Quitting Smoking With Depression or Anxiety: What to Expect and How to Get Through It

If you live with depression or anxiety, cigarettes may feel like one of the few things that help you cope. That can make quitting feel risky, or even impossible. Quitting smoking and depression are closely linked, and the first weeks can be rough, but people with depression and anxiety quit successfully all the time, and many feel better for it in the long run.

Key takeaways

• Irritability, anxiety, low mood and poor sleep in the first weeks after quitting are often signs of nicotine withdrawal, and they usually ease.
• Over time, quitting is linked with better mood and less anxiety, not worse.
• Support and medication make quitting more likely to stick.
• Quitting can raise the levels of some psychiatric medications, so tell your prescriber before you quit.
• Free help is available at 1-800-QUIT-NOW (1-800-784-8669).

If you're struggling right now: If you have thoughts of harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline. Call 911 in an emergency, or text HOME to 741741. You can find more options on our crisis resources page.

Why your mood can dip after you quit

Nicotine acts on brain chemicals tied to reward, focus and mood. With regular use, your brain adapts to having it around. When you stop, your brain needs time to readjust, and that adjustment is nicotine withdrawal.

Common withdrawal symptoms include:

• Irritability, frustration or a short temper
• Anxiety and restlessness
• Low or sad mood
• Trouble concentrating
• Trouble sleeping or vivid dreams
• More appetite
• Strong urges to smoke

Symptoms often start within hours to a day of your last cigarette and tend to be strongest in the first week or so. For most people, they ease over the following weeks. Cravings can pop up longer than that, often triggered by stress, coffee, alcohol or certain times of day, but they get shorter and less frequent.

It also helps to know that much of the calm a cigarette seems to bring comes from relieving withdrawal that has built up since the last one. That's why smoking can feel like it eases anxiety, even though it keeps the cycle going.

Quitting smoking and depression: what happens over time

The early weeks aren't the whole story. Research has found that people who quit tend to have less depression, anxiety and stress afterward than people who keep smoking. That's encouraging if you've been afraid quitting will make your mental health worse for good.

That doesn't mean it's easy, and it isn't guaranteed. For some people with a history of depression, quitting can stir up symptoms, which is why it helps to have your psychiatric provider involved. If low mood lasts more than a few weeks, keeps getting worse or comes with hopelessness, it may be depression rather than withdrawal, and it deserves attention.

How to quit successfully with depression or anxiety

You don't need to wait until your mood is perfect. A stretch when things feel relatively stable is a good time to try, and planning ahead makes a real difference.

• Make a plan with your prescriber. Talk about timing, medication and what to watch for.
• Combine medication and support. Using both tends to work better than willpower alone.
• Know your triggers. Plan what you'll do instead during your usual smoking times, such as after meals or on work breaks.
• Have go-to coping tools. A short walk, slow breathing, a glass of water or a quick call to a friend can carry you through a craving. Movement can also lift mood, as we cover in our post on exercise and mental health.
• Protect your sleep. Keep a steady bedtime and wind-down routine while your body adjusts.
• Treat slips as information. Many people need several tries before quitting for good. A slip shows you what to plan for next time.

Free help is easy to find. Call 1-800-QUIT-NOW (1-800-784-8669) to reach your state's quitline. Smokefree.gov also offers free text programs, apps and tips.

Medications that can help

Three main types of medication can make quitting easier:

• Nicotine replacement, including patches, gum, lozenges, inhalers and nasal spray. Some are available over the counter.
• Varenicline, a prescription medication that reduces cravings and makes smoking less rewarding.
• Bupropion, a prescription medication also used as an antidepressant.

In the past, varenicline and bupropion carried an FDA boxed warning about serious mental health side effects when used to quit smoking. The FDA removed that warning after a large safety study that included people with psychiatric conditions. Even so, report any new or worsening mood changes, agitation or unusual thoughts to your prescriber.

Bupropion, like all antidepressants, carries a boxed warning about a higher risk of suicidal thoughts and behaviors in children, teens and young adults. It also isn't right for people with certain conditions, such as a seizure disorder or an eating disorder. Talk with your prescriber before starting, stopping or changing any medication.

E-cigarettes are not FDA-approved as quit aids. If you vape, or are thinking about switching, talk it over with your provider.

Tell your prescriber before you quit

Chemicals in tobacco smoke speed up how the liver breaks down certain medications. When you stop smoking, that effect wears off over days to weeks, and the levels of those medications in your blood can rise.

Two well-known examples are clozapine and olanzapine, both antipsychotic medications. Levels of some other psychiatric medications can be affected too. Your prescriber may want to check blood levels or adjust your dose around your quit date.

The effect comes from the smoke, not the nicotine. That means switching to nicotine patches or gum won't prevent it. It also works in reverse, so if you start smoking again, levels may drop. Let your prescriber know about any change in your smoking, and never adjust a dose on your own.

Caffeine is affected in a similar way. After you quit, your usual coffee may hit harder, leaving you jittery, anxious or awake at night. Cutting back on caffeine can make withdrawal easier to tell apart from anxiety.

When to call for help

Call your prescriber if you notice:

• Low mood or anxiety that lasts more than a few weeks or keeps getting worse
• New agitation, hostility or unusual changes in behavior
• Sleep problems that aren't easing
• Side effects from a quit-smoking medication
• Unusual sleepiness, dizziness, unsteadiness or confusion, which could mean a medication level has risen
• You've started smoking again after quitting

Get help right away for thoughts of suicide by calling or texting 988. Call 911 for a seizure, fainting or sudden severe confusion.

If smoking is one part of a bigger picture with alcohol or other substances, our post on anxiety and substance use explains why treating both together helps.

Frequently asked questions

Will quitting smoking make my depression worse?

You may feel worse for the first few weeks as withdrawal runs its course. Over the longer term, research links quitting with better mood, not worse. Having your psychiatric provider involved helps you tell withdrawal apart from depression that needs attention.

Should I wait until my depression is under control to quit?

Not necessarily. A relatively stable time is helpful, but you don't need to feel perfect. Your prescriber can help you pick a good time and set up support.

Can I use nicotine replacement while taking an antidepressant?

Many people use the two together. Still, tell your prescriber about every product you use, including over-the-counter nicotine replacement. That helps them track how you're feeling and spot any problems.

Does switching from cigarettes to vaping affect my medication?

It can. The effect on medication levels comes from smoke, so switching to vaping may raise levels of certain medications much as quitting does. Tell your prescriber before you make the switch.

Get support as you quit

You don't have to choose between your mental health and quitting. At Musec Medical, our psychiatrist and psychiatric physician assistants offer addiction psychiatry and medication management to help you quit while keeping your mood steady, in person in Chicago and by telehealth anywhere in Illinois. Request an appointment to start planning.