Quitting smoking and mental health: what the evidence says about mood

Many people smoke partly to manage stress, low mood or anxiety, so the idea of quitting can feel risky for mental health. The CDC reports that in 2019, 27.2% of US adults with a mental health condition reported smoking cigarettes in the past month, compared with 15.8% of adults with no mental health condition. This page covers how common smoking is among people with mental health conditions, what happens to mood in the early weeks, what a major 2014 review found about mental health after quitting, and when to involve a clinician.

How common smoking is with mental health conditions

The CDC says people with certain diagnoses, such as depression and anxiety, are more likely to use commercial tobacco than people without them. Its health equity pages state that almost 40% of all cigarettes smoked by US adults are smoked by people with behavioral health conditions. For one condition, schizophrenia, the CDC cites a 2006 survey in which nearly 90% of adults with the diagnosis reported smoking cigarettes.

A second CDC page, drawing on a 2020 national survey, reports that 23.1% of US adults with any mental illness smoked cigarettes in the past month, against 14.5% of adults with no mental illness. The two pages use different survey years and different groupings, so their percentages are not directly comparable. Both show the same direction of difference.

The health stakes are significant. The CDC states that people with mental health conditions who smoke have two times the risk of premature death compared with people with behavioral health conditions who do not smoke, and that the most common causes of death in this group, heart disease, cancer and lung disease, can all be caused by smoking.

Why smoking feels like it helps

Surveys and interviews summarized in the BMJ review described below find that regular smokers report smoking to relieve emotional problems, feelings of depression and anxiety, to stabilize mood and to relax. That pattern appears in smokers with and without a diagnosed mental disorder.

Smokefree.gov, from the US National Cancer Institute, offers an explanation for the felt benefit. It says some regular smokers believe smoking eases anxiety, but that this is because smoking relieves their nicotine withdrawal symptoms, and the relief is only temporary. It adds that nicotine itself can cause anxiety symptoms or make them worse. The mechanics of that cycle are described on how nicotine dependence works.

What the largest review found about mood after quitting

In 2014 a team led by Gemma Taylor published a systematic review and meta-analysis in the BMJ titled "Change in mental health after smoking cessation." It pooled 26 longitudinal studies of adults who were assessed before they stopped smoking and at least six weeks afterwards. Follow-up measurements were taken between seven weeks and nine years after baseline, in both healthy and clinical populations.

Compared with people who kept smoking, those who quit showed significant decreases in anxiety, depression, mixed anxiety and depression, and stress. They also showed significant increases in psychological quality of life and positive affect (a measure of positive mood). The authors found no evidence that the effect differed between the general population and people with physical or psychiatric disorders. Their conclusion was that smoking cessation is associated with reduced depression, anxiety and stress and improved positive mood and quality of life compared with continuing to smoke, and that the effect sizes seem as large for people with psychiatric disorders as for those without. They also state the effect sizes are equal to or larger than those of antidepressant treatment for mood and anxiety disorders.

Two cautions apply. The review pooled observational studies, which show an association and cannot on their own prove that quitting caused the improvement. And the finding is about average change across groups of people. It cannot predict how any one person will feel, particularly in the first days.

The early weeks can feel different

The BMJ finding concerns follow-up of at least six weeks, so it does not describe the first days after the last cigarette. The CDC says nicotine withdrawal can include irritability, anxiety or depression for a short time, and that these feelings can be managed by being active, connecting with other people and staying busy. It adds that once people have been smoke-free for a few months, their anxiety and depression levels are often lower than when they were smoking.

Smokefree.gov also tells readers that some people feel increased anxiety, sadness or depression after quitting, and to watch for this especially if they have had these symptoms before. NIDA says withdrawal symptoms usually peak within the first few days and subside within a few weeks, although for some people they last for months. The expected pattern is laid out on withdrawal symptoms and how long they last.

When to talk to a clinician

The CDC says people with mental health conditions such as depression and anxiety face challenges in quitting and may benefit from extra help, and that with the right support it is possible to quit smoking without worsening a mental health condition. It advises that feelings of depression or anxiety lasting more than two weeks, or feelings that seem unmanageable or get worse, are a reason to get help and talk to a doctor. In the US, the CDC and Smokefree.gov point to the 988 Suicide and Crisis Lifeline (call or text 988) for anyone in distress or having thoughts of self-harm, and to 911 or an emergency department in an emergency. Readers elsewhere should use their local emergency number.

Anyone with a diagnosed condition, or who takes medicine for one, should raise quitting with the prescriber or pharmacist before the quit date. This site does not advise starting, stopping or changing any medicine. The product label and a clinician decide that. Options such as prescription medicines for quitting and counselling and quitlines are described on their own pages, and preparing to quit covers lining up support before a quit date.

The short version

Smoking is more common among adults with mental health conditions, and many use it to cope, but the best pooled evidence links quitting with lower anxiety, depression and stress after at least six weeks. The first days can be harder, so planning support helps. Anyone with a mental health condition, or taking medicines, should speak with a clinician or pharmacist about quitting, and seek urgent help if mood becomes unmanageable.