Go on any health-related website and you’ll find the same message regarding smoking and mental health: namely, if you give up smoking you’ll benefit from reduced stress, anxiety and depression. But what so many people fail to address is just how difficult the transition from smoker to non-smoker is when you’re depressed and (crucially) why this is so.
How smoking appears to help depression
Lighting up a cigarette provides a few moments of relaxation and a sense of wellbeing. Nicotine is the culprit. Nicotine triggers the release of a neurotransmitter called dopamine, which among its other functions is associated with sensations of pleasure. Not surprisingly, people with depression who also smoke, use cigarettes for precisely this reason. What they may not realize is continued smoking encourages the brain to turn off its natural dopamine supply. This results in people having to smoke more and more in order to maintain the same effect.
When depressed smokers try to quit
Let's imagine you’ve got the message that smoking is making your depression worse. You try to quit, but it’s so much harder than you imagined, and far from feeling better you feel utterly miserable. What’s going on?
Professor Brian Hitsman and his team from Northwestern University believe they know why nicotine withdrawal is so difficult for people with depression. They say an attempt to quit is met by a combination of negative effects. First, there’s a dip in the few pleasurable effects that resulted from smoking; secondly, there’s an increase in negative emotions and difficulties in focusing and making decisions.
Added to the burden is the fact that people with depression already have reduced coping skills, so the chances of relapse are much higher.
Sometimes referred to as the outside-in method, behavioral activation (BA) is a treatment method. The outside-in method of BA takes away the emphasis of how we feel inside and replaces it with an outside plan. With this approach you set a target activity in advance and then carry it out regardless of how you feel about it on the elected day.
The clinical study underway at Northwestern combines behavioral activation with the FDA-approved medication Chantix. According to Pfizer’s own literature, Chantix is said to reduce the urge to smoke.
Getting past the first couple of weeks is often the biggest challenge. Most people find the irritability and moodiness that comes with stopping smoking usually subsides after a few days. The habit of reaching for cigarettes, meanwhile, needs to be replaced with something else. This is where planning comes in useful. Consider healthy alternatives to lighting up and you’ll find the mood benefits come in the longer term.
(1) Northwestern University. "New treatment for depressed smokers trying to quit." ScienceDaily. ScienceDaily, 20 September 2016. <www.sciencedaily.com/releases/2016/09/160920104749.htm>
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Dr. Jerry Kennard is a Chartered Psychologist and Associate Fellow of the British Psychological Society. Jerry's clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of positivityguides.net.