The Association of Mental Health and Smoking

Everyone knows that smoking is bad for your physical health, but few are aware of its association with mental health. It is estimated, in the developed world at least, that about 20% of the population suffer from some form of mental illness. Interestingly, about 50% of sufferers are also smokers, a rate which is about twice the rate of the 'mentally healthy' population. Not only are smoking rates higher for those with poor mental health but as a group they consume more cigarettes in comparison to other smokers. In addition, those with mental illness also have lower quit rates.

Smoking and Schizophrenia

Studies have shown that schizophrenics are particularly prone to smoking with 75% to 90% classified as regular smokers. It is thought that schizophrenics are self medicating with nicotine. Nicotine stimulates several chemicals in the brain, including dopamine and acetylcholine, these chemicals affect a whole range of physiological processes, influencing mood, memory, alertness and feelings of well being. An imbalance of these same chemicals occurs in the brains of schizophrenics. Nicotine therefore, appears to relieve some of the symptoms of the disorder, although the relief is short lived and probably explains the relatively high cigarette consumption amongst schizophrenics. The self medication hypothesis has also been invoked to explain the link between smoking and other types of mental illness.

Smoking and Depression

It comes as no surprise that patients with depression have higher smoking rates than the general population. And again, the mood modifying effects of nicotine is thought to be responsible; but perhaps this not the whole story. The latest research suggests that there may be other chemicals in cigarette smoke which contribute to the alleviation of depressive symptoms. A new treatment for smoking cessation (Zyban) was originally assessed because of its anti-depressive properties. Coincidently it was discovered that it helped users to quit smoking. It remains an effective treatment for depression and for smoking cessation, and has promise as a quit aid for depressive smokers. To make matters more complex it has been reported that smoking may actually be a factor in depression causation. However, the reason for this relationship, as yet, remains unclear. The research is not definitive and according to current knowledge the association remains suggestive, but not established. Consequently, the role of cigarette smoking in depression is complex, and admittedly, poorly understood.

Hospital Smoking

Visit any hospital and you will see no smoking signs plastered everywhere. The most ineffective are those posted on the entrances and exits. Every day you will notice clusters of staff, visitors and sadly patients (some attached to IV drips) just outside the doors and mostly underneath the 'no smoking' signs, frantically puffing away. Therefore, it is surprising to observe smoking on the wards. Or to be exact one ward- the psychiatric ward. This is where smoking is tolerated. Understandably, the medical focus is on the treating the mental disorder. Nicotine addiction is viewed as a side issue, and perhaps an ally. Tackling nicotine addiction in these circumstances is of secondary importance. Doctors facing acute mental illness should be forgiven for focusing on the short term management of symptoms. In this regard I am a realist. As always, when dealing with nicotine dependency, as with most things in life, there are really no simple solutions