Today is World Tobacco Day. In the special feature, we reach out to those who have been trying to quit smoking or chewing tobacco to help them.

Everyone who smokes knows that smoking is not good for them, yet they do it. There is a reason for this – smoking and mental health are connected. People who smoke or chew tobacco have linkages with anxiety, stress and depression as per research at Purdue, WHO, Hebrew University and Mental Health Foundation UK. And that is why they turn to tobacco for enhanced moods, or simply gaining confidence to be able to face the world

We often associate tobacco with the looming spectre of physical ailments, such as cancer and heart disease. But there is a quieter, insidious battle being fought within the realms of the mind.

The vicious cycle of tobacco use and mental illness

Mental illness makes people twice as likely to use tobacco and, at the same time, tobacco makes people more vulnerable to mental health concerns.

People with mental health problems, including anxiety, depression, or schizophrenia:

• are much more likely to smoke than the general population.
• tend to smoke more heavily.
• die on average 10 to 20 years earlier than those who don’t experience mental health problems – smoking plays a major role in this difference in life expectancy.
• need higher doses of some antipsychotic medicines and antidepressants because smoking interferes with the way these medicines work.

“The connection between nicotine use and mental health is a vicious cycle,” said Lindsay Bloom, health coach at Purdue Fort Wayne. “Statistics show the connection between those living with mental health issues and the use of tobacco (smoking, vaping, etc.). This increase can be linked to individuals wanting to self-medicate to help alleviate symptoms of their mental health issues; however, using tobacco doesn’t really alleviate the symptoms. It negatively impacts mental health. Over time, smoking can lead to lower levels of dopamine production by the brain, which then triggers a need to smoke more to increase the dopamine levels.”

Smoking and mental health

According to the WHO, the relationship between tobacco use and mental health is complex and eye-opening. People with severe mental health conditions die on average 15–20 years prematurely, with tobacco cited as one of the main causes of death.

The impact of tobacco use is not limited to mortality rates but also affects the quality of life and attempts to cope with poor mental health. For example, tobacco reduces the effectiveness of certain medications for mental health. Conversely, quitting tobacco can allow people on certain antipsychotic medications to reduce the dosage by up to 25%.

In 2012, global prevalence rates for tobacco smoking were estimated to be 31% for men and 6% for women. Rates of smoking are markedly higher among people with psychiatric illness than in the general population, estimated at being 2–5 times higher in patients with several disorders, including schizophrenia, mood disorders, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), binge eating disorder, bulimia, and substance use disorders.

Smoking and anxiety disorders

Smoking has been linked to the development and maintenance of anxiety disorders due to nicotine’s ability to alter fear memory and emotional processing. It has also been proposed that smoking’s effects on the monoaminergic and glutamatergic systems, oxidative stress, as well as inflammatory and neurotrophic processes, may contribute to the neuropathological mechanisms underlying the development of bipolar illness.

Thus, while individuals with mental health issues smoke and use tobacco at higher rates, the effects of the users can also bring about mental health concerns such as:

• Addiction
• Stress
• Depression
• Schizophrenia

Smoking and depression

Research by Hebrew University studied the relationship between health-related quality of life and smoking and strongly observed an association between smoking and poorer physical and mental health components of health-related quality of life (HRQoL). Overall, the study found that having a higher Beck Depression Inventory (BDI) score was associated with smoking. Furthermore, the students who smoked were two to three times more likely to have clinical depression than those who had never smoked.

“A strong association between Beck Depression Inventory (BDI) score Physical composite score (PCS) and Mental composite score (MCS) score was found across all five quantile scores,” explained Professor Levine from the Hebrew University-Hadassah Braun School of Public Health and Community Medicine in Jerusalem, Israel who is also the senior and corresponding author of the study paper. The study appeared in the journal PLoS ONE.

Those who smoked also consistently had more depressive symptoms and poorer mental health, as reflected in the “vitality” and “social functioning” parameters.

“These findings highlight the need for further research on the interaction between smoking, mental health, and quality of life, with implications for prevention, diagnosis, and treatment,” conclude the study authors. Prof. Levine adds, “Our study adds to the growing body of evidence that smoking and depression are closely linked.”

“While it may be too early to say that smoking causes depression, tobacco does appear to have an adverse effect on our mental health,” Prof. Levine added.