Smoking And Depression
Smoking And Depression
Linda Hyder Ferry (Associate Professor, Preventive Medicine and Family Medicine, Loma Linda University School of Medicine) gives expert video advice on: Why is it so easy for some people to quit smoking and so hard for other's?; How are depression and addiction connected?; Why do I become depressed when I try to quit smoking? and more...
Why is it so easy for some people to quit smoking and so hard for other's?
Some people find it so easy to quit smoking because they have only one problem they're dealing with, and that is the lifestyle, the environment, the habit , the rituals and routines of smoking. Their nicotine addiction itself is not very strong and when they make a decision to quit smoking, they don't have severe withdrawal symptoms, they don't feel terrible, they lay their cigarettes down and they go about their way. This is once they make up their mind. About 10-20% of the population of smokers find it easy to quit smoking. The vast majority find it much more difficult because the way they feel, their withdrawal symptoms or their whole life environment is just wrapped around their smoking in such a way that holds them very tightly. There are other underlying conditions that you need to consider, too, such as depression or other mood disorders for which cigarette smoking really makes someone feel much better and when they quit smoking their symptoms significantly increase to the point where they find life unmanageable. So the long risk people, I call them, are the ones who aren't heavily addicted, they don't have to smoke the first thing when they wake up in the morning, they can go for hours without minding having a cigarette. Those people, when they quit, don't have much that pulls them back in. But the people who have a very strong addiction, a brain chemistry disorder set up by their nicotine dependence, and when they have an underlying condition that makes them want the cigarette to treat that problem, those individuals have a much more difficult time quitting smoking, and need professional help. But with that help they can be just as successful in the long run.
How are depression and addiction connected?
The brain is an amazing complex of pathways that communicate with each other about influences, thoughts, moods and emotions. When you use alcohol or a chemical that changes your mood and you do it repeatedly, daily to the point where you really like that change, and it feels better than the way you felt before, you set up a pathway in your addiction and reward center. When someone uses a chemical that is an upper, a stimulant, to their mood then they don't feel as sad, or low, or depressed, or irritable, or grumpy or miserable. That is how a lot of people describe depression - a lack of energy, and no interest in anything. If they use a chemical such as stimulants like amphetamines, crack cocaine, or nicotine, those stimulants really give a boost in the same chemicals that would cause depression. What happens here is you take your chemical, you feel good, you don't take your chemical, you sink down to the level of depression where you don't feel good at all. Some people think that is just withdrawal, but for a significant portion of smokers, maybe up to 25%, 30% percent of smokers, what they are doing is self-medicating a depression.
Why do I become depressed when I try to quit smoking?
There are a significant number of people just like you who say, every time I quit smoking, I just feel miserable. My moods deteriorate, I'm grumpy, I'm irritable. I don't enjoy anything. All I can think about is a cigarette. I would encourage you to talk to your doctor about what else could be the explanation for that. Nicotine itself works in the brain stimulating chemicals to make you feel good. The problem is that it stimulates it in such a way that it depletes those chemicals, and when you don't have nicotine repeatedly, over and over again stimulating them, they drop to a level far below what's normal, and makes you feel miserable. If you're already pre-disposed to a mood disorder such as depression or anxiety, nicotine actually makes that whole pathway, that cycle, much worse. There are some people, we understand, who didn't seem to have any symptoms of depression, started smoking, but when they quit smoking, then they determine, in addition to all the stresses in my life, now I'm feeling really depressed going through withdrawal. So it might be that some people start smoking because they don't feel so great. When they give it up, that problem is still there. It didn't go anywhere. But there are other people for whom going through the process of nicotine addiction and changing the brain chemistry actually may spark the trigger to follow that up and down pattern of brain chemistry changes to leave them in a state of being depressed when they quit smoking. If you are experiencing any of the symptoms of depression, I would encourage you to look information up about that and read about what it means to have a major depressive disorder. Talk to your health care provider and ask about a screening test for that, and determine what medications would be the best for you to use during the time that you quit smoking. Because you should not allow quitting smoking to be a barrier to you getting help for your depression, and you shouldn't allow depression to be a barrier to quitting smoking. There are medications that can treat both of those, and help you feel much better in the long run.
How can I quit smoking without becoming depressed?
If you are someone who's never had an episode of depression, you don't have premenstrual syndrome, you didn't have, as a woman, post partum depression after delivering a baby, you don't have a strong family history of depression, then you really don't need to worry about getting depressed when you quit smoking. You'll just have to deal with some nicotine withdrawal symptoms, and there are medicines that can treat that. However, if you do believe that you're someone who's at risk, and you periodically had periods of your life where you felt very sad or low or went for counselling, or you didn't snap out of a blue mood, then I would encourage you to talk to your doctor, because there are some cognitive behavioral therapies, meaning someone talking you through the way that you think about problems, that can help. Exercise can make a big difference. Giving good nutrition and adequate sleep is also important during the time you quit smoking, to avoid depressive moods. There are medications that will help you quit smoking and help stabilize your brain chemistry so that you don't get sad or blue or lonely or irritable, and there are also anti-depressant medications that may be needed in addition to just your "stop-smoking medication".
Can nicotine withdrawal trigger depression?
The list of nicotine withdrawal symptoms actually includes one of the six or seven items as depressive mood. Not everyone gets that symptom. Some people are more predisposed. The common nicotine withdrawal symptoms are irritability, difficulty in concentrating, increase in hunger. Those things are pretty universal. Not everyone gets those, either. If you think you've had that symptom before when you've tried to quit, where your mood deteriorates, go talk to someone about it and get some help because it certainly is recognized as one of the more common nicotine withdrawal symptoms that smokers do experience, usually two to six weeks after the time they quit smoking.