Can stopping smoking be bad for mental health?

Author and presenter:
Jonathon Foulds
Professor, University of Medicine and Dentistry of New Jersey,
School of Public Health, and Director, Tobacco Dependence Program, New Jersey, USA

Abstract
Stopping smoking frequently results in a syndrome of withdrawal symptoms that includes depression, anxiety, insomnia and irritability. Most studies find that these symptoms are mild to moderate and are time limited, peaking in the first week, and are largely resolved within four weeks. However, it has been suggested that nicotine or other substances in tobacco may have a medication-like effect for some smokers, and that stopping smoking may trigger the onset or worsening of more serious and longer term mental health problems. The move to providing mental health care on a smoke-free campus, and attempts to understand reports of psychiatric adverse events in smokers using varenicline have prompted a reevaluation of the evidence that stopping smoking may produce more serious mental health problems in some people. This presentation will summarize that evidence. It is concluded that for the vast majority of smokers, quitting smoking involves a temporary period of mood disturbance, quickly followed by a period of normal or improved functioning. If anything, most smokers overestimate the benefits of smoking for reasons such as stress-relief. However, it is plausible that for a small proportion of smokers, quitting smoking cold turkey may result in longer term problems. Onset of depression due to normalization of brain MOAB levels is one plausible mechanism. These smokers will need more intensive tobacco dependence treatment.

Source of funding: Jonathan Foulds has for the past nine years been primarily funded by a grant from New Jersey Department of Health and Senior Services. His other recent grant funding (also as P.I.) is from the Cancer Institute of New Jersey, the Rutgers Community Health Foundation and the Robert Wood Johnson Foundation. He was previously on a speakers’ bureau for Pfizer and has previously worked as a paid consultant for pharmaceutical companies involved in production of tobacco dependence treatment medications (e.g. Pfizer, Novartis, GSK, Celtic Pharma). He writes a regular column on a health website: http://www.healthline.com/blogs/smoking_cessation/

Declaration of interest: Some may perceive conflicts between my paid employment in tobacco control and my teaching/research/advocacy on this topic, or between my paid consulting with pharmaceutical companies and research/teaching/advocacy that could be relevant
to those companies’ products.

About the presenter
Jonathan Foulds PhD, is a Professor at UMDNJ-School of Public Health and the Director of its Tobacco Dependence Program (www.tobaccoprogram.org). He trained as a clinical psychologist in the United Kingdom and has spent most of his career developing and evaluating methods to help smokers beat their addiction to tobacco. He was on the Management Group of the Hungarian Anti-Smoking Campaign (1995 – 6), has been a technical leader of a World Health Organization project to improve the regulation of tobacco dependence treatment in Europe (2000), and was Director of Research for the charity, Quit, which ran the largest telephone helpline for smokers in the world at that time. He was a founding member and Vice President of the Association for the Treatment of Tobacco Use and Dependence (ATTUD) 2004 – 6. He has published over 75 papers on tobacco and writes a regular blog on smoking cessation http://www.healthline.com/blogs/smoking_cessation/