Smoking and psychiatric illness

Some of you might be wondering exactly what smoking has to do with psychiatric illness or mental health at all. You're not alone; this topic has not been widely discussed or considered in psychiatric circles until fairly recently. However, as new research emerges it becomes clear that the two subjects are more linked than we often imagine.

What has come to light is that people with psychiatric conditions are far more likely to smoke than the general population. In fact, approximately 60% of people who experience a psychiatric condition are smokers compared with 25% of the general population.

It has been estimated that 30% of smokers in North America also have a psychiatric condition.

While this fact in itself is astonishing, it has also been discovered that people with psychiatric conditions have a much harder time quitting smoking than those without psychiatric illness.

Until fairly recently, these numbers were insignificant because of society's more accepting attitude toward smoking in general. As attitudes change and societal pressure to quit smoking increases, it becomes more and more clear that a large group of the smoking population is having a harder time kicking the habit than most.

Most alarming are the numbers of people with schizophrenia or depression who smoke and have a difficult time quitting.

It is estimated that 70% of people with schizophrenia also smoke. Studies have shown that cigarette smoking seems to have a positive effect on some of the cognitive symptoms of schizophrenia. Attempting to quit smoking can worsen these symptoms.

Similarly, as many as 76% of people with depression say they have smoked at some point in their lives. People with a history of depression also seem to have a hard time quitting smoking. Very often, after stopping the use of tobacco, this group will experience a recurrence of depressive symptoms. This usually ends the attempt at smoking cessation.

The same phenomena are often found in people with other psychiatric illnesses including bipolar disorder, anxiety disorders and attention deficit / hyperactivity disorder (ADD/ADHD). Starting and stopping smoking can cause a bipolar patient to experience a manic episode. Smoking also seems to have anti-anxiety effects as well as helping people to focus a little more. Often, people use cigarettes in part to self-medicate even if they aren't aware of it.

It is unknown exactly how tobacco improves psychiatric symptoms, but there are a number of theories. It is known that nicotine stimulates the release of a number of chemical messengers (called neurotransmitters) in the body, some of which may be the same ones affected by active psychiatric medication.

Also, the body has nicotine specific receptors in many areas and there has been extensive research on their location and function. Progress has been made in understanding the biological basis of smoking in the mentally ill but it is a complex subject.

With all of this in mind, it is not surprising that current smoking cessation aids include widespread use of an antidepressant (as in Zyban). Zyban is an inhibitor of nicotinic receptors and that may be one of the ways it contributes to smoking cessation. As more research is completed in this area, it may become even more commonplace for psychiatric tools to be used in helping people butt out.

Since it seems that smoking and mental health are more connected than we thought, it may be time for governments and hospital administrations to consider the benefits of providing coverage for Zyban and other smoking cessation aids as well as accounting for nicotine replacement drugs in psychiatric ward budgets.

The ill-effects of chronic smoking bring huge costs to health and healthcare and any way we can work to help people break the habit should be considered worthwhile.


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