Intended for healthcare professionals


Quitting smoking is associated with long term improvements in mood

BMJ 2014; 348 doi: (Published 17 February 2014) Cite this as: BMJ 2014;348:g1562
  1. Judith J Prochaska, associate professor of medicine
  1. 1Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Road, Stanford, CA 94305-5411, USA
  1. JPro{at}

Reassuring new evidence for all smokers who would rather stop, including those with poor mental health

Use of tobacco is partly reinforced through the effects of nicotine on the brain. Nicotine stimulates the release of many neurotransmitters in the central nervous system, including dopamine, norepinephrine, serotonin, β endorphin, and GABA (γ aminobutyric acid), which induces pleasure, arousal, mood modulation, and a reduction in anxiety and tension.1 Abrupt nicotine withdrawal is characterized by irritability, anxiety, difficulty concentrating, impatience, depressed mood, insomnia, impaired performance, increased appetite, and cravings, experienced most acutely in the first 24-48 hours after quitting smoking.2 These symptoms typically resolve within two to four weeks after cessation. Though depression is one of the less common symptoms of nicotine withdrawal,2 concern that mood changes might persist or precipitate clinical depression can dissuade smokers from trying to quit and healthcare providers from intervening, especially among smokers with current or past mental illness.

In a linked systematic review and meta-analysis (doi:10.1136/bmj.g1151) Taylor and colleagues combined data from 26 studies to examine the effect of smoking cessation on changes in mood.3 The authors hypothesized that individuals who quit smoking would report improvements in mental health due to no longer experiencing …

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