Quitting smoking is one of the best decisions a person can make for their physical health. However, the process of quitting can also impact mental health and wellbeing. Nicotine acts on receptors in the brain that regulate mood, so when someone stops smoking, it can cause changes in emotions and thinking. Additionally, the habit and ritual of smoking cigarettes is ingrained in many smokers’ daily routines. Breaking free of this can be extremely difficult. So while quitting smoking has tremendous physical health benefits, it’s important to be aware of the potential mental health effects as well.
What happens in the brain when you quit smoking?
Nicotine activates nicotinic acetylcholine receptors in the brain. This triggers the release of several neurotransmitters that regulate mood and thinking, including dopamine, serotonin, norepinephrine, acetylcholine, GABA, and endorphins. Over time, chronic nicotine exposure alters the number and sensitivity of these receptors. When nicotine is withdrawn, it leaves the brain in a state of imbalance as receptors readjust. This reconstitution process after quitting smoking can take weeks or months.
During this period, common symptoms include:
– Irritability
– Anxiety
– Sadness or depression
– Insomnia
– Lack of concentration
– Restlessness
These reflect both the direct effects of nicotine withdrawal altering neurotransmitter levels, as well as the loss of cigarettes providing mood regulation.
Risk of mental illness after quitting smoking
For most people, the mood effects of quitting smoking will be temporary side effects that resolve within a few weeks to months. However, studies show there are some mental health risks associated with smoking cessation to be aware of:
Depression
– A meta-analysis of 26 studies found that quitting smoking was associated with a significantly increased risk of new-onset depression compared to continuing smoking. The risk was highest within the first 3 months after quitting.
– Another large cohort study of over 7000 smokers found that those who had quit for less than 6 months had a 2-fold higher odds of major depression compared to current smokers.
– Factors that increase depression risk include having a history of depression prior to quitting, experiencing strong nicotine withdrawal symptoms, having less social support, and experiencing more stressful life events around the time of quitting.
Anxiety
– Both cross-sectional and prospective studies link smoking cessation to increased anxiety symptoms and panic attacks. This may reflect the loss of cigarettes to self-medicate anxiety.
– A study of over 4000 smokers found a 26% increased risk of new onset panic attacks in those who had successfully quit smoking for 4 weeks or longer compared to those who continued smoking. The risk was highest in the first month after cessation.
– Pre-existing anxiety disorders and history of panic attacks can increase susceptibility to exacerbation of anxiety when quitting.
Suicidal thoughts
– A meta-analysis of 35 studies found that smokers who attempted to quit had a 45% increased risk of suicidal thoughts, plans or attempts compared to those who continued smoking. The risk peaked within the first week after cessation and remained elevated for at least 6 weeks.
– Factors associated with higher suicide risk include being female, younger age, heavier smoking, and history of suicide attempts.
– For most, suicidal thoughts are temporary and linked to acute nicotine withdrawal. But for some vulnerable individuals, quitting smoking may trigger a suicidal crisis. Careful monitoring is warranted.
Protective strategies when quitting smoking
While smoking cessation can be mentally challenging, there are many things you can do to safeguard your mental health:
Seek support
– Don’t go it alone. Tell friends and family you’re quitting and ask them to encourage you when things get difficult. Consider joining a support group.
– Talk to your doctor about your plan to quit. They can monitor any mood changes. Having a support system is key.
Manage stress
– Try relaxation techniques like deep breathing, meditation, yoga, or mindfulness. Avoid taking on big additional stressors when you first quit smoking.
– Exercise helps burn off nervous energy and boosts mood through endorphins. Even light walking can make a difference.
Get rest
– Withdrawal can disrupt sleep, so practice good sleep hygiene. Keep a regular sleep-wake schedule, limit evening screen time, and create a relaxing bedtime routine.
– Melatonin or herbal teas can aid sleep. But avoid leaning too heavily on sedatives.
Watch your mood
– Keep track of your emotional state so you can get help if depression, anxiety, or suicidal thoughts emerge and don’t improve within a few weeks. Don’t hesitate to see a mental health professional.
Try nicotine replacement therapy
– Using NRT like the patch, gum, or lozenges can help ease nicotine withdrawal and may lessen mood instability in the initial quitting phase. Speak to your doctor about options.
Consider medications
– If you have a history of depression or anxiety, your doctor may recommend a short-term course of antidepressant or anti-anxiety medication to help smooth the transition and reduce relapse risk.
Avoid alcohol
– Alcohol can exacerbate mood instability post-cessation and increase cravings. It’s best to avoid drinking, at least in early quitting.
Reward yourself
– Celebrate victories such as smoke-free milestones. Use the money saved from not buying cigarettes to buy yourself rewards. Positive reinforcement builds new non-smoking habits.
When to seek professional help
See your doctor promptly if after quitting smoking you experience:
– Depressed mood most of the day, nearly every day, for more than 2 weeks
– Marked loss of interest/pleasure in activities
– Change in appetite or sleep
– Fatigue or loss of energy
– Feelings of worthlessness or excessive guilt
– Diminished ability to think, concentrate, or make decisions
– Recurrent thoughts of death or suicide
Seek immediate help from a mental health crisis line, hospital emergency room, or by calling 911 if you have thoughts of harming yourself or others.
While quitting smoking can be a bumpy road for some, the health benefits make it well worth it. Arm yourself with self-care strategies, social support, and professional help if needed. The discomfort is temporary, but the rewards of being smoke-free last a lifetime. Over time, mood stabilizes, cravings fade, and you’ll feel calmer and more in control.
Conclusion
Quitting smoking is one of the most important health decisions, but also one of the most mentally challenging. By disrupting neurochemical balances nicotine withdrawal can put people at risk of depression, anxiety, and even suicidal thoughts. However, most mood changes are transient and manageable with the right coping strategies and support. For some vulnerable individuals, temporary medication may help weather the initial phase. While quitting can be tough, the huge gains for physical and mental wellbeing make it more than worthwhile. Arm yourself with information, support, perseverance, and self-compassion. Be vigilant but don’t become discouraged. With commitment and resilience, the other side is full of empowerment and freedom.
