychiatry Web site:

Woods, Michael. (2002, May 20). Studies: Smoking may be a cause of mental illness. Retrieved October 9, 2008 from Toledo Blade Web site:

{ 50 comments… read them below or add one }

Kim Woodbridge
October 14, 2008 at 10:42 pm

I have never read that smoking can cause anxiety disorders – but do you think the person may have already been predisposed to the illness, which caused him to start smoking in the first place?

Woops – I asked in another article if you were a smoker and now find my question answered.

Really informative Mike – keep up the great work!


Mike October 20, 2008 at 4:39 pm

Thanks again, Kim, for the comment and the complement!

My belief is that people are predisposed to mental illnesses by genetics, upbringing, personality and environment. The exact mix of these varies by the mental illness and the person, but each of these factors is always there. And the triggers for mental illness varies by the person, as well; to be predisposed doesn’t mean a person will always develop the disorder.

I don’t know the percentage of teens and others who try out smoking, only the percentage that go on to become smokers. But I think that those who do continue either find some “benefit” (Part 1) for an existing mental illness or make themselves vulnerable to the effects smoking has on one’s mental health.

The research on smoking and mental health is in its infancy. However, there is a great deal of research going on at this moment, so I expect to be able to report some more findings soon.


Tim October 20, 2008 at 9:06 pm

I am again overwhelmed by the volume and quality of information on this site. I am fascinated by the current topic. As we move from the “here – take this” medical model to a more holistic approach, this is certainly an area that needs attention. Its a hard sell in my practice, trying to get folks to think beyond the prescription to the lifestyle.
Shine the light,


Mike October 20, 2008 at 9:20 pm

Thank you, Tim, for your complements! [full disclosure: Tim's my brother!]

I think that the holistic approach to health is a change that’s coming, based not only on the buzz, but on the health plans of both Presidential candidates. It will be a real shift for most people, who are used to getting a prescription for what ails them and that’s that.

But to make any real advances in the health of our country, the holistic approach is the only way to go. That being said, I think it will be a long time before we see it as a way of life for our fellow citizens — old habits die hard!


kathy October 28, 2008 at 6:35 am

Hello, I enjoyed reading, tho I havent read all thats on here, I really wanted to just add my own thoughts, for I have been working on quitting smoking cigarettes an have been successful for One Month, Tho I guess you could say I cheat alittle, I started smoking, Legal weed, Herb, its different from tobacco, so ya still want a cigarette,for an Old time smoker, its miserable to quit, so, now I can enjoy Not smoking cigarettes an still smoke a few puffs a day of Herbal smoke with my evening coffee,an a hit or two during the day.
anything can become an addiction, so ya have to learn control an moderation, but herb smoke isnt as addicting as tobacco, just thought you might want to try it, Im thrilled to be ridding my cigarette habbit, and still havin the pleasure of smoking a few hits,you might want to try it, it might be your ticket to quitting :) thanx, kathy


Mike October 28, 2008 at 8:12 am

Thank you for your comment, Kathy. And thank you for the suggestion.

One of my friends once commented, “It’s easier to be abstinent than abstemious.” In other words, it’s easier to quit entirely than to cut back. In my case, I know that’ s true. I’ve tried gradually cutting back, smoking a pipe, and a host of other things, but obviously none of them worked. I’m just going to have to get up the will and courage and quit entirely. I don’t look forward to it!


Sherri November 12, 2008 at 1:48 pm

I read your article today after searching for help for myself. I used to be a smoker of 20 years. I came from a family of heavy, heavy smokers. Everyone in my family smokes. I have severe mental illness’s, have had them all of my life. But I do not take medication. Used to, but don’t anymore.

I’ve been smoke free for about 6 months now and today, feels like the second day when I tried to quit. I want a cigerette so badly today. Why? Because I’ve been so stressed out lately, seeing things, having intense phobia’s, anxiety… ect..

I almost feel, at this point, that smoking might be better then living a life everyday where it’s just impossible to think, or concentrate. Living everyday with a fog, seeing things again, hearing things again. I think most mentally ill smoke to keep them straight and self medicate. I know when I was smoking, I was able to handle life better…


Mike November 12, 2008 at 3:20 pm

Thank you for your comment, Sherri!

I’m sorry you are having such a rough time. But you’ve taken a big step that I haven’t — quitting smoking. As you say, a lot of people self-medicate with cigarettes, getting doubly hooked by the physical nicotine addiction and the psychological benefits. I admire your ability to stick with it for six months!

I urge you to seek some help from a mental health professional. There’s no need for you to suffer like you are from the symptoms of your mental illness. With the appropriate medication and/or therapy, you can have some relief from your symptoms.

Let me know how you are doing. You can use the “contact” form and correspond by email if you wish.


Sherri November 12, 2008 at 3:42 pm

I would seek help from a Mental Health Professional, but that would mean most likely being put on some sort of medication. A few years back I had a problem with a medication that eventually was recalled and have since spent thousands of dollars to fix my teeth because of it. (The medication started with a “Z”, can’t think of the exact name of it now, but it was recalled because it caused extreme enamal errosion to your teeth and was also found to cause liver funtioning problems.)

I also feel that if I’m going to be taking medication for my mental illness’s, the end result will most likely hurt some organ in my body eventually from long term use. And if that’s the case, it wouldn’t matter if I smoke or not as either way, I’m doing something harmful to my body.

Like most others who self medicate, I have good days and bad days. My Mental Illness’s are: Personality Disorder, Anger Disorder, Bipolar Disorder, PTS Disorder and Schizophrenia.

For the most part I’ve learned to cope on my own, without medication, illegal drugs, alcohol and now, smoking. I just take life one day at a time, and sometimes, one minute at a time.

I also have a blog on a Body Modification Website:, that helps alot. Although most people there do not understand my illness, it helps to get it out and vent. (I also have 85% of my body covered in Tattoo’s. So that might be part of my “Self medication”).


Mike November 12, 2008 at 8:19 pm

Sherri, the choice to take medication is always yours. Have you tried talk therapy? Therapy can be very effective without medication, and can give you the tools to manage and control your symptoms.

Although I take medications for my mental illness, I think therapy has done the most for me in learning to live with my symptoms day-to-day. If I had to give up one or the other, I’d give up the drugs. I really admire how you’ve been able to get along on your own!

This site, too, is a form of therapy for me. I don’t vent personally, but it does me good to try to help others that are going through what I’ve experienced. It keeps reminding me that there are a whole lot of people out there who have a much more legitimate right to complain than I do!


Eric December 7, 2008 at 7:37 pm

Hello Mike, I left you a comment on the part 1 page, I’m a 33 year smoker with a 1 1/2 year quit and 45 years old. When I read Sherri’s posts it hit home. Sounds like I could have wrote that if I knew how to write. Very nicely put Sherri, I’m with you, only I have only about 20% tats(upper arms and chest)and just general anxiety disorder.

That said, I’m still on the fence about starting to smoke again. I would like to start smoking to find out if it will reign in my mental issues, but, I’m afraid I don’t have another quit in me. Again the question is…… Mental health now or possible smoking related illness later..

I don’t feel it as intense as Sherri, but, I feel an unknown physical craving for something that’s missing. I can’t say that the crave is for a smoke, but, for something that I can’t put my finger on. Maybe from one of chemicals in cigs, I don’t know!!!! I get relieve from the crave when eating or chewing gum, but, it doesn’t feel like the original crave early in my quit. It seems to be something that I can’t satisfy.

Sherri, do you think you will smoke again in an effort to get some relief from the mental problems???? Best of luck to all and thank you for sharing…….. Eric


Mike December 8, 2008 at 4:48 pm

As I mentioned to Sherri and to you in my reply to your comments in Part 1, I believe that you would benefit from therapy or counseling. I urge you to try therapy rather than counseling, though it might take longer. It can equip you to deal with your Anxiety without having to take drugs, and give you the tools to cope long-term.

I congratulate you on your quitting smoking and staying quit. I recommend doing everything you can to keep from starting back again. I believe there is help out there for you that can relieve your Anxiety symptoms!


Eric December 8, 2008 at 9:56 pm

Mike, I’l just stick to the first page you linked. Thanks Eric


Sherri December 9, 2008 at 9:13 am

Eric, I always had in the back of my mind this idea that going back to smoking would be like in the old Hollywood movies, this glorious event that would change my entire life. And I always fought with myself over that.

But this weekend proved that wrong. I had a complete mental breakdown this weekend. Horrible things happened one after another (Think bad country and western song.. dog running away, truck breaking down.) It was to much and as I was standing with my brother in the parking lot of a middle american Mall, I said to him, “Give me a fucking cigerette”. (Pardon the language). He handed me one, I put it in my mouth, lit it and proceeded to die. The smoke entering my lungs felt like somebody stepped on my chest. It was so unpleasent, I coughed and hacked. I got all light headed and felt like I was going to pass out. (Think that first morning cigerette you had after a long night of sleeping and the rush you sometimes felt from the nicotene going back into your system and multiply that by X300).

All the glamour, all the relief I’d envisioned, were gone. I instantly felt sick, put the cigerette out and handed it back to my brother. I thanked him for giving it to me, because now I know, I won’t ever be a smoker again.

I thought like you did as well, Mental Illness now or Smoking Related Illness later? I struggled with that. But now I can honestly say, I personally, have to find another way to deal with my mental illness because smoking, isn’t an answer for me anymore.


Eric December 9, 2008 at 6:31 pm

Sherri, I’m sorry for your break down and kudos to you that you were able to get through it. You sound like you have a great spirit and sense of humor.I hope that you will be able to find relief for the problems you have and like you said you can cross smoking off your list. The positive side (if there is one) of this is that you have narrowed the list (smoking)of possible treatments toward your mental health. This is probably one of the best to throw out in regard to overall health. I’m really curious to see if your craves will cease now that seem to have put smoking to bed.

I think in my case that quitting smoking was the trigger to my anxiety or quitting uncovered the underlying anxiety which smoking was successfully treating. Or it could all be non-sense and I developed anxiety right after I stopped smoking. Problem is that neither I nor science have a clue which and I’m trying to figure out a way to stay quit and get mentally healthy. Thanks for your reply and best of luck with your struggle. Eric


Mike December 10, 2008 at 3:21 am

@Sherri – Congratulations! It’s really good to hear that you are staying quit, and that smoking is entirely out of the equation for you.
@Eric – It’s unfortunate that the state of research is a bunch of hunches and maybe’s, and not anything that we can sink our teeth into. It helps me to remember that a lot of research in this area is going on, and that there will be real answers someday.


Sammy January 8, 2009 at 10:54 pm

Hi Mike,

I came across your site while looking for some info which would help me cope with the psychological effects of stopping smoking. I haven’t smoked for three weeks now and I’m sincerely hoping I can stay stopped. I’m not diagnosed with mental illness although I have had a couple of fairly short bursts of again fairly mild (if you can ever call it that!) depression but I feel that smoking had a severe affect on my life both physically and psychologically. I was a non smoker until my mid thirties but then stupidly took it up during a period of stress – so I only smoked for 5 years – but what an effect it had. I feel like I turned from a fairly optimistic and definately very zestful energetic and healthy person to a physical wreck – I became severely asthmatic, legs like blocks of lead climbing short flights of stairs and often needing a rest and my inhaler going from room to room around the house. But the worse thing was I no-longer cared about my health and these obvious severe physical effects of smoking. Additionally I became emotionally detached to most aspects of life – friends, family, partner and completely lost all ambition. Even though I didn’t smoke all the time (20 or so a day) – my life still seemed to revolve around it and opportunites to smoke – I feel like I became a smoking machine. I knew this was happening at the time – but as I say didn’t care less – it was like being in self-destruct mode. Eventually I felt so ill with so many symptoms I thought I must have cancer and was going to die – although I still didn’t really care enough. Eventually I saw the Dr and following blood tests which gave me the all clear on that front – I felt I should give up because at least I knew then that I had just been given a clean bill of health on that front. In the end it was only really a period of financial difficulty following quitting a stressful job that made me stop. All that said I now feel a bit traumatised and shocked by all that has happened. Its like coming out of the grip of something very powerful and for me very destructive…. but it also feels scary that I am starting to feel again – becoming emotionally reattached and having to deal with caring and being sensitive to life again and all its inevitable difficulties. Sorry to go on so much but it is a release to say all this. I guess it will take time and I will have to learn to deal with life without cigarettes – but thankyou for having a post that discusses the psychological effects of smoking – I guess I had a severe reaction to smoking which is not dealt with on most websites.


Sean February 6, 2009 at 12:49 am

Really -here we are. We have terrifying and and disabling mental illness. Quitting smoking -how many of us are happier? Has anyone told you what is most precious in life? It’s hard to put into words. I would love to be a non-smoker. I really would like to feel the healthy freshness I would have in my breathing. And yet what is the cost? I would have fresh breath, but would I be happier? Would I be mentally and emotionally healthier? Non of this can really happen for someone who is inclined to smoke. smoking comes about much like mental illness or any other activity we manifest. We are naturally inclined and that inclination shapes us into an active individual with that.

Your most precious thing is your identity, not the one we assume, but the one that defines our greatest happiness. There is no substitute for nicotine. True smoking is a habit, but the nicotine itself, as you put it Mark, is therepeutic in a very wonderful way. Especially suited to our condition.

More and more from self examination and listening and reading others, I find we’re not so much concerned with health matters in wanting to quit, but a false sense of shame and wanting to please the pundits. Not from any pesonal wish, nothing from a reliable rationale.

Be happy, Take Peace!

One important note Mark outlined in the con’s part 2 is the impact of smoking on our medication. I’m depressive and schizo. and I was having real trouble with symptoms , smoking heavily trying to asjust to my family after all these years away, and adjusting to the new environment of this wonderful but unfamiliar town I’ve come to live in.

But I set rules for my smoking. Never smoke more than two cigarettes in a row and such. Drink less coffee. We all know how coffee and cigs go together. I have started drinking tea more in the day.

I also found that I had to eat several times a day. I eat small portions. I was losing weight and instead of eating I was smoking and drinking coffee. This is some thing so many of us have gotten in the habit.

Eating, counting my cigarettes. and trading coffe for more tea -I cut my smoking by a 1/3 in two days and half of that in a week. i relapsed recently. but I got back to it by the same 3 things and now I smoke less than “a pack a day” ( I roll at home, and smoke filters when I’m out -American Spirit -about a pack of them a week )

I know from experience that Untreated Tobacco is far healthier, more satisfying and less craving then the doctored tobacco. It realy is the only solution. So I reccommend learning to roll your own.

Place a modest amount in a creased cigarette paper. Make a little less tobacco in the center. this will make it roll evenly. Roll it up and down with your thumbs pointing up, until it’s firm. Now turn a little twist and catch the lewer edge of the paper under the one facing you. Catch it and carefully roll the cigarette right up. Be careful not to lick the gum to heavily or you will rip the paper.

Reading at first seems complex but follow the steps and you will be surprised (as I was ) how simple it becomes almost immediately. and especially you’ll be surprised at what a nice looking cigarette you roll -almost every time.

Castles in the Air -is our worst curse. Especially as we are more or less impaired rationally or cognitivley. Really if you’re a smoker. Smoke. Nothing is more natural.

A Caveat -Marijauna is invariably the greatest drug hazard to your mental and emotional health and well-being. At least for people with my condition. We just can’t hang out with those people in private. Sad But True. ThnQ ~Sean


Sean February 6, 2009 at 12:53 am

Hi. I’m sorry I got lost in the rolling instructions. I am in remission , non-delusional and only have mild symptoms. I am rarely incapacitated with my fear. this is according to my good doctor. Good luck with it. Sean


Gogi March 11, 2009 at 7:06 am

Smoking isn’t good for mental illness because not enough oxygen is delivered into the brains, so they can’t regenerate as they should. This is just one cause, there haven’t been exact studies for hunderds of ingredients that one ciggarette has in itself. I was having anxiety and OCD for 2 years, but when i stopped smoking and started running instead every morning, i was surprised that my anxiety and OCD really changed, after a month when i stopped smoking. Doing some more research lately i found that if you stop smoking, your anxiety diminishes because ciggarette releases lots of adrenaline and that keeps you tensed and not-relaxed, anxious, so you keep smoking because of that feeling, adrenalin levels are high all the time so you’re trapped in vicious circle all the time.

It’s worth to try! It helped me with anxiety A LOT.

Goog luck and best wishes everyone!

Gogi =)


TSB April 3, 2009 at 7:53 am

One thing I have noticed is lumping everyone mentally ill together. Someone with mild clinical depression controlled by a good anti-depressant is not in the same class as someone like me with full-blown BPD and numerous social phobias added on top. Throw in some panic attacks and unrelated chronic pain caused by a car accident about 15 years ago that has left me basically disabled, and I think the situation is not exactly the same. My doctors have all told me that smoking is bad, but I would be better off smoking and adding exercise, better diet, and more social activities than to quit smoking and lead the same lifestyle I currently do. Thoughts? Because every time I have tried to quit I have been reduced to a quivering, insane almost psychopath with complete inability to focus on anything. Cutting down is always easy, last time I went from 3 packs a day to 2 cigarettes a day within a week with no problem, but I have to concentrate on not smoking and as soon as I think about anything else, I am back smoking more again. Anyone else have thoughts on ease of quitting for people with less mental issues versus people that are much worse off?


Sean Alan Romanek April 4, 2009 at 1:43 pm

I’m glad to see someone with my attitude for smoking. and I really agree that those severely disabled are in another smoker cateegory from those who are less mental. I think what I would note is that people capable of powerful acts of will tend to run their life that way -and insuing are pretty miserable with themselves. all the really great men and woman I’ve known have some sort of casual relaxation -many smoke. Think about it.


Rob Becerra April 6, 2009 at 11:35 am

I suffer from depression and general anxiety disorder. I am a heavy smoker and in the past year have quit twice for about 60 days each time. During cessation, my anxiety symptoms improved dramatically as did my depression. I have no doubt that smoking exacerbates my symptoms.


Alan Selk September 19, 2009 at 5:17 pm

I ran across this article when researching smoking and mental illness. Interesting read, in particular the comments. Glad to see it isn’t dominated by anti-tobacco/nicotine fanatics.

I have been self-medicating with nicotine for ADD for more years then I care to think about. The few times I managed to quit I was a mess within weeks. In three months time close friends of mine, who for years urged me to quit, suggested I may want to start smoking again. It was that bad. After starting smoking again I was back to normal within hours.

There’s clearly more going on here then many people would have use believe.

The good news is that after doing more research I discovered a tobacco product that satisfies my cravings, and my ADD, with greatly reduced harm. I’m using Swedish style snus, and was able to quit smoking within weeks of trying it. I’ve been off cigarettes for 5 months, the longest I’ve been able to quit in nearly 40 years.

The whole concept of reduced harm tobacco should be looked into by both health professionals and the public at large. There is no reason that an addiction to nicotine has to lead to the health problems associated with smoking. A basic tenet of reduced harm is that nicotine is not the killer, it’s the smoke.


Eric September 20, 2009 at 12:12 pm

Hey Mike, Anything new???? Are you ok???


John June 7, 2010 at 2:14 pm

I only started smoking about 5 months ago and quite a few weeks back. I know I already had issues with anxiety and depression and everytime I touched a cigarette it made it a lot worse, its like all the symptoms went into high gear and after a cigarette I’d feel totally stressed out and depressed. Smoking seems to make previous issues much worse, at least thats what it did for me. I won’t touch them again, feel much better and calmer now.


Sherri June 7, 2010 at 3:27 pm

Here I am 2 years later after posting the initial response to your article yet again, a smoker. I gave it the best effort I could for over 3 years and just could not seem to overcome the mental effects of quitting.

Couldn’t focus, couldn’t make a single simple decision no matter what it was. Felt depressed, full of anxiety. Angry, Paranoid, easily upset and completely unhappy and sad about every aspect of my life.

During my whole phase of 3 years of not smoking I gave it a good go. I moved into a larger, nicer house. Became more financially secure, worked on my relationship with a passion and tried to find new hobbies and intrests I enjoyed. But I still felt “Not Me”.

After a long debate I quit quitting. It’s my new program to make me feel better. I don’t take any medication and haven’t for well over 10 years now. The only side effects of smoking I now suffer are occasional migranes and headaches.

But the most important thing I think I gained from smoking is being able to think clearly, being more decisive and a calmer me. I don’t think quitting was a good idea for me on a personal and mental level and I think when I quit, it was actually more life threatening to me mentally then smoking is to me physically.


Eric June 8, 2010 at 9:22 am

Hello Sherri, Thanks for the update. I’m still a non-smoker and struggling. I, like you , am at the 3 year mark as a non smoker. Again, a lot of what you describe is what I feel. The anxiety and a kind of disconnected unsatisfied foggy feeling is the worst. My Doctor tells me it’s my “inner junkie” screwing with me, but I don’t think so after 3 years. I’m not making it up, but I’ve had the worst 3 years of my life from a mental and physical health point of view, I’ve tried waiting it out with the mantra that it took 30 years to get here smoking and I should give it time. I don’t obsess over the smoking thing much at all, when I try to figure out why I feel poorly overall it always comes up. Besides aging, the only change that I can think of is quitting smoking, I thought I would feel great after quitting. I’m at the Doctor every few months with something new and even asked him ” how many things can one guy have wrong with him”??? I know anxiety can tear you up physically and that could be part of my problem. I only started getting anxiety 3 months after quitting. My fear is that if I start again I will be the same as I am now, but be smoking again. I really don’t want to smoke, it’s nice not having to live my life scheming/planning my next cig, but I hate the thought of living the time I have left with this struggle if smoking will alleviate it. The question still seems to be ……….mental health and peace now(if smoking is the cause) or smoking related physical problems later. Of course one could argue that no medical issues could arise and you should live for today and all that jazz, but the truth is most of us smokers will have illness.

Sherry, How do you feel now??? How long have you been back smoking??? Do you have guilt about smoking again or are you at peace with your decision???

Mike, I hope you’re ok………where are you????

Thanks to all who contribute here!!!!! Eric


Sherri June 8, 2010 at 10:22 am

You could replace your name with mine in what you wrote there Eric, I felt the same way and always said the same mantra in my own head about staying quit. But much like you, after 3 years, I literally just threw my hands up. I mean, after so long of not smoking and still feeling the way I felt a week after I quit was just to much for me. So much pressure is put on people that smoke in general society, but nobody says anything to the guy that’s beating his wife because he’s been an alcoholic for 30 years.

I feel fantastic now. I made peace with myself that I gave it a good go and although I don’t consider it a failure, I consider it a learning experience for sure.

I’ve been back to smoking now for about a month. I have no guilt about it anymore. I feel that in this world everyone has some type of physical or mental illness and while most people go to a doctor and take medication, my form of medication is smoking. It keeps me clear headed, thwarts off any anxiety I might have and just makes me feel more well rounded as a person. I’m able to make decisions easier and my thinking has become clearer.

The day I decieded to Quit Quitting, I promptly went down to the store, bought a pack of cigerettes, came home and smoked one. Within minutes of smoking it I felt like my old self. I went into the house so clear headed and focused that I spent the next 2 hours finishing up a chapter in my book that had been sitting for 3 years.

I thought about it this way Eric, and in no way, shape or form am I trying to justify my own personal reasons for going back to smoking, it’s just the truth. But I thought to myself, you know all medications have their side effects. Some cause Liver damage, some damage vital organs over long term use, some have ill effects like nausea and headaches and if I’m going to suffer some type of long term damage or side effects for any form of medication, I’d rather be able to pick the one that fits me best. Besides that and not having insurance, smoking for me is the cheapest form of self medication in the long run honestly.

Yeah, I might die of lung cancer, sure I may have complications when I’m 80, but I live in Florida, and most people who are 80 years old, regardless of whether their a smoker or not, have some form of health problems.

Like I said though, with the world the way it is today between Cadmium in McDonalds toys to the air you breath, to mold that might be in your house or medication that has side effects or long term effects, eventually we’ll all die or be afflicted with something. Regardless of how healthy or unhealthy you live your life.

At the end of it all, I know I feel at peace with my decision and it was the best decision I could make for me. You just have to figure out what your decision is for yourself.


sumankumarsingh September 13, 2010 at 1:26 pm

i am the patient of phobic anxiety since last 12 years and also a smoker please suggest what i should do?


Jack Rivers July 13, 2011 at 8:44 pm

Illness came first… Smoking was next. I’m ill now. I was never ill when I smoked; just somewhat shy most probably due to the experiences I had growing up causing low self esteem.

I’ve given up one year of my life. I don’t know what to say or do anymore; my youth is going to slip away if I’m not careful. The last thing I want to find out is that I’m still the same in 40 years time.

My opinion is this: all you need is love. Do whatever makes you happy…


vin July 17, 2011 at 7:42 pm

Im 30 years old and i suffer from panic,anxiety,and depression ever since i was a child.the past 8 years ive been taking light medication,antidepressants and a sleeping pill every now and then when needed.smoking and alcohol definetly enhances my anxiety and panic disorders,trust me.i advise that people that have this illness should stay away from cigarretes,cafeine,alcohol,and illegal the same time take medication,it has helped me very much!!


John July 17, 2011 at 7:46 pm

Hi Vin, just saw your message pop up. I couldn’t agree with your more about the smoking and alcohol. I suffer from OCD & depression. One cigarette is enough to set off the OCD symptoms and anxiety. I went and had therapy some years ago but I gotta be carefull, if I go on the binge over a weekend, I suffer incredibly scary anxiety and depression for days and days afterward. Avoid alcohol and smoking, they only make things worse!!


vin July 18, 2011 at 1:23 pm

Yes i know exactly how you feel john.sometimes i feel like im dying,really scary stuff.i have been smoking since 17 years old.sometimes i quit for a while,and trust me i feel so much better.people like us have to keep a clear mind and a healthy body.we have to let our body and brain oxygenate,and smoking doesnt help our body to get well eat healthy excersize ur mind and body and keep yourself busy.keep ur dick up and think positive and also dont take things too serious!!


chloe January 19, 2012 at 4:11 am

Hi Mike.

Wow! This 2 part article not only blew my mind, but has made me really want to quite smoking. I am young, but I started smoking last May, and went through a 20 pack every 2-3 days. It had helped with my mood, I had just started college and it definitely helped me socially. I have been trying to quite since about Christmas but have been finding it hard, the motivation was not fully there. For some reason I, like many others, have shaken off the threat of Cancer as if it was nothing. Reading this article has really opened my eyes and put a healthy fear in me.
Thanks so much for sharing this.
I’ll be keeping it on my desktop to read over in my moments of weakness.


Jan April 20, 2012 at 12:09 pm

A different viewpoint based on 20 years of experience with mental illness and the medications:

1) Smoking is used as the stress/anxiety release caused by most of the meds given for a mental illness and also for people without a mental illness.
2) Certain medications given actually cause one to start smoking which becomes an addiction very quickly. A craving/need develops.
3) Fact, no longer has asthma while taking certain psychotrophic med, but causes smoking.
4) Fact, smoking does decrease the effectiveness of the medication and higher dosages are required depending on smoking intake.
5) What is in the drug that prevents asthma, yet causes smoking??
6) Medications given to individuals are a major problem since no person’s chemistry is the same. There are too many assumptions made that are unproven on how one metabolizes drugs.
7) A negative in smoking, yet a positive for preventing asthma. This is one example of one med.
8) The molecular formulas need to be evaluated and the results that have the positives retrieved and a new drug developed. Example: one drug can give one focus; another, calmness; another, energy, etc. Take the combination and put them in one drug only. Sounds simple, no, but it is a start on taking the old drugs and new drugs used today and simplifying the process of trying to correct the chemical imbalances which we today call mental illness.
9) Fact, none of us are perfect and a chemical imbalance can happen to any of us at anytime. Treating mental illness as a chemical imbalance might help people understand it better. The functions of the neurotransmitters in our head need to be better understood by all people and most of us need to be educated because there is fear and too many misunderstandings in this area. We need to educate at a very young age so ignorance is eliminated. Prevention, preparation, and progress are key factors in eliminating ignorance and fear. The biggest step in overcoming a chemical imbalance/mental illness is acceptance. Our society shames those who do not meet their expectations and that is our downfall in so many areas. We accept heart disease, cancer, diabetes, etc., as normal and stigmitize other illnesses as degrading.


Case May 16, 2012 at 1:30 pm

I live with GAD and quit smoking about 6 weeks ago. Within a couple of weeks I immediately noticed a difference in my anxiety levels… Nicotine causes an elevated heart rate- double that of a non smoker- a faster heart rate would make anyone more agitated right!?

I am positive cigarette smoking has exasperated by GAD over the years.


kgb909 May 30, 2012 at 6:08 pm

Am 50 years old. Quit smoking again 4 months ago. This time, the anxiety, anger and depression are much worse than ever before. Of course, I took antidepressants from 1992 through March 2011. That may have kept me from noticing the mental health issues other times I’ve quit. Problem is that when I’m smoking, I constantly have bronchitis. Now they call is bronchiectisus because of the damage the constant bronchitis has done to my lungs.
I’ve tried a number of different medicines since I quit to alleviate the anxiety, etc, but the nothing has helped. I really don’t want to go back on SSRIs but starting to smoke again just isn’t an option if I want to breathe.
I can relate to many of you who posted here. I have ADD and a panic disorder, but I don’t remember ever being this anxious or depressed since ’92 when I started on the SSRIs. I hate what they (SSRIs) do to me. They make everything just middle of the road. Nothing is great and nothing is r eal bad. Not to mention the permanant damage they do to internal organs, but I really don’t see many other options.
Any ideas??? I’d appreciate any opinions.


bippin June 30, 2012 at 7:36 am

I stopped smoking and drinking since 3 years and never will I smoke and drink alcohol again. But I have had some psychological problems. I am sorting this now. Contact me.


Lori October 13, 2012 at 10:53 pm

I have had OCD since I was young and have been a smoker since I was 14. I did quit once for 4 years. The first year was horrible! My OCD grew out of control and I had to start taking an ssri to control it. It was very scary. I’ve often wondered if the nicotine was doing something to the serotonin and dopamine receptors while I was smoking and when I quit my brain just went bonkers. I have started smoking again but plan to quit again. I’m hoping that because I am still taking the ssri that this time will be easier. I googled to see if there was a possibility that I may be onto something with my thoughts on nicotine causing mental illness and was directed here. Thanks for this :)



Lynn December 19, 2012 at 10:19 pm

Hi, I am 52 and had been a smoker for 32 years. Never attempted to quit. This past April I had a lung abscess. They don’t know what caused it, but I quit smoking immediately after my hospital stay.

I suffer from Generalized Anxiety Disorder. Two months after quitting, I slipped into a deep depression for 5 months. I could hardly talk to people or leave the house. I am finally starting to feel better, but still crave cigarettes daily. My anxiety has increased to the point that I can hardly do anything. I am on every possible medication to help with the anxiety and depression.

As I said, I’ve always suffered anxiety, but this time, I don’t have my friend the cigarette. Starting with a cognitive therapist in a couple of weeks. Hope that helps. Never thought I’d be smoke free.

Good luck to everyone.


Sol December 20, 2012 at 5:49 am

I found your article very interesting and I totally agree with the link between smoking and mental health. Yes one may have an underlying disorder/illness but from experience smoking has made it worse, infact I would say smoking js the main contributor in flaring up my anxiety and panick attacks yet I find it very difficult to quit, a viscous circle most definitely.
However, after reading your article I am attempting to try and quit but this when I think of a cigarette I will also think about the panick attacks and all the unpleasant feelings I get.
Thanks your article was very good.


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Marsha Blair February 11, 2013 at 1:19 pm

I have quit smoking and just about at the 4 week mark. Well, so much material on smoking, what it does, blah, blah.

However, I noticed that one of the best results of quitting is that general anxiety and depression (mostly from fatigue) have lifted. I did a search of “smoking and anxiety” and here is your site.

After smoking about 12 years I had some vague sense that smoking a pack a day was keeping my nervous system continually jacked up and just felt “frayed” all the time. Of course, then there was the worry and quick to escalate under stress.

So thank you for this article, there doesn’t seem to be alot about it in main stream information, it does, however, confirm what I have experienced in quitting.

I have far less worry and anxiety and more energy (less despression).



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sanya August 12, 2013 at 8:26 pm

anxiety condition, as well as emotional depression (which is different from clinical depression) are not mental illnesses!! Shame on you


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Christina May 30, 2014 at 10:58 am

I developed panic disorder about 10 years ago… depression and heavy drinking/ recreational drugs years before that. I smoked for 20 years. Predisposition to mental disorders and “addictive personalities” go hand in hand. I quit smoking regular cigarettes 3 days ago- smoking a very light e-cig right now to wean myself off. Cheating, yes. Easier this way? Absolutely. I don’t know if it is the chemicals in cigarettes or the peace of mind that I am finally doing it, but I have a calmness that I haven’t felt in years. The sunsets are more amazing (not being metaphorical here, I actually “feel” them again), my children aren’t annoying me as much, and I have an “easy come” and “easy go” attitude again… the part of me I missed since before my panic attacks began. No meds… just exercise, healthy eating, and now 72 hours of tobacco free! Definitely a correlation, even if just the power of the mind.


Lisa August 8, 2014 at 8:26 pm

I enjoyed this article very much as I am a sufferer of anxiety and panic attacks. I’m not really sure what came first, the smoking or the anxiety, because I started smoking when I was very young (12 years old).
I did have a few panic attacks, starting from when I could first remember 4-5 years old. Of course at that age, I didn’t know what they were and assumed that something was physically wrong with me. The bigger problems started when I was around 12 years old and smoking.
Anyway, I tried to quit a few times previously (one time lasting 4 months), but I always went back to it due to my mental status. I never felt good emotionally and I sunk into deep depression each time.
Now I’m on my most recent attempt to quit. It has been a little over 3 months and out of the blue I’ve started getting panic attacks like I did when I was a kid. The quitting process wasn’t too bad as I used the nicotine patches and psychologically that pulled me through. I’ve been off them for 5 weeks though and I can see what a powerful effect nicotine had on my anxiety levels!
I think that I have been self medicating my anxiety with cigarettes for all these years. Now the nicotine is gone and everything is roaring back. I don’t want to start smoking again obviously and I don’t want to start taking medication either. That leaves me in quite a bind!


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