Schizophrenia and Smoking
In my last post, I discussed some of the changes in lifestyle that can help improve the heart health of people with schizophrenia. I'd like to continue my discussion about one particular area, smoking. Some research has shown that people with schizophrenia smoke almost twice as much as the population in general. Depending on what research you look at between 50 and 70% of people with schizophrenia smoke compared to the national average of about 30%. While this is a problem because of the many consequences to health overall, there are some specific concerns for people with schizophrenia and other people with psychotic disorders.
Smoking has been implicated in many disease processes including lung cancer, strokes, and heart disease but one affect of smoking that is not discussed as much is the effect of smoking and specifically nicotine on medications people take. It's been known for decades that nicotine affects how the body processes many different medications. Smoking stimulates certain enzymes in the liver, and this can cause a wide range of effects.
For people taking antipsychotic medication, there has been research that's shown that smoking can affect how the body processes these medications. Smokers taking antipsychotic medications tend to require higher dosages than nonsmokers. Smoking tends to reduce blood levels of certain antipsychotic medications and abrupt discontinuation can causes levels to rise again. For example, studies of patients who smoked who were taking haloperidol or clozapine had lower plasma levels than non smokers. There is also some evidence that people taking antipsychotic medications tend to have more side effects if they smoke. Some research shows that drowsiness tends to be worse when patients are smoking while taking antipsychotic medication.
It's been my experience that many people with schizophrenia who smoke do want to quit, but their physicians don't talk to them about quitting. We live in an era in which there are many different treatments to help people quit smoking. Research shows that combination therapy improves the chances of quitting. A smoking cessation support group or talk therapy, nicotine replacement, and a medication to curb cravings can really improve the chances of a person quitting. Each of these options has risks and benefits associated with them, so it's important to talk to your physician to come up with a plan for quitting that's right for you.