Quitting smoking is a challenge for most people who are used to lighting up as part of their daily routine, but it can be particularly difficult if you struggle with your mental health. We explore how to make the process as painless as possible, and the emotional benefits of stubbing out the habit.
If you're a smoker, chances are you've thought about quitting. According to Public Health England, around 60% of the 6.1 million smokers in England say they want to quit, and nearly one in five say they want to stub out the habit within the next three months.
However, this is often far from an easy ride. And it can be particularly difficult if you struggle with your mental health. Many people use smoking as a form of self-medication, lighting up as a way to temporarily relieve stress. This means trying to quit can stir up some uncomfortable feelings.
According to Professor Ann McNeill, a professor of tobacco addiction at King's College London and a tobacco policy expert, it is easy to see why so many people associate smoking with stress relief.
"After a short period of not smoking, many smokers will start to feel the need for a cigarette, and other withdrawal symptoms such as feeling irritable or on edge become apparent," she says. "Having a cigarette relieves such discomfort, so smokers believe that smoking relieves their stress."
She points out, however, that this reprieve in the withdrawal symptoms should not be confused with actual mental health benefits. In fact, something close to the opposite is true.
"Research that followed up smokers before and after quitting found that stopping smoking was associated with improvements in mental health, both for smokers with and without mental health problems," she says. "This is important. We often talk about how smoking damages people physically, and this has been heavily researched. How smoking affects mental health is less well researched and needs much greater attention."
The links between smoking and mental health conditions
While cause and effect can get jumbled here (do people start smoking because they have mental health problems, or do they develop these problems because of smoking?) we do know there's a link between smoking and poor mental health.
The data consistently show that people with mental health conditions are more likely to smoke, and the more severe the condition the higher the smoking prevalence. According to statistics cited by ASH (Action on Smoking and Health), 33% of people with a mental health condition smoke, compared to 18.7% of the general population.
Among adults with depression, smoking rates are about twice as high as among adults without, and among those with schizophrenia, rates are about three times higher. What's more, people with mental health conditions tend be at higher risk of smoking-related harm and suffer worse withdrawal symptoms.
"The more severe the mental health problems, the more likely people are to be smokers and to smoke more heavily," says McNeill. "However, research has shown that smokers with mental health problems are as keen to stop smoking as those without mental illness."
This is not surprising, considering the benefits (mental and physical) that quitting smoking confers. According to the World Health Organization, within a year of quitting smoking, your risk of heart disease falls to about half that of a smoker's, and within 15 years it falls to the level of someone who has never smoked. If you quit smoking aged 30, your life expectancy will be 10 years higher than someone who continues to smoke.
Over the shorter term, you will benefit from increased energy, improved sense of taste and smell, a boost to your immune system and better lung function. Importantly, quitting smoking is associated with improvements in psychological quality of life and a decrease in anxiety and depression.
How to quit
So if you're struggling with your mental health, and want to stop smoking, what can you do to make the process as painless as possible?
As McNeill points out, people with mental health problems can generally follow the same guidance as the rest of the population. This means contacting your local NHS stop smoking service (available at many pharmacies), and seeking expert support along with the many tools designed to help. Willpower alone is not recommended here!
Nicotine replacement therapies may be particularly useful for smokers with depression, as, like cigarettes, they stimulate the release of dopamine in the brain.
"The good news is there is now good evidence that the same treatments for smokers without mental health problems work for those with, and now we have more treatments available than ever before," says McNeill. "This should include e-cigarettes, where there is also emerging evidence of effectiveness with this population."
She adds that some health professionals are loath to broach the subject, fearing that a patient's mental health will worsen if they stop smoking. However, this is a misconception.
"It's important they are familiar with the research in this area and encourage smokers with mental health problems to quit," she says. "Given that they can be heavier smokers it will be important to give them support when they try to stop and they may need to be monitored more closely."
Make sure to tell your doctor that quitting smoking is a priority for you. This is particularly crucial if you're taking antidepressants or antipsychotics, as it could affect the dosage you require.
It may not be the easiest road ahead, but you can rest assured you're making the best decision for both your physical and mental health.