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The harmful effects of smoking on physical health are well publicised but people are less aware of the impact smoking can have on mental health.

Many smokers use cigarettes to relieve stress, and do not know the damage their habit could be doing to their mental health and wellbeing. They believe so strongly that smoking aids relaxation that it prevents them from successfully quitting, however, smoking can exacerbate symptoms of stress, anxiety and even depression. Currently 36% of those with a mental health illness smoke compared to just 19% of the general population across Wales. To mark World Mental Health Day, we’ve taken a look at the relationship between smoking and mental health.

A short term fix
Regular smoking leads to changes in the brain which trigger nicotine withdrawal symptoms in the gaps between cigarettes. When a smoker lights up, the rush of nicotine temporarily improves their mood, lowers their stress levels and relaxes their muscles. The feeling of relaxation they get is because they have fed their nicotine addiction, not because nicotine is helping to deal with the underlying causes of their anxiety.

The stress cycle
For smokers, anxiety will kick in again once they start to experience the next cycle of nicotine withdrawal symptoms, which usually begin within a few hours after their last cigarette. If they did not smoke they would not experience this spike in anxiety as the effects of the nicotine wear off.

According to a booklet produced by the Mental Health Foundation (MHF) –  there could be a relationship between smoking and depression, though it is not clear whether smoking leads to depression or depression encourages people to start smoking, and/or discourages people to quit. The MHF states that most people start to smoke before they develop symptoms of depression.

Nicotine stimulates the release of dopamine in the brain which is the chemical that triggers positive feelings. Smoking encourages the brain to switch off its own mechanism for making dopamine, leading the supply to decrease and encouraging people to smoke more. Supplies of dopamine are often low in people who suffer with depression which could lead them to use smoking to increase their dopamine supply.

Other side effects

Smoking is an expensive habit that can contribute to debt and limit lifestyle choices. With cigarettes costing around £250 a month on average for smokers, it’s a pricey habit to feed, and that financial pressure alone can cause stress levels to rocket.

The constant worry about the toll on physical health is also stressful, particularly if others around the smoker are urging them to quit. Giving up smoking can remove these added pressures and have a significant impact on a person’s wellbeing.

Why quit
For those who use smoking as a crutch to support themselves through stressful situations, the thought of quitting can be daunting. However, the long-term benefits to mental health include reduced anxiety, depression and stress levels, a better quality of life and more positive moods.

Surviving nicotine cravings
We asked Steve Clarke, clinical and therapy services manager for The Priory Group, about coping with nicotine withdrawal and its short terms effects on mental health. Here is his advice.

“Smokers who attempt to quit might want to be prepared for managing some anxiety that is created by cravings. Cravings are likely to happen as the body withdraws from its reliance on nicotine. These cravings may feel intense at first, however they will significantly recede within a short space of time. Cravings are often triggered by a cue or stimuli such as having dinner or drinks, or break-times at work. These urges to smoke will decrease as time passes; however, their intensity often remains strong for a reasonable period of time as we associate these events with smoking. In time, the association will completely diminish.”

“Cravings are natural. It’s a way of understanding that behaviours are changing. When we experience cravings and they are intense, it can be a good tactic to remind ourselves of the consequences if we pick up a cigarette once more. One good way to support this may be to make two lists:

1 – What will life be like 5 years from now if I continue to smoke – maybe include “I’ll be less fit, I’ll have more health issues, I’ll have less money…”

2 – What will life be like in 5 years if I stop smoking? – maybe include “I’ll be healthier, I’ll be fitter, I’ll have more money, my clothes will be fresher…”

Getting started
Going ‘cold turkey’ is the least effective way to quit smoking, but thankfully you don’t have to go solo. There is plenty of help available through NHS Wales, including nicotine replacement therapy and support from a smoking cessation advisor in a one-to-one or group setting. Everybody is different and there is no one size fits all solution to quitting smoking. Help Me Quit is run by NHS Wales and will help you to find the stop smoking service that best suits you. Contact them on 0800 085 2219 or visit

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