Evidence shows people with mental health issues who quit smoking saw greater reductions in anxiety and depression and improvements in positive feelings and mental wellbeing compared to those who continued to smoke.
People with mental health and substance misuse issues smoke more cigarettes per day, are more addicted to nicotine and, although they are just as likely to want to give up smoking as others who smoke, they find it harder to quit.
How smoking can affect medication
Smoking can significantly alter how your body processes certain medications. This is mainly due to chemicals in tobacco smoke (not nicotine). The smoke can reduce the effectiveness of many medications such as:
- Clozapine (an antipsychotic)
- Olanzapine (an antipsychotic)
- Chlorpromazine (an antipsychotic)
- Theophyline (for asthma)
- Warfarin (a blood thinner)
- Mehadone (for addictions)
- Some antidepressants
- Some sleeping tablets
*The medicines listed are a small example only. Always check with your healthcare provider if your medicines need tweaked if you decide to stop smoking or are affected by your smoking.
Stopping smoking can mean that you need to use less of certain medications which could lead to a lessening of any side-effects related to certain medications.
Why some people think smoking helps their mental health
1. Relief from nicotine withdrawal
Nicotine is addictive. When someone hasn’t smoked for a while, they can feel anxious, irritable, restless, low in mood.
Smoking relieves these withdrawal symptoms so it can feel like it’s reducing stress or anxiety. In reality, it’s only bringing you back to your usual baseline. This creates a cycle: nicotine causes the discomfort → smoking relieves it → the relief is mistaken for improved mental health.
2. Short‑term dopamine release
Nicotine briefly increases dopamine – a brain chemical linked to pleasure and reward. This can cause:
- a temporary lift in mood
- a sense of calm or focus
However, this effect is short‑lived and weakens over time as the brain adapts, leading people to smoke more to get the same feeling.
3. Smoking as a coping behaviour
For many people, smoking becomes linked with:
- taking a break
- stepping outside
- slowing down
- social connection
The relief may come from the pause of routine, not the cigarette itself. Without other coping tools, smoking can feel like the only way to manage stress.
4. Cultural and personal beliefs
Smoking has historically been portrayed to:
- calm nerves
- cope with stress
- manage difficult emotions
If someone has smoked during hard times, the association can feel very real even when the cigarette isn’t solving the problem.
Why smoking doesn’t help mental health in the long term
1. Nicotine increases anxiety overall
Although smoking feels calming in the moment, nicotine:
- raises heart rate and blood pressure
- stimulates the stress response
Smokers, on average, report higher levels of anxiety and depression than non‑smokers.
2. It worsens mood over time
Repeated nicotine use alters brain chemistry, which can:
- reduce the brain’s natural ability to regulate mood
- make low mood and stress more frequent between cigarettes
This leads to a pattern of “needing” cigarettes just to feel normal.
3. It keeps people stuck in a stress cycle
Instead of learning healthier coping strategies, smoking:
- temporarily masks stress
- doesn’t resolve the cause
- reinforces dependence
As a result, everyday stress can feel harder to manage without a cigarette.
4. Stopping improves mental health
Strong evidence shows that stopping smoking improves mental wellbeing including:
- reduced anxiety
- improved mood
- reduced stress
- benefits comparable to antidepressant treatment for some people
These improvements occur regardless of whether someone has a diagnosed mental health condition.
Importantly, using Nicotine Replacement Therapy (NRT) can help manage withdrawal symptoms without the harmful effects of smoking, making quitting more mentally manageable.
To Summarise
Smoking doesn’t really reduce stress – it relieves nicotine withdrawal. When people stop smoking, their mental health usually improves once the addiction cycle is broken.
Get in touch
If you would like support to help you stop smoking/vaping or to talk to one of our Quit Your Way team, please contact us using the self-referral form below.
You can also contact us by email or telephone or follow us on Facebook.
Freephone: 0800 783 9132
Email: QYWAyrshire@aapct.scot.nhs.uk