Can cigarettes cause depression

Can Smoking Cause Depression?

Researchers have made bold claims about cigarette smoking leading to depression. It has long been known that smokers have higher rates of depression than nonsmokers, but researchers from the University of Otago in New Zealand investigated the link further, and say they have found a causal relationship.

The team took figures from over 1,000 men and women aged 18, 21 and 25 years. Smokers had more than twice the rate of depression. Using a computer modeling approach, their analysis supported a pathway in which nicotine addiction leads to increased risk of depression.

In the British Journal of Psychiatry, the researchers wrote, “The best-fitting causal model was one in which nicotine dependence led to increased risk of depression.” They suggest two possible routes, one involving common risk factors, and the second a direct causal link.

According to the researchers, “this evidence is consistent with the conclusion that there is a cause and effect relationship between smoking and depression in which cigarette smoking increases the risk of symptoms of depression.”

Professor David Fergusson, the study’s lead researcher, said, “The reasons for this relationship are not clear. However, it’s possible that nicotine causes changes to neurotransmitter activity in the brain, leading to an increased risk of depression.” But he adds that the study “should be viewed as suggestive rather than definitive.”

Writing in the same journal, Marcus Munafo, PhD of Bristol University, UK, reports that cigarette smokers often talk about the antidepressant benefits of smoking. “But evidence suggests that cigarette smoking may itself increase negative affect , so the causal direction of this association remains unclear,” he writes.

As Munafo points out, the role of nicotine in depression is complex, because smokers often feel emotionally uplifted following a cigarette. Bonnie Spring, PhD, at Hines Hospital, VA Medical Center, Illinois, looked at the link. Spring explains that depression-prone smokers are thought to self-administer nicotine to improve mood. But little evidence supports this view, so she examined nicotine’s effect on depression.

Her team recruited 63 regular smokers with no history of diagnosed depression, 61 with past but not current depression, and 41 with both current and past depression. All were given either a “nicotinized” or a “denicotinized” cigarette following a positive mood trigger.

Those who had experienced depression showed an enhanced response to the positive mood trigger when smoking a nicotinized cigarette. The researchers wrote, “Self-administering nicotine appears to improve depression-prone smokers’ emotional response to a pleasant stimulus.” The reason for this effect is not clear.

This study was followed up in 2010 by scientists at the University of Pittsburgh. Kenneth A. Perkins, PhD and colleagues looked at whether smoking can improve a negative mood.

Again using nicotinized and denicotinized cigarettes, they found that smokers do feel better after a cigarette, but only when they haven’t smoked since the previous day. The improved mood after abstinence from smoking was a “robust” finding. However, cigarettes “only modestly” improved negative mood due to other sources of stress — in this case, a challenging computer task, preparing for a public speech, and watching negative mood slides.

The researchers say that relief from negative mood due to smoking depends on the situation rather than nicotine intake: “These results challenge the common assumption that smoking, and nicotine in particular, broadly alleviates negative affect.”

One major factor must be the smoker’s expectations. These were investigated by a team at the University of Montana. They write, “Expectancies about nicotine’s ability to alleviate negative mood states may play a role in the relationship between smoking and depression.”

They asked 315 undergraduate smokers to complete a survey, which supported the theory. Smokers believed that “higher levels of tobacco smoking will reduce negative emotions.” This expectation “fully explained the link relationship between depressive symptoms and smoking,” the researchers said.

Could the link between tobacco smoking and depression actually be due to other substance dependencies? A team from Switzerland thinks not. After surveying 1,849 men and women they found that alcohol and cocaine dependence were also significantly linked to depression. But when taking this into account, “the association between smoking and depression still remained statistically significant. This study adds support to the evidence that smoking is linked to depression,” they concluded.

So it seems that the evidence is stacked against nicotine as a mood lifter, despite widely-held beliefs to the contrary.

Schleicher, H. E. et al. The role of depression and negative affect regulation expectancies in tobacco smoking among college students. The Journal of American College Health, Vol. 57, March-April 2009, pp. 507-12.

Perkins, K. A. et al. Acute negative affect relief from smoking depends on the affect situation and measure but not on nicotine. Biological Psychiatry, Vol. 67, April 2010, pp. 707-14.

Can Smoking Cause Depression?

Smoking and Depression

If you have depression, there is a good chance you smoke, too. Studies have shown that depression and smoking often go hand in hand. People with depression are not only more likely to smoke, but may also find it harder to quit smoking than those who are not depressed.

Researchers have long recognized that there is a link between smoking cigarettes and depression. It is still not entirely clear exactly how smoking and depression are related, but several theories may explain the link:

  • Depression leads to smoking. It may be that people who are depressed turn to smoking, hoping to make themselves feel better and alleviate their depression symptoms.
  • Smoking causes depression. Recent research suggests that an increased risk of depression is among the many negative effects of smoking, possibly because nicotine damages certain pathways in the brain that regulate mood. As a result, nicotine may trigger mood swings.
  • A vicious cycle is at play. Other studies have suggested that smoking makes people more depressed and depression makes people turn to smoking — smoking and depression may actually perpetuate each other.
  • There may be shared genetic triggers. It has also been proposed that certain genetic predispositions may increase both the risk of smoking and depression in some people.

Secondhand Smoke and Depression

People who don’t smoke, but who spend a lot of time around people who do, are at increased risk of smoking-related death and disease. This is significant, since so many people are exposed to secondhand smoke.

Now studies have shown that secondhand smoke exposure may also be linked to depression. One found that those who never smoked or smoked fewer than 100 cigarettes in their lifetime but lived with or worked around smokers were more likely to have major depression than non-smokers not exposed to secondhand smoke.

What This Means for You

If you have depression, smoking or exposure to secondhand smoke could make your symptoms worse. Likewise, if you’re a smoker, an increased risk of depression is one more reason you should try to stop smoking and avoid secondhand smoke exposure.

As most smokers know, however, quitting is easier said than done. For people already managing depression, giving up cigarettes can be even trickier, since stopping smoking can also trigger worsening symptoms of depression. Even so, these symptoms eventually pass and the health benefits of quitting clearly outweigh any downside. To get the help you need to quit smoking, don’t be afraid to tell your doctor and ask for suggestions.

Remember that it is completely natural to feel irritable and sad in the first days and weeks after you stop smoking. Also keep in mind that many smokers who have depression experience more severe nicotine withdrawal symptoms than those who don’t. But sticking with your plan and staying away from cigarettes is worth it — it will help you feel better in the long run and, ultimately, proud that you have conquered the challenging task of quitting smoking.

Most people feel better within a month after they stop smoking. If your feelings of sadness and depression are overwhelming or if your depression continues for more than a month, be sure to talk to your doctor.

Does smoking cause depression?

Most of us are familiar with the physical health effects of smoking, but can the habit also affect our mental and emotional well-being? A new study suggests that it can, after finding a link between smoking cigarettes and depression.

Share on PinterestA new study examines the link between mental health and smoking among students.

The new study now appears in the journal PLOS ONE.

Prof. Hagai Levine — from the Hebrew University-Hadassah Braun School of Public Health and Community Medicine in Jerusalem, Israel — is the senior and corresponding author of the study paper.

In it, Prof. Levine and colleagues explain that there are clues in existing research that point to smoking as a predisposing factor to depression.

For instance, depression tends to be twice as likely among people who smoke than those who do not, but it is not yet clear which causes which. Some researchers, however, believe that smoking may lead to depression, not vice versa.

What is more, other studies have found that people who had never smoked generally have a better health-related quality of life (HRQoL), as well as less anxiety and depression.

So, to help shed some light on the matter, Prof. Levine and team decided to study the association between HRQoL and smoking among students in Serbia. Few studies have looked into this association in low- and middle-income countries.

However, more than 25% of people living in Serbia and other Eastern European countries smoke, which is another reason that studying this subject in this population is of interest. Furthermore, about a third of students in Serbia smoke.

Studying smoking and mental health

The new study included data from two cross-sectional studies that gathered information from two universities: the University of Belgrade and the University of Pristina. The former has around 90,000 students, and the latter has around 8,000.

Of this total, the researchers enrolled 2,138 students in their study. The students took part in regular health checkups between April and June 2009 at the University of Belgrade, and between April and June 2015 at the University of Pristina.

The participants provided information about their social and economic backgrounds — such as their age, social status, place of birth, and parents’ education — as well as information on any preexisting chronic conditions. They also provided information about their habits and lifestyle, such as smoking status, alcohol use, exercise levels, and eating habits.

The researchers classed people who smoked at least one cigarette per day or 100 cigarettes in a lifetime as “smokers” for the purposes of this study.

To assess the students’ HRQoL, Prof. Levine and colleagues asked them to fill in a questionnaire comprising 36 questions across eight dimensions of health. These were:

  • physical functioning
  • role functioning physical
  • bodily pain
  • general health
  • vitality
  • social functioning
  • role functioning emotional
  • mental health

For each of these parameters, a score between 0 and 100 reflected how the interviewee perceived their own mental and physical health.

The team also used the Beck Depression Inventory (BDI) to assess the students’ depressive symptoms. The BDI has 21 items, each with a score from 0 to 3.

According to the BDI, a final score of:

  • 0–13 represents “no or minimal depression”
  • 14–19 ranks as “mild depression”
  • 20–28 represents “moderate depression”
  • 29–63 ranks as “severe depression”

Tobacco negatively impacted mental health

Overall, the study found that having a higher 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.

At the University of Pristina, 14% of those who smoked had depression, whereas only 4% of their non-smoking peers had the condition. Among those who smoked at the University of Belgrade, 19% had depression, compared with 11% of those who did not smoke.

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. Hagai Levine

He goes on to warn against the perils of smoking, and he encourages policymakers to help prevent these dangers.

“I urge universities to advocate for their students’ health by creating ‘Smoke-Free Campuses’ that not only ban smoking on campus but tobacco advertising, too.”

Smoking & Depression

Find Help 24/7

Sometimes people who are feeling depressed think about hurting themselves or dying. If you or someone you know is having these feelings, get help now.

The Substance Abuse and Mental Health Services Administration (SAMHSA)—a part of the U.S. Department of Health and Human Services—runs both crisis centers. For more information visit the National Suicide Prevention Lifeline website.

Para obtener asistencia en español durante las 24 horas, llame al 1-888-628-9454.

Mood Changes

Mood changes are common after quitting smoking. Some people feel increased sadness. You might be irritable, restless, or feel down or blue. Changes in mood from quitting smoking may be part of withdrawal. Withdrawal is your body getting used to not having nicotine. Mood changes from nicotine withdrawal usually get better in a week or two. If mood changes do not get better in a couple of weeks, you should talk to your doctor. Something else, like depression, could be the reason.

Smoking may seem to help you with depression. You might feel better in the moment. But there are many problems with using cigarettes to cope with depression. There are other things you can try to lift your mood:

  • Exercise. Being physically active can help. Start small and build up over time. This can be hard to do when you’re depressed. But your efforts will pay off.
  • Structure your day. Make a plan to stay busy. Get out of the house if you can.
  • Be with other people. Many people who are depressed are cut off from other people. Being in touch or talking with others every day can help your mood.
  • Reward yourself. Do things you enjoy. Even small things add up and help you feel better.

Nicotine Lessens Symptoms Of Depression In Nonsmokers

The finding does not mean that people with depression should smoke or even start using a nicotine patch, the researchers caution. They say that smoking remains the No. 1 preventable cause of death and disability in the United States, and that the addictive hazards of tobacco far outweigh the potential benefits of nicotine in depression.

But the finding suggests that it may be possible to manipulate nicotine’s effects to safely reap its potential medical benefits, according to the researchers. As an example of the drug’s potential, they said, pharmaceutical companies already are developing compounds for treating other brain disorders by mimicking the beneficial properties of nicotine while avoiding its addictive nature.

“The hope is that our research on nicotine will spur the development of new treatments for depression, which is a huge public health problem,” said lead study investigator Joseph McClernon, Ph.D., an assistant research professor of medical psychiatry and researcher at the Duke Center for Nicotine and Smoking Cessation Research.

“Our study also provides evidence that smokers may indeed smoke, in part, to improve their mood — a notion that has been quite controversial in the field,” he said.

The team’s findings are scheduled to appear the week of Sept. 11, 2006, in the online edition of the journal Psychopharmacology and will be published in print in November.


The research was supported by the National Alliance for Research on Schizophrenia and Depression.

Scientists have established that people prone to depression are twice as likely to be smokers, and are less likely to succeed in quitting smoking after taking up the habit, according to McClernon. The Duke study explored the theories behind the higher smoking rates among people experiencing depression.

“Smokers may be more prone to depression than nonsmokers,” said Edward Levin, Ph.D., a professor of biological psychiatry and researcher at the Duke center, who was senior investigator in the current study. “Or, people with depression may be self-medicating by smoking, albeit in a deadly way.”

In the study, the researchers recruited 11 people who did not smoke but who were experiencing symptoms of depression. Participants were randomly assigned to wear either a nicotine patch or a placebo patch that did not contain any nicotine. The researchers used a standardized method, a 20-item questionnaire called the Center for Epidemiological Studies Depression scale, to measure depression symptoms among the study participants.

“Despite the small number of participants, this is the largest study of its kind,” McClernon said.


The team found that participants who wore the nicotine patch for at least eight days experienced a significant decline in their depression-assessment rating scores. McClernon said this finding indicates that the drug led to an improvement in depression symptoms.

As a possible explanation for how nicotine exerts its beneficial effect, McClernon said: “The same areas of the brain that are stimulated by nicotine appear to be involved in the regulation of mood.”

Nicotine stimulates the release of specific neurotransmitters, including serotonin, dopamine, and norepinephrine, which carry messages between nerves cells. Depression has been linked to chemical imbalances of these neurotransmitters, McClernon said.

Looking ahead to possible therapeutic uses of nicotine for treating depression, the researchers say the nicotine molecule can be manipulated to remove its addictive effect while maintaining its ability to increase levels of the various brain chemicals that can alter mood. Currently, pharmaceutical companies are developing nicotinelike drugs that target chemical imbalances in the brain that are thought to cause anxiety, schizophrenia, attention deficient hyperactivity disorder, Alzheimer’s disease and Parkinson’s disease.

The study also suggests that people prone to depression may need extra help in order to quit smoking, such as nicotine replacement therapy, the scientists said.

Despite the positive effects of nicotine discovered in their study, the researchers emphasize that it is not currently appropriate for treatment of any medical disorder outside of nicotine dependence.

“I certainly recommend that people don’t smoke,” Levin said. “If you do smoke, quit.”

Other researchers participating in the study included F. Berry Hiott, Eric C. Westman and Jed E. Rose.

Smoking and mental health

Most adults in the UK are aware of the physical health risks of smoking tobacco, but research shows that smoking also affects people’s mental health.

Although the reasons for smoking differ from person to person, understanding why many people smoke can help those who want to stop.

Smoking and addiction

The biological factors involved in smoking relate to how the brain responds to nicotine. When a person smokes, a dose of nicotine reaches the brain within about ten seconds. At first, nicotine improves mood and concentration, decreases anger and stress, relaxes muscles and reduces appetite.

Regular doses of nicotine lead to changes in the brain, which then lead to nicotine withdrawal symptoms when the supply of nicotine decreases. Smoking temporarily reduces these withdrawal symptoms and can therefore reinforce the habit.

This cycle is how most smokers become nicotine dependent.

Social and psychological factors also play a part in keeping smokers smoking. Although many young people experiment with cigarettes, other factors influence whether someone will go on to become a regular smoker. These include having friends or relatives who smoke and their parents’ attitude to smoking. As young people become adults, they are more likely to smoke if they misuse alcohol or drugs or live in poverty. These factors make it more likely that someone will encounter stress. Most adults say that they smoke because of habit or routine and/or because it helps them relax and cope with stress.

Smoking and stress

The idea that people smoke cigarettes to help ease the signs and symptoms of stress is known as ‘self-medication’. Stress is very common, affecting us when we feel unable to cope with unwelcome pressure. It can cause physical symptoms like headaches or breathlessness as well as making people feel irritable, anxious or low.

These feelings can alter our behaviour and feeling stressed often makes people drink alcohol or smoke more than usual. Long term stress is also related to anxiety and depression.

Smoking and anxiety

Research into smoking and stress has shown that instead of helping people to relax, smoking actually increases anxiety and tension. Nicotine creates an immediate sense of relaxation so people smoke in the belief that it reduces stress and anxiety. This feeling of relaxation is temporary and soon gives way to withdrawal symptoms and increased cravings.

Smoking reduces nicotine withdrawal symptoms, which are similar to the symptoms of anxiety, but it does not reduce anxiety or deal with the underlying causes.

Smoking and depression

In the UK, smoking rates among adults with depression are about twice as high as among adults without depression. People with depression have particular difficulty when they try to stop smoking and have more severe withdrawal symptoms during attempts to give up.

Nicotine stimulates the release of the chemical dopamine in the brain. Dopamine is involved in triggering positive feelings. It is often found to be low in people with depression, who may then use cigarettes as a way of temporarily increasing their dopamine supply. However, smoking encourages the brain to switch off its own mechanism for making dopamine so in the long term the supply decreases, which in turn prompts people to smoke more.

Most people start to smoke before they show signs of depression so it is unclear whether smoking leads to depression or depression encourages people to start smoking. The most likely explanation is that there is a complex relationship between the two.

Smoking and schizophrenia

People with schizophrenia are three times more likely to smoke than other people and they tend to smoke more heavily. One of the most common explanations of this is that people with schizophrenia use smoking to control or manage some of the symptoms associated with their illness and to reduce some of the side effects of their medication.

A recent study has shown that there could be a causal link between smoking and schizophrenia. However, there are various factors which may increase the risk for developing schizophrenia and further research is needed to fully understand the link and causal pathway.

Does smoking improve mental health?

Although many people with mental health problems say that they smoke to reduce their symptoms, they usually start smoking before their problems begin. Heavy smoking does not necessarily lead to fewer symptoms of mental health problems in the long term. Any short term benefits that smoking seems to have are outweighed by the higher rates of smoking-related physical health problems, such as lung cancer, that are common in people with mental health problems.

Ways to help you quit

Stopping smoking suddenly through willpower alone (‘going cold turkey’) is the least effective way to quit. Stopping is more likely to be successful if you plan ahead, have support and choose the right time to try. Your attempt is less likely to work if you are feeling unstable, experiencing a crisis or undergoing significant changes in your life.

To prepare for change, think about your relationship with smoking. Understanding the effect that it has on you can boost your motivation to quit. Think about what you will gain by not smoking, for instance better physical health, fresher breath, improved concentration and more money in your pocket to spend on other things. You may find it helpful to write this down as a reminder of why you want to stop.

Finding other ways to cope with stress

Because smoking is often used as a way of coping, smokers need other ways of dealing with stress, anxiety or other problems if they want to stop smoking. Methods that people have found helpful include meditation and breathing exercises, regular exercise, cutting down on alcohol, eating a well-balanced diet, acupuncture and clinical hypnosis. Counselling or talking things through with a supportive friend or family member and religious or spiritual activities can also help.

Making changes takes time and effort – progress is often slow. Be patient. You may not be able to control all the factors that contribute to your stress, but identifying the source of your anxiety and trying to find ways to reduce or overcome it are as important as finding new ways to cope with it.

Getting support from family and friends

Stopping smoking can be easier if you talk about it to family and friends and let them support you. If other people who live with you smoke, it may be harder for you to give up. You could try to get other household members who smoke, or friends who smoke, to stop smoking at the same time. At the least, encourage them not to smoke around you or leave their cigarettes, ashtrays or lighters where you will see them.

Avoiding triggers linked to smoking

The mind is very sensitive to associations, so removing all tobacco products from your home can help lessen some of the cravings of nicotine withdrawal. Smokers are accustomed to smoking in certain situations like in the pub or after a meal. If you can identify your trigger situations and avoid them, the chances of relapse will be much lower.

Being prepared for withdrawal symptoms

Likely withdrawal symptoms include headaches, nausea, irritability, anxiety, craving cigarettes, feeling miserable, difficulty in concentrating, increased appetite and drowsiness. Drinking more fresh fruit juice or water, eating more high fibre foods and reducing the caffeine and refined sugar in your diet all help some people cope with withdrawal symptoms.

Talking therapies

Individual, group or telephone counselling can help people to stop smoking. Talking therapies can help people change their behaviour by thinking and acting more positively. Many counselling programmes use the techniques of cognitive behavioural therapy (CBT) and social skills development. Research has shown that CBT may be particularly effective in smokers with or without mental health problems.

Nicotine replacement therapy and medication

Nicotine replacement therapy (NRT), anti-depressants and other medication have all been shown to help smokers without mental health problems to stop smoking and they may also be helpful for people with depression or schizophrenia. NRT appears to be more effective when combined with a talking therapy.

For advice on stopping smoking and which treatments might be suitable for you, talk to your doctor, a pharmacist or a health visitor. They will also be able to point you to services for smokers in your area.

Further help and support

NHS Smoking Helplines
  • England & Wales: 0800 16 9 016 9
  • Northern Ireland: 0800 85 85 85
  • Scotland: 0800 84 84 84
NHS Asian Tobacco Helplines

(Lines open 1pm-9pm on Tuesdays)

  • Urdu: 0800 16 9 0881
  • Punjabi: 0800 16 9 0882
  • Hindi: 0800 16 9 0883
  • Gujarati: 0800 16 9 0884
  • Bengali: 0800 16 9 0885

Campaigns to reduce the health problems caused by tobacco

  • ASH website

Supports people wanting to stop smoking

  • Quit website
  • Quitline: 0800 00 22 00

Physical Withdrawal Symptoms

Everybody is different, and symptoms of withdrawal depend on many things, like how long and how many packs a day you’ve smoked. But for the most part, you can expect to have these common physical issues when you quit:

  • Appetite. Within a day or so of your last cigarette, your appetite will shoot up for a while. Cigarettes contain 2 chemicals (serotonin and dopamine) that reduce hunger, so when they’re out of your system you’ll want to eat more. A lot of people also find that they eat to fill the time when they used to be smoking. And unfortunately, you might crave more carbs and sweets. The first 2 weeks are the worst — most people gain about 5 to 10 pounds as they try to quit smoking.
  • Cravings. Nicotine cravings are the symptom you will deal with the longest, and they could start just 30 minutes after your last cigarette. Each craving will last only about 15 to 20 minutes, but they’ll keep coming. You’ll need to do your best to avoid triggers (like drinking alcohol or being around people who smoke) and find ways to get yourself through each craving.
  • Cough. Your respiratory system can’t clean itself very well when nicotine is around. As your body works it out, you’ll probably have a cough that could last for a few weeks.
  • Headaches and dizziness. These are usually on the mild side, and they’re often the first withdrawal symptom to show up and first to taper off.
  • Fatigue. Nicotine is a stimulant and perks you up, so you’ll probably feel tired without it. But you’ll also be restless and might have insomnia.
  • Constipation. For the first month, constipation can be another unpleasant side effect.

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