Depression and quitting smoking
“I have found that when I am
anxious, I smoke more, but that
actually increases my anxiety in
the short term.”
– Alice, 30
Will quitting make my
depression better or worse?
Nicotine withdrawal or
depression?
Quitting smoking is one of the
most important things you can do
to improve your health. Quitting is
also likely to improve your mental
wellbeing. If you’ve had depression
in the past, your chances of
quitting for good are about the
same as someone who hasn’t
had depression. If you’re
experiencing depression now it
can make quitting more
challenging, but with the right
support you have a good chance of
quitting smoking successfully.
Smoking and stress
Depression may leave you with less
mental energy to make changes to
your life so you can cope without
cigarettes. The encouraging news is
that some of the strategies that help
to improve mood are also very useful
for quitting smoking e.g. relaxation,
exercise and doing things you enjoy.
It’s also a good idea to talk to your
doctor, who will be able to provide
advice and options about how to quit.
Smoking actually causes stress.
Having a cigarette is not going to make
problems go away. Research shows
that people who start smoking are
more likely to become stressed and
depressed.1 Many people who quit
find that, after a while, they feel less
stressed and depressed.
www.beyondblue.org.au 1300 22 4636
Many people who smoke say that
smoking helps to calm them down
and reduces stress. After you’ve been
smoking for a while, your body gets
used to nicotine (the addictive drug in
tobacco) and relies on it to feel
normal. The relief you feel when you
smoke comes from having nicotine in
your system again. The more you
smoke, the more often you will feel
the need for a cigarette to relieve the
stress of nicotine withdrawal.
Quitting breaks this vicious cycle.
At first, it might feel like quitting is
making your depression worse.
It can be hard to tell the difference
between nicotine withdrawal and
symptoms of depression – both can
include low or depressed mood,
difficulty sleeping and concentrating,
and feeling restless.
Other nicotine withdrawal symptoms
include cravings, feeling frustrated,
irritable or angry, anxiety, or hunger.
Some people also report coughing,
mouth ulcers, dizziness, or
bowel disturbance.
Most withdrawal symptoms peak
48 hours after quitting, improve within
two to four weeks and are completely
gone within a few months. For some
people, symptoms may fall and rise, or
stay high for several weeks, and this
can make quitting harder. Talk to your
doctor about using nicotine replacement
products or quit medications to reduce
withdrawal symptoms. You may also
find it useful to fill in a daily mood chart
or keep a journal to monitor your mood.
If you are troubled by cravings or
withdrawal symptoms, you can talk
to a Quitline advisor (13 7848) for
professional advice and support.
1
If after quitting, you experience
worsened symptoms of depression
(every day for two weeks or more),
see your doctor.
Once nicotine withdrawal subsides
After a few months, most people who
quit smoking report either improved or
the same level of mood as when they
were smoking. However, occasionally
people do experience depression in
the months after quitting smoking.
Sometimes these feelings may be
related to quitting, but often they’re not.
You could be more vulnerable to
developing depression after quitting if:
• you’ve had symptoms of depression
following previous attempts to quit
• you’ve had an increase in symptoms
of depression just before quitting
• you’re in the process of changing
your medication for depression
• you have current or past problems
with drugs and alcohol.
It’s important to talk to your doctor
about any concerns you may have.
Overall, the benefits of quitting for
people with depression are far greater
than any possible risks of quitting.
“I believe stopping smoking has
helped my mental health and
management of my depression.
I stopped smoking in the peak of
my depression and looking back,
I am so proud of myself for finally
doing it and I haven’t looked back.”
– Amanda, 35
Steps for success
Understanding addiction
and withdrawal
Smoking is an addiction that is made
up of three parts: chemical addiction,
habits and emotional ties.
Chemical addiction
• You have cravings and withdrawal
symptoms when you try to quit.
If you answered yes, then quitting
medications are likely to help you.
Habits
Do you smoke as part of certain
routines, in certain places and/or with
particular people? These situations
can become triggers for craving a
cigarette. For example, drinking coffee
or alcohol, after a meal, smoking with
friends or watching TV.
Emotions
Do you use smoking to deal with
feelings? Negative moods such as
stress, anger, sadness or frustration
might make you feel like smoking. You
may smoke for pleasure or to increase
your concentration. You might feel like
a cigarette when you are happy and
want to reward yourself with
something you enjoy.
“I began smoking during a difficult
time. I was suffering depression
and anxiety, my father was
diagnosed with leukaemia and
my grandmother passed away.
I felt I needed something to
relieve my pain.”
• You smoke more than 10
cigarettes per day.
2
Quitting smoking is hard, but there
is no need to do it alone. There are
treatments to help to reduce
withdrawal symptoms and cravings,
and support services to help you
manage habits and emotions linked to
your smoking.
Both coaching (professional support)
and quitting medications (including
nicotine replacement products) have
been shown to increase quit rates. You
have the best chance of quitting for
good if you combine coaching with
quitting medication.2
“Write down your reasons for
quitting as you think of them.
I finished up with 32 after starting
with one. They all add to your
resolve when it weakens for
whatever reason. We had a saying
at our quit support group, ‘If you
have a problem and you light up a
cigarette to help solve it, you will
then have two problems, the
original and now you are a
smoker again’.”
– Dale, 66
– Jessica, 25
Why do you smoke?
Find out what triggers your desire to
smoke. For one day, write down when
you smoke or have a craving – see
the table below. This will help you
learn about your smoking. The more
you know, the more you’ll be able to
anticipate and plan ways to deal
with cravings.
Date
Time
Activity/
situation
Feeling/
mood
Value
Outcome
What I could
do instead
1/9
9am
Running late
Stressed
4
1 cigarette
Deep breathing
10am
Coffee break
OK
3
1 cigarette
Eat an orange
1pm
Lunch with
friend who
smokes
Good
4
2 cigarettes
Tell him I
don’t smoke
anymore
10pm
Last one
before bed
Tired
3
1 cigarette
Listen to
relaxing music
Do you have any of these signs of
nicotine addiction?
• You smoke your first cigarette
within 30 minutes of waking up.
Treatment and support
Example:
Value: 1 = I could do without it; 2 = I feel like it; 3 = I need it; 4 = I really need it; 5 = I’m desperate for it
You can download the ‘My smoking record’ from www.quit.org.au
Coaching or professional support
Quitting medications
A quit coach gives you structure,
motivation, support, new skills and
confidence. It’s so much harder to get
these things when you’re trying to quit
on your own. The more times you’ve
tried to quit and the less confident you
are, the more coaching you’re likely to
need. Good coaches include:
Quitting medications reduce withdrawal
symptoms such as cravings, irritability,
mood swings and anxiety. Medications
don’t usually stop all withdrawal
symptoms because most people’s
smoking is also linked to habits and
emotions. This means you’re likely to
get some cravings when you’re in
situations where you used to smoke.
Coaching can help you handle
these times and adjust to life
without cigarettes.
• Your doctor or another mental
health professional
Your doctor can advise on the best
time for you to quit and help you
choose the most suitable quitting
medications. Your doctor can also
monitor your depression, advise on
treatments and help you manage your
mood while you quit. They can also
check whether you are taking any
medications that might be affected
when you reduce or quit smoking.
Some medications – including some
antidepressant medications – are
used more quickly by the body in
people who smoke, so the dosage may
need to be reduced when cutting down
or stopping smoking.
If you are taking any medication it
is important to talk to your doctor
about it.
• Quitline 13 7848 (13 QUIT)
The Quitline telephone service
provides access to self-help
resources, advice, support and
confidential counselling for people
who want to quit smoking. If you
decide to use Quitline’s free callback
counselling service, Quitline advisors
will arrange to call you before and
after your quit date at times convenient
to you. Quitline may also be able to
help coordinate care with your doctor.
• QuitCoach (www.quitcoach.org.au)
QuitCoach is a free online tool that
sends personalised support direct to
your computer. It does this after you
have answered some questions about
your lifestyle and your smoking.
Quit Coach can help you before,
during and after you quit.
There are two kinds of medication:
• Nicotine replacement products
These are available in the form of
nicotine patches, gum, lozenges,
inhalers and mouth spray. If you have
strong cravings or withdrawal
symptoms, you can use both the
nicotine patch and 2mg gum (or the
2mg or 1.5mg lozenge) at the same
time if you need to. If you smoke 15 or
more cigarettes a day, using a
pre-quitting patch for two weeks
before your quit date can further
improve your chances of success.
For those who are not ready or unable
to quit, the nicotine gum, inhaler or
lozenge can be used while cutting
down the number of cigarettes you
smoke over six months before you
stop smoking completely. Your doctor
can provide you with a prescription to
access discounted nicotine patches
– this is much cheaper than buying
them over the counter.
• Prescription medications
There are currently two subsidised
medications prescribed by doctors
for stopping smoking - varenicline
(Champix) and bupropion (brand
names Zyban and Prexaton). These
medications work for some people
but are not suitable for everyone.
Bupropion is also an antidepressant
(but not used as such in Australia).
Nortripyline (Allegron) is an
antidepressant, which may also
help people quit smoking.
“Quitting was difficult, but it also
allowed me to see the light at the
end of the depression tunnel.
Every day I went without one
made me feel better and stronger.”
– Liz, 35
Strategies to help with both
quitting and improving mood
• Regular exercise is a great stress
buster, can improve your sleep and
help prevent weight gain. Make a
plan that is realistic for you to
achieve. Getting more exercise can
be as simple as getting off the bus
one stop before your destination or
using stairs instead of lifts. Or try
signing up for group exercises or
a team sport.
• Eat a healthier diet and include lots
of healthy snacks. (See beyondblue
Fact sheet 30 – Healthy eating for
people with depression and anxiety
at www.beyondblue.org.au)
• Treat yourself to something that’s
fun such as a weekend getaway,
fishing, full body massage, or try
something that you’ve wanted to do
for a while, but have put off.
• Reduce or stop drinking alcohol for
a while and try to halve your intake
of caffeine (e.g. coffee, chocolate,
cola drinks). Chemicals in cigarette
smoke make your body get rid of
caffeine faster. If you quit without
reducing your caffeine intake, you
will have higher levels of caffeine in
your blood, which may make you
feel restless, nervous or cranky.
3
• Spend time with positive
people who are supportive of
you quitting smoking.
• Relax and breathe. Regularly
practising breathing or muscle
relaxation exercises can really help
reduce your stress levels. (See
beyondblue Fact sheet 6 – Reducing
stress at www.beyondblue.org.au)
“Quitting made me healthier and
able to breathe more easily, leading
to me being able to exercise more
and be more active. Plus, I had
more dollars in the pocket!”
– Graeme, 45
How to cope with cravings
• Use the 4Ds – Delay, Deep breathe,
Drink water and Do something else.
Most cravings only last a few minutes.
• Think positive – tell yourself ‘I can
quit’ or ‘I don’t need cigarettes’ and
remind yourself of your main reasons
for wanting to quit smoking.
• Plan how to handle the feelings,
places and events that you know
make you want to smoke. For example,
meet friends who smoke at smokefree venues such as the movies or a
restaurant, avoid smoking breaks
at work and keep your hands and
mouth busy by chewing gum,
playing with your mobile phone or
sipping a bottle of water.
• Remember – if you have a cigarette,
it’s not the end of your quit attempt.
A slip-up is a setback, not a defeat.
It’s safe to keep using your quit
medication and to keep trying to quit.
“Don’t stop trying – persist even if
you have to have 10 goes. Keep
trying different methods, eventually
you will find the right method and
support that will work for you.”
– Amanda, 35
“No matter how many times you
have tried, it is always worth one
more go. You can do it if you really
want to, but do not feel that one
slip means that the task is
impossible, it means you have
another chance.”
– Graeme, 45
Where to find more information
Quit
www.quit.org.au
Read, interact with and download information on how to quit.
Quitline
13 7848 (13 QUIT)
Professional coaches who provide strategies and support.
QuitCoach
www.thequitcoach.org.au
Free online tool that sends personalised support direct to your computer.
beyondblue
beyondblue, in collaboration with
Quit Victoria, have also produced
‘Depression and quitting smoking:
an information booklet’. The free
booklet is available to download or
order from www.beyondblue.org.au
www.beyondblue.org.au 1300 22 4636
Information on depression and anxiety, available treatments and where to get help.
beyondblue would like to thank
members of its national reference
group, blueVoices, for sharing their
personal experiences for the fact
sheet and booklet. Their comments
are quoted throughout and their
feedback has been invaluable.
mindhealthconnect
Lifeline
www.lifeline.org.au 13 11 14
Access to crisis support, suicide prevention and mental health support services.
www.mindhealthconnect.org.au
Access to online programs and trusted information on depression, stress or
anxiety from the Australia’s leading mental health organisations.
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twitter.com/beyondblue
1 Parrott AC & Murphy RS. Explaining the stress-inducing effects of nicotine to cigarette smokers. Hum Psychopharmacol Clin Exp 2012: 27: 150-155,
DOI: 10.1002/hup.1247
2 Tobacco Use and Dependence Guideline Panel. Treating Tobacco Use and Dependence: 2008 Update. Rockville (MD): US Department of Health and
Human Services; 2008 May. Available from: http://www.ncbi.nlm.nih.gov/books/NBK63952/
www.beyondblue.org.au 1300 22 4636
© Beyond Blue Ltd. BL/1055 02/13