Quitting Smoking With Depression or Anxiety: What to Expect and How to Get Through It
Quitting smoking and depression can feel like a hard mix. Learn why mood dips at first, which medications help, and why your prescriber should know you quit.
A drink at the end of a hard day, or cannabis to help you sleep, can feel like relief when you're depressed. But depression and alcohol often make each other worse over time, and cannabis can do the same. Here's how both affect your mood and your treatment, and how to make changes safely.
Key takeaways
- Alcohol slows down the brain, and heavy drinking can cause or worsen depression.
- Cannabis may bring short-term relief, but frequent heavy use is linked with worse depression over time.
- Antidepressants can still help if you drink or use cannabis, but heavy use can blunt the benefit and add risks.
- If you drink heavily every day or most days, don't stop suddenly. Alcohol withdrawal can be dangerous.
- Treating depression and substance use together tends to work better than treating one at a time.
If you need help now: If you have thoughts of suicide, call or text 988, or text HOME to 741741. Call 911 in an emergency, including if someone may have had a seizure or taken too much of a substance. For free, confidential treatment referrals, call the SAMHSA National Helpline at 1-800-662-4357. More options are on our crisis resources page.
How depression and alcohol affect each other
Alcohol brings quick relaxation, which is why it's easy to lean on. But it slows down the brain, and the relief fades fast. Here's how it can feed depression:
- The rebound. As alcohol wears off, mood can drop and anxiety can rise, sometimes lower than before you drank.
- Poor sleep. Alcohol may help you fall asleep, but it disrupts sleep later in the night. Poor sleep makes depression harder to manage.
- The next day. Hangovers, guilt and low energy can make it harder to do the things that help you feel better.
- Lower inhibitions. Alcohol makes impulsive actions more likely, including during dark moments. That's one reason safety plans often include limiting alcohol.
Heavy drinking can also cause depression on its own. When that's the case, symptoms often improve noticeably after a few weeks without alcohol. If depression stays after that, it likely needs its own treatment.
How cannabis affects depression
Many people use cannabis for stress, sleep or low mood, and some say it helps in the moment. The longer-term picture is less reassuring. Frequent heavy use, especially of high-THC products, has been linked with more depression, lower motivation and a flat or foggy feeling.
A few other things are worth knowing:
- Many of today's products contain much more THC than in the past.
- Use that starts in the teen years has been linked with a higher risk of depression later on.
- Regular use can lead to cannabis use disorder, where it becomes hard to cut back despite problems.
- Stopping after regular use can cause withdrawal, with irritability, low mood, poor sleep, vivid dreams and less appetite. This usually eases within a couple of weeks.
- High-THC cannabis can trigger or worsen psychotic symptoms in some people.
Cannabis is legal for adults in Illinois, but legal isn't the same as low risk for your mood. The National Institute on Drug Abuse has more on how cannabis affects the brain.
| Alcohol | Cannabis | |
|---|---|---|
| Short-term effect on mood | Relaxation, then a rebound dip | Relief or calm for some, anxiety or paranoia for others |
| Effect on sleep | Disrupts later-night sleep | May help at first, with sleep problems when stopping |
| Longer-term link with depression | Heavy use can cause or worsen it | Frequent heavy use is linked with worse symptoms |
| Withdrawal | Can be dangerous after heavy daily use | Uncomfortable but usually not dangerous |
Do antidepressants work if you drink or use cannabis?
Often they still can, and you don't need to be perfectly sober to start treatment. But heavy or frequent use can get in the way:
- The substance keeps pushing your mood and sleep in the wrong direction, working against the medication.
- It's harder to tell what's helping. Was a bad week the medication or the weekend?
- Missed doses become more likely.
Many prescribers advise limiting or avoiding alcohol while you take an antidepressant. Be honest about how much you drink or use. Your prescriber isn't there to judge.
Interaction and safety cautions
Some combinations call for extra care:
- Extra sleepiness. Alcohol and cannabis can add to the drowsiness from sedating medications, such as mirtazapine, trazodone, sleep medications and some antipsychotics. Don't drive if you feel impaired.
- Benzodiazepines. Combining these with alcohol or opioids can slow breathing to a dangerous degree.
- Bupropion. Heavy drinking, and especially stopping heavy drinking suddenly, can raise the risk of seizures.
- MAOIs. Certain beers and wines contain tyramine, which can cause a dangerous rise in blood pressure with these medications.
- Liver strain. Heavy drinking stresses the liver, and some medications, such as duloxetine, aren't recommended with heavy alcohol use.
- Medication levels. Cannabis products, including CBD, can change how the liver processes some medications.
- Bipolar disorder. Cannabis can make mood episodes harder to control.
Antidepressants also carry an FDA boxed warning about a higher risk of suicidal thoughts and behaviors in children, teens and young adults. Talk with your prescriber before starting, stopping or changing any medication.
How to cut back safely
Small, specific steps tend to work best:
- Track how much and how often you drink or use for a week or two.
- Set a clear goal, whether that's cutting back or stopping.
- Plan other ways to handle the moments you usually drink or use, such as winding down at night.
- Tell someone you trust about your goal.
The Rethinking Drinking site from the National Institutes of Health has free tools for checking and changing your drinking.
Alcohol withdrawal can be dangerous
If you drink heavily every day or most days, stopping suddenly can cause shakiness, sweating, a racing heart and anxiety. In severe cases, it can cause seizures, hallucinations or delirium tremens, a state of severe confusion that can be life-threatening.
Talk with a medical provider before you stop. Some people can withdraw safely as outpatients with close monitoring, while others need a medically supervised withdrawal program. Call 911 for a seizure, confusion or hallucinations.
Stopping cannabis
Cannabis withdrawal is usually not dangerous, but plan for a week or two of poor sleep and irritability. It passes.
Treating depression and substance use together
When depression and substance use happen together, treating both at the same time tends to work best. In outpatient addiction psychiatry, care can include:
- A full evaluation to sort out how much depression is driven by substances and how much is separate
- Antidepressants chosen with your substance use in mind
- FDA-approved medications for alcohol use disorder, when they fit
- Lab work, such as liver tests
- Help connecting with skills-based treatment with a trained mental health professional and peer support
Our post on anxiety and substance use covers medications for alcohol and opioid use disorders in more detail. If you need more support than outpatient visits provide, read about signs you need a higher level of care.
Frequently asked questions
Is it okay to have one drink while on an antidepressant?
It depends on your medication, your health and your history with alcohol. For some people an occasional drink is low risk, while for others any alcohol is a bad idea. Ask your prescriber what's safe for you.
Will cannabis stop my antidepressant from working?
Occasional use may not stop it from working, but frequent heavy use can work against your progress and make it hard to judge whether the medication is helping. Tell your prescriber how often you use so you can plan together.
How can I tell if drinking is causing my depression?
If symptoms improve a lot after a few weeks without alcohol, drinking was likely a big factor. A psychiatric evaluation can help sort it out safely.
Is cannabis a safer choice than alcohol for depression?
Neither is a treatment for depression, and frequent use of either is linked with worse mood over time. Your provider can help you find treatments with real evidence behind them.
Get help for both, in one place
You can work on your mood and your drinking or cannabis use at the same time. At Musec Medical, our psychiatrist and psychiatric physician assistants offer outpatient addiction psychiatry and depression care, in person in Chicago and by telehealth anywhere in Illinois. Request an appointment to take the first step.
