Stopping smoking may improve mental health, Cochrane review finds
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n676 (Published 10 March 2021) Cite this as: BMJ 2021;372:n676
People who stop smoking are not likely to experience a long term worsening in mood and may see improvements in their mental health, such as reduced symptoms of anxiety and depression, a Cochrane review has found.1
The review, which brought together the results from 63 studies that measured changes in mental health symptoms during smoking cessation, reported that people who stopped smoking for at least six weeks experienced less depression, anxiety, and stress than people who continued to smoke. Evidence also suggested that cessation did not lead to a reduction in social wellbeing.
Researchers from the UK universities of Bath, Birmingham, and Oxford, as well as New York University Abu Dhabi, said that the review aimed to tackle the common perception that smoking generally helped people to manage stress and may be a form of self-medication in people with mental health conditions.
They wrote, “There are biologically plausible reasons why smoking may worsen mental health through neuroadaptations arising from chronic smoking, leading to frequent nicotine withdrawal symptoms (e.g. anxiety, depression, irritability), in which case smoking cessation may help to improve rather than worsen mental health.”
Wellbeing
The review found that, when compared with people who continued to smoke, people who stopped smoking showed greater reductions in anxiety (low confidence in evidence), depression (very low), and mixed anxiety and depression (moderate). The researchers noted that the level of confidence was based on limitations to the studies.
Additionally, people who stopped smoking showed greater improvements in symptoms of stress, positive feelings, and mental wellbeing. Meanwhile, new cases of mixed anxiety and depression were fewer in people who stopped smoking than in those who continued smoking.
Gemma Taylor, the study’s lead author and research director for the Addiction and Mental Health Group at the University of Bath, said, “The benefits of smoking cessation on mood seem to be similar in a range of people, and most crucially there is no reason to fear that people with mental health conditions will experience a worsening of their health if they stop smoking.
“Many people who smoke are concerned that quitting could disrupt their social networks and lead to feelings of loneliness. People can be reassured that stopping smoking does not seem to have a negative impact on social quality of life.
“People may also be concerned that quitting is stressful. The evidence shows that stress is reduced in people who stop smoking and that there are likely longer term benefits for people’s mental health.”
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