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The Royal College of Psychiatrists Improving the lives of people with mental illness

Smoking and mental health

Introduction

This leaflet is for anyone who has a mental health condition and is worried – or just curious – about:

  • How smoking affects your body.
  • How smoking affects your mental health.
  • How to stop or cut down smoking.

 

if you have a mental health problem and smoke, your smoking is probably harming you. It's the single largest reason why someone with a mental health condition is likely to die 10-20 years younger than other people. So, stopping smoking is the single best way to improve your health – and live longer. You may feel that there's nothing you can do about it. Luckily, this isn't true. Many people with a mental health condition manage to stop smoking. You can feel better – in both body and mind - and live longer. You have the same right to help with your smoking as anyone else – so, we hope that this leaflet can help you get the right help. It has information about how smoking affects your health – and some things you can do to tackle it.

 

Smoking and mental health
One person's experience:

 

“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.”  

 

Introduction

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 will:

  • Feel much healthier and better in yourself. 
  • Probably feel less depressed and anxious. ·
  • (Perhaps) be able to reduce the dose of some of your medications. · Save money - 10 cigarettes a day is almost £2000 a year. ·
  • Be able to get much fitter
  • Feel that you have achieved something.

And if I don't ….. ?

  • Die early - o You will, on average, die about 10 years earlier than you should. 
  • Even worse - half of smokers die 15 years earlier than they should, while a quarter die 23 years earlier
  • Have more breathing problems, heart disease, diabetes, lung cancer - and many other kinds of cancer.
  • Carry on smoking more than other people – so your smoking is even more likely to harm you.
  • Spend a lot of money on tobacco - so you may have to miss out other things you might enjoy.

 

Mental health and smoking

2 out of every 5 cigarettes in England are smoked by people with mental health conditions. And, the more you smoke, the more likely you are to: · Have a mental health condition. · Feel anxious or depressed. · Think about suicide - and go on to commit suicide. · Use more drugs and alcohol – which can make a mental health condition worse. · Develop dementia.

 

Other problems with smoking

Women who smoke tend to: 

  • find it hard to get pregnant. 
  • have a more difficult pregnancy. 
  • have babies who are born too early,
  • have a lower birth weight, and are less healthy.
  • It can be more stressful to care for them, and they are more likely to develop mental health conditions. 

Men can find it difficult to get an erection and are less fertile. 

 

If your health is poor, you may not be able to do things you want to.

For some people that might be work, while others may find it hard to keep up with their children and so miss out on being an active part of their lives. 

You can harm the health of people around you through “passive smoking”. This is when someone is harmed by breathing in the smoke from your cigarette. 

Most public places don't allow smoking - so you might not be able to do things you enjoy, like going to the cinema.

If you stop smoking, you can feel better, be healthier and live a lot longer - you have the right to help with stopping smoking

 

Isn't it too late to stop?

 

No. Even if you have smoked since your teenage years:

  • 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 on smoking.

How will I feel if I stop smoking?

  •  You will feel less anxious and depressed.
  • Stopping smoking seems to help anxiety and depression as much as antidepressants.
  • You may get some withdrawal symptoms, but they can be controlled with medications (see below). ·
  • You'll be able to get much fitter. ·
  • You may be able to cut down the amount of some medications by up to half. This can reduce unwanted and unpleasant side effects. ·
  • You could save more than £3500 each year if you were smoking 20 cigarettes a day.
  • You can feel proud that you have done something to make yourself healthier - and live longer. ·
  • You may feel worse for a short time after stopping - but getting support will help with this - and it does get better. ·
  • You may cough more for a while after you stop smoking. This can take few months to clear up. ·
  • You may put on weight – but you can control this with exercise and a healthy diet. 
  • Think about who else might benefit if you stop smoking – like your baby or child.

How can I stop smoking?

Everybody is different. But we know that your best chance of stopping is a combination of medication and other support. You need to find what is best for you. Try different things to see what works best for you.

 

Think about:

 

Medications

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, lozenges, tablets, sprays or inhalers. It works best if you use both a slower-acting patch and a faster acting type, like an inhaler or gum (combination NRT). The patches, gum or inhalers can irritate your skin, mouth, throat or nose, but usually just for a short time – and most people don’t have these problems. NRT doubles your chance of giving up completely. E-cigarettes are another way to replace nicotine which you can try. We don’t know yet if they have any long-term risks – but experts reckon that they are much less harmful than cigarettes.

 

Bupropion (Zyban): This will reduce any craving for nicotine, but can make it hard to sleep – and might make you anxious. You should not take it if you have had epilepsy (seizures or fits), bipolar disorder (manic depression), are a heavy drinker, have an eating disorder or have recently stopped taking sedatives or medicines for anxiety.

 

Varenicline (Champix):This 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.

BUT 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.

Which medications work the best?·

  • A combination of NRT products (a patch together with an inhaler or gum). 
  • Varenicline.

Try NRT first. But remember - medications work better when you use on of the other types of support described below.

You can buy NRT over the counter or get it prescribed by a Stop Smoking clinic or your GP. Bupropion and varenicline must be prescribed - from a Stop Smoking clinic or your GP.

 

Other types of support

  • Get advice from your doctor, nurse, pharmacist or other health care professional.
  • Self-help leaflets, books or websites. ·
  • Get help from a specialist “smoking cessation” practitioner. You can find them in your GP practice, an NHS stop smoking service, or a pharmacy. ·
  • Use telephone or internet support. ·
  • Join a support 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 also give you valuable support. ·
  • Some people like acupuncture and hypnotherapy – but clinical trials have not shown that they help. 

Self Help

  • Read a self-help book ·
  • Do some regular exercise

Finally - don't be discouraged if you start smoking again - many people do, it's all part of learning not to smoke. Just try to stop again soon!

 

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. Even if you just cut down, this doubles your chance of stopping in the future. As well as doing some of the things mentioned above, you could: ·

  • Keep a diary of when, where and with whom you smoke.
  • You can then can plan ways of avoiding or dealing the times and situations when you are more likely to smoke. ·
  • See if there are some cigarettes during the day which you could go without. ·
  • While you are cutting down, work out some ways of coping without cigarettes.

 

OK,  I stop smoking – what about my mental health?

 

Depression and anxiety

 

You may well feel less depressed and anxious.- stopping smoking can help as much as antidepressants. Taking NRT, bupropion and varenicline will help withdrawal symptoms – and these are relatively short lived. A few people do feel more depressed for a short time 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 (CBT).

Psychosis, such as Schizophrenia

 

  • Someone with psychosis can stop smoking – 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. These include:
    • Antidepressants (the older tricyclics such as amitriptyline and the newer mirtazapine)
    • Antipsychotics (especially clozapine, olanzapine and haloperidol)
    • Benzodiazepines (eg diazepam)
    • Opiates (eg methadone).
  • 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 weeks.
  • However, if you start smoking again, you will probably need to go back to the old dose of medication.

What about being in hospital?

  • Even if you want to carry on smoking, you can't smoke indoors in any hospital in the UK, including mental health units. ·
  • All hospitals in the UK are now working to ban smoking in hospital grounds as well - part of the drive to improve everybody's physical and mental health. ·
  • Ward staff will help you to not smoke while you are an in-patient. They can make sure you have the right NRT to help with any withdrawal symptoms - and can help you to stop smoking, if you want to.

Mental health services can help you with your mental health – and with other things

Someone with a mental health condition who smokes is less likely to get help for their smoking than someone without a mental health condition.

 

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 healthily
  • 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 smoking.

Look after your body and your mind will feel better

 

You can stop smoking - ask for help - it’s your right

 

Key points about mental health and smoking ·

 

  • Smoking is the single largest cause of preventable death in the UK ·
  • Smoking harms both your physical and mental health. ·
  • People with mental health conditions are more likely to smoke - and to be harmed by it
  • Yet - people with mental health conditions are less likely to get help to stop smoking than people without mental health conditions. ·
  • Stopping smoking is the single most powerful way to improve your physical health - but can also help your mental health.
  • For example: 

 

  • Stopping smoking is as effective as taking antidepressants for anxiety and depression symptoms. 
  • Doses of some medications for treating mental health conditions can be reduced by up to half within four weeks of stopping smoking. 
  • Free up money to spend on things to promote your health and wellbeing. ·

 

  • There are effective ways to help you to stop smoking.
  • These can also reduce the unpleasant but temporary withdrawal symptoms following stopping smoking. ·
  • If you don’t feel ready to stop completely, you can receive help to reduce the amount you smoke. This will make it more likely that you will be stop completely in the future. · It’s never too late to stop - you can get help to stop and reduce smoking from your GP surgery, pharmacist or mental health team.

Resources

 

References

 

  • Anstey KJ, von Sanden C, Salim A et al (2007) Smoking as a risk factor for dementia and cognitive decline: A meta-analysis of prospective studies. Am J Epidemiology 166: 367-378
  • ·        Anthenelli R, Benowitz N, West R et al 2016) Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomized, placebo-controlled clinical trial. Lancet 387(10037): 2507-20
  • ·        Britton J, Bogdanovica I (2014) Electronic cigarettes. A report commissioned by Public Health England. Public Health England  
  • ·        Brown S, Kim M, Mitchell C et al (2010) Twenty-five year mortality of a community cohort with schizophrenia. British Journal of Psychiatry 196: 116-121
  • ·        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 et al (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: 208-216
  • ·        Chang C-K, Hayes RD, Perera G et al (2011) Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London. PLoS ONE 6: e19590
  • ·        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: 745
  • ·        Hughes JR (2007) Depression during tobacco abstinence. Nicotine Tob Res. 9:443-6
  • ·        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. http://www.natcen.ac.uk/media/21994/smoking-mental-health.pdf
  • ·        McNeill A, Brose LS, Calder R et al (2015) E-cigarettes: an evidence update. A report commissioned by Public Health England
  • ·        Szatkowski L, McNeill A (2013) The delivery of smoking cessation interventions to primary care patients with mental health problems. Addiction 108(8): 1487-94
  • ·        Taylor D, Paton C, Kapur S (2015) Maudsley prescribing guidelines. 12th Edition. Informa Healthcare
  • ·        Taylor G, McNeill A, Girling A et al (2014) Change in mental health after smoking cessation: systematic review and meta-analysis. British Medical Journal 348: g1151
  • ·        Thomas K, Martin R, Davies N et al (2013) Smoking cessation treatment and risk of depression, suicide and self-harm in the Clinical Practice Research Datalink: prospective cohort study. British Medical Journal 347:f5704
  • ·        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  

Original authors

Dr Jonathan Campion (Director for Public Mental Health and Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust) Dr Ken Checinski (CRI South East)

 

We also wish to acknowledge the following people for their helpful comments and advice: ·

Dr David Shiers (University of Manchester) ·

Professor Ann McNeill (National Addiction Centre, King’s College London) ·

Professor John Britton (UK Centre for Tobacco and Alcohol Studies) ·

Professor Sharon Lawn (Flinders University, Australia) ·

Dr Debbie Robson (National Addiction Centre, King’s College London)

 

This leaflet was edited by the RCPsych Public Engagement Editorial Board.

 

Series Editor: Dr Philip Timms.

Series Manger Thomas Kennedy

 

© Illustration by Huw Briscoe www.unfoldstudio.com

This leaflet reflects the best available evidence at the time of writing.

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© June 2017. Due for review: May 2020. 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 permissions@rcpsych.ac.uk. 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 Scotland SC038369.

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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