Smoking and mental health
This leaflet is for anyone who has a mental
health problem and is worried – or just curious – about:
One person's experience:
- how smoking affects your body
- how smoking affects your mental health
- how to stop smoking
“I feel so much healthier overall after
stopping smoking a year ago. I also have much more money to do
things that I wasn’t able to afford while I was smoking. The doses
of my medication have also come down a lot.”
If you have a mental health problem and smoke,
you may feel that there's nothing you can do about it. This isn't
true. Many people with mental health problems have stopped
smoking. They feel better and live longer. You have the same
right to help with this as anyone else.
What's in it for me if I stop smoking?
- You'll probably feel much healthier and
better in yourself.
- You may be able to reduce the amount of medication you
- It 's the single most powerful way of improving your health –
and living longer.
- If you stop smoking 10 cigarettes a day, you'll save more than
£1000 a year.
- You'll be able to get much fitter.
And if I don't ….. ?
- If you have a mental health problem, you probably smoke
more than other people – so your smoking is even more likely to
- You are more likely to be one of the 100,000 people in the UK
each year who are killed by smoking.
- You are more likely to die early.
- You will, on average, die about 10 years earlier than you would
have done if you had not smoked.
- But - half of smokers die 15 years earlier than they
should while a quarter die 23 years earlier.
- You are more likely to have breathing problems, heart disease,
diabetes and many kinds of cancer (not just lung cancer).
Mental health and smoking
If you have a mental illness, you are more
likely to smoke. 2 out of every 5 cigarettes in
England are smoked by people with mental health problems.
The more you smoke, the more likely you are
- develop a mental illness – but it's unclear
- feel anxious or depressed
- think about suicide - and to go on to commit suicide
- use more drugs and alcohol – which can make a mental health
Overall, if you have a mental health problem
and smoke, you are more likely to have poor general health – it's
one of the main reasons why people with a mental health
problem tend to die younger.
- If you stop
smoking, you can feel better, be healthier and live a lot
have the right to help with stopping smoking
Other problems with smoking
- Men can find it difficult to get an
- Women tend to:
- find it hard to get pregnant
- have a more difficult pregnancy
- have babies who are less healthy
and have a lower birth weight.
- It harms non-smokers who breathe
- It's expensive.
- If your health is poor, you may not be able to do things you
want to – work, for example.
- Most public places don't allow smoking - so you can find
yourself shut out from things you might want to do.
Isn't it too late to stop?
No. Even if you have smoked since your teenage
- If you stop smoking before the age of about 35, you will live
nearly as long as people who have never smoked.
- If you stop smoking before the age of 50, you will be half as
likely to die from smoking-related diseases as someone who carries
How will I feel if I stop smoking?
- Probably much healthier and better in yourself.
- A few people feel worse for a short time after stopping. This
does get better but you may need some extra support if you are
finding it hard.
- You may cough more for a while after stopping smoking – this is
usually temporary, but may last a few months.
- You may put on weight – but you can control this with exercise
and a healthy diet.
- You'll be able to get much fitter.
- You may be able to reduce the amount of certain medication
you take by up to half.
- Proud that you have done something that will give you a
healthier, longer life.
How can I stop smoking?
Different people find different things helpful
– you need to find what is best for you.
- Read a self-help book.
- Do some regular exercise.
support from other people
- Get advice from your doctor,
nurse or other health care professional – this may be all you
need to stop smoking.
- Get help from your local NHS stop
- Telephone/internet support.
- You can get support from a
friend, a professional or someone else or a group of other people
who are giving up smoking.
- Pair up with a friend who is also
trying to stop.
- At first you may find it easier
not be around friends who smoke - but friends and family
can give valuable support.
- Some people like acupuncture and
hypnotherapy – but clinical trials have not shown that they
How you can
help other people by stopping smoking
- Think about who else you know who you might help if you stop
smoking – like your baby or child.
Finally - don't be discouraged if you start smoking again - many
people do, it's all part of learning not to smoke.
Nicotine replacement therapy
(NRT): This is a way of giving your body the nicotine it
craves without using cigarettes. It comes as skin patches, gum or
inhalers. It seems to work better if you use a patch together with
an inhaler or gum. The patches, gum or inhalers can irritate your
skin, mouth, throat or nose, but usually just for a short time. NRT
doubles your chance of giving up completely.
Bupropion (Zyban): This cuts
down the craving, but can make it hard to sleep and you might
experience anxiety. You should not use it if you have had epilepsy
(seizures or fits) or bipolar disorder (manic
cuts down the craving for nicotine – but, if you do have a
cigarette, it also cuts down the pleasure you get from it. However,
there have been reports that it can make you anxious, depressed,
agitated and suicidal. It can also give you mood swings
and make it hard to sleep, even if you don't have a history of
mental health problems.
If you take varenicline and have a mental health problem, tell
your doctor. If you develop any of the side-effects above, you
should stop varenicline straight away and see your doctor
as soon as possible.
Electronic Cigarettes (E-cigarettes):
Electronic cigarettes were invented in China in 2003. By 2012,
nearly 1 in 5 regular smokers in the UK were using them and
around 400,000 people had completely stopped smoking
cigarettes, using e-cigarettes instead.
E-cigarettes produce nicotine as a vapour which can be
breathed in - as you do with "real" cigarette smoke. But, as
no tobacco is not burnt, the nicotine vapour of e-cigarettes
contains less toxic chemicals than normal cigarette smoke. It's
also helpful that other people aren't exposed to the effects of
"passive smoking" that you get with ordinary cigarettes.
They seem to be fairly effective in helping smokers stop or
control their smoking and seem to be more helpful than nicotine
free products. For people with mental illness, e-cigarettes may be
as effective and safe as nicotine patches, and more useable.
Although they seem to be safe, we aren't yet clear about
longer-term health risks.
But I don't think I can stop completely
You might feel – especially if you smoke
heavily – that you can't stop completely. Don't worry, just:
- Cut down before stopping – you don't have to
- Keep a diary of when, where and with whom you smoke. This can
remind you of the times and situations when you are more likely to
smoke. You can then plan ways of avoiding these situations or
deal with them differently.
- While you are cutting down, you can work out how to cope
- You can use NRT to help you do this (see above).
OK, I stop smoking – what about my mental
You may well feel less depressed. A few people
do feel more depressed when they stop smoking, so:
- Keep in regular contact with your doctor and
(if you have one) key worker or case coordinator.
- Ask if you can have a talking therapy like
cognitive behaviour therapy
- You may find it harder than other people to
stop smoking – but your symptoms won't get worse.
- NRT or bupropion can help.
- If you use any of the above medications and go to a
support group, you are more likely to give up.
Smoking and Medication
- Smoking can interfere with some medication, so you may have to
take a higher dose than you would if you were not smoking.
- So, if you stop smoking, the amount of some medications in your
blood can go up, often within a few days. Your doctor may need to
reduce the dose of some medications by a quarter in the first
week, and perhaps even more in the following three
- However, if you start smoking again, you will probably need to
go back to the old dose of medication.
Some of the medicines affected by smoking include:
- Antidepressants (the older tricyclics such as amitriptyline and
the newer mirtazapine)
- Antipsychotics (especially clozapine, olanzapine and
- Benzodiazepines (eg diazepam)
- Opiates (eg methadone).
What about being in hospital?
- Even if you want to carry on smoking, you can't smoke indoors
in any mental health unit in the UK.
- Ward staff should be trained to help you to not smoke while you
are an in-patient. They can help you to stop smoking, if you want
- The ban on smoking in hospitals is part of the drive to improve
everybody's physical and mental health.
Mental health services can help you with your mental
health – and with other things
Your GP, psychiatrist, care coordinator and
anyone else you see in mental health services can help you to:
- improve your physical health
- develop a healthy lifestyle – exercise and eating
- get advice, information, support and, if necessary, medication
to stop smoking
- not put on weight after stopping smoking
- make any changes you need to your medication after you stop
Look after your
body and your mind will feel better
You can stop smoking - ask for help - it’s your
- Brown S, Barraclough B, Inskip H. (2000).
Causes of the excess mortality of schizophrenia. British
Journal of Psychiatry. 176: 109.
- Cahill K, Stead L, Lancaster T (2007).
Nicotine receptor partial agonists for smoking cessation.
Cochrane Database of Systematic Reviews, issue 1,
CD006103. Wiley Interscience.
- Campion J, Checinski K, Nurse J, McNeill A
(2008). Smoking by people with mental illness and benefits of
smoke-free mental health services. Advances in Psychiatric
Treatment. 14: 217-228.
- Campion J, Checinski K, Nurse J (2008).
Review of smoking cessation treatments for people with mental
illness. Advances in Psychiatric Treatment. 14:
Campion J, Hewitt J, Shiers D, Taylor D (2010) Pharmacy guidance on
smoking and mental health. RCPsych and RCGP Forum.
- Cuijpers P, Smit F, ten Have M et al (2007).
Smoking is associated with first-ever incidence of mental
disorders: a prospective population based study.
Addiction. 102(8): 1303-9.
- Doll R, Peto R, Boreham J, Sutherland I
(2004). Mortality in relation to smoking: 50 years’ observation on
male British doctors. British Medical Journal. 328:
- Farrell M, Howes S, Bebbington P et al.
(2001). Nicotine, alcohol and psychiatric morbidity. Results of a
national household survey. British Journal Psychiatry.
- Foulds JGK, Steinberg MB, Richardson D et al
(2006). Factors associated with quitting smoking at a tobacco
dependence treatment clinic. American Journal of Health
Behavior. 30: 400-412.
- Hughes, J.R. (2007) Depression during tobacco
abstinence. Nicotine Tob Res. 9:443-6.
- John, U., Meyer, C., Rumpf, H. J., et
al (2004) Smoking, nicotine dependence and psychiatric
comorbidity – a population-based study including smoking cessation
after three years. Drug and Alcohol Dependence, 76,
- Malone KM, Waternaux C, Haas GL et al.(
2003). Cigarette smoking, suicidal behavior, and serotonin function
in major psychiatric disorders. American Journal
Psychiatry. 160(4): 773-9.
McManus S, Meltzer H, Campion J (2010) Cigarette smoking and mental
health in England. Data from the Adult Psychiatric Morbidity
Survey. National Centre for Social Research.
- Phelan M, Stradins L, Morrison S (2001)
Physical health of people with severe mental illness. British
Medical Journal. 322: 433-444.
- Royal College of Physicians and Royal College of Psychiatrists.
Smoking and mental health. Report by the Tobacco Advisory
Group. London: RCP 2013. Royal College of Psychiatrists:
- Taylor D, Paton C, Kapur S (2012) Maudsley prescribing
guidelines. 11th Edition. Informa Healthcare.
- Willi C, Bodenmann P, Ghali WA et al (2007)
Active Smoking and the Risk of Type 2 Diabetes. A Systematic Review
and Meta-analysis. JAMA. 298(22):2654-2664.
Dr Jonathan Campion (Director for public
mental health and consultant psychiatrist, South London and
Maudsley NHS Foundation Trust)
Dr Ken Checinski (St George’s University
Reviewed by: Dr Ashok Kumar.
We are grateful to the service users who
commented on this leaflet and thank Dr David Shiers, Dr Sharon
Lawn, Simon Lawton-Smith (Mental Health Foundation) and
Aine Duggan (Rethink) for
This leaflet was edited by the RCPsych
Public Education Editorial Board.
Series Editor: Dr Philip Timms.
© Illustration by Huw Briscoe www.unfoldstudio.com
This leaflet reflects the best available evidence at the time of
© May 2015. Due for review: May 2018. Royal College
of Psychiatrists.This leaflet may be downloaded, printed out,
photocopied and distributed free of charge as long as the RCPsych
is properly credited and no profit is gained from its use.
Permission to reproduce it in any other way must be obtained from
The College does not allow reposting of its leaflets on other
sites, but allows them to be linked to directly.
For a catalogue of public education materials or copies of our
leaflets contact: Leaflets Department, The
Royal College of Psychiatrists, 21 Prescot
Street, London E1 8BB Tel: 020 3701 2552.
Charity registration number (England and Wales) 228636 and in
Please note that we are unable to offer advice on individual cases. Please see our
advice on getting help.
Please answer the following questions and press 'submit' to send your answers OR
E-mail your responses to firstname.lastname@example.org
On each line, click on the mark which most closely reflects how you feel about the
statement in the left hand column.
Your answers will help us to make this leaflet more useful - please try to rate
Did you look at this leaflet because you are a (maximum of 2 categories please):
Age group (please tick correct box)