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Change in mental health after smoking cessation: systematic review and meta-analysis

BMJ 2014; 348 doi: (Published 13 February 2014) Cite this as: BMJ 2014;348:g1151

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Re: Change in mental health after smoking cessation: systematic review and meta-analysis

This meta-analysis does seem to show that the benefits of smoking cessation on mood are significant, and relatively long-lasting. The authors have looked at 26 studies that assessed levels of anxiety, depression and stress in several groups of patients, before and after quitting, and have found similar positive results across the board. What would be interesting to know, is what the range of psychiatric disorders included were. Was this limited to mood disorders, or were other groups included, such as patients with schizophrenia, who have notoriously high smoking rates, or psychotic illnesses? Also, was the severity of psychiatric illness graded and did this have any bearing on the results?
Whilst it’s clear that smoking cessation should be advocated to all patients where practical, the issue of clinician reluctance in patients with severe mental health illnesses does not entirely seem to have been addressed. Additionally, in order the stop smoking, a degree of motivation is required, and the chaotic lifestyle of certain patient groups would make this harder, which one can imagine might bias the population characteristics of those that quit and those that did not.
Stopping smoking, along with exercise, may be shown to have good efficacy in treating mild or moderate mood disorders. I’m not yet convinced that the results would be so positive in those requiring depot antipsychotics or electroconvulsive therapy however.

Competing interests: No competing interests

22 February 2014
Dawn J Swan
core medical trainee
Bristol Royal Infirmary
BRI, Upper Maudlin Street, BS2 8HW