Resources regarding mental health issues
Video discusses how most people experience minor emotional reactions when first quitting, but also how people with pre-existing mental health issues may need physician assistance in dealing with problems that seem to be exacerbated after quitting.
Comments lifted from my string "Normal depressive reaction or a real organic depressive episode" on Freedom from Nicotine Support Board:
I see we had some recent issues with quitting and depression and anger at the board. The fact is everyone who ever quit smoking faced these issues to some degree. I am creating a string here that covers depression from a number of angles. Some of these letters were written to my clinic graduates and others were specific answers to people who wrote questions with background histories. I think they will give everyone an overview of different physical and emotional issues around depression while quitting.
Again, some of the emotional reactions are a simple adjustment period. But some people have histories of emotional problems that may take more than the individual alone to overcome. The people involved may need to be working very closely with their doctors and medical professionals. These articles should give a little overview of those issues too.
Joel
The first letter here is in response to someone who wrote me a question regarding depression who had a past history of depression.
I take it from your post that you had been on medication for depression prior to smoking cessation. While becoming depressed upon smoking cessation is common, this depression normally subsides over time. But, when depression is a preexisting condition there are special considerations that need to be addressed. First, you may have been on a medication that initially took time to adjust, to find the right dosage for you. Now, when you quit smoking and stay on that dosage you can initially become depressed as part of the normal separation process from smoking, in a sense, feeling bad but not thinking anything is wrong. But when it doesn't subside over time you may assume that nothing can be done, its part of not smoking, you are already on an adjusted dose of depression medication and you just have to put up with it. This is a wrong assumption. Chances are even though you are on your normal dosage of medication, that dose was set while you were a smoker. This may not be the proper (normal dose) for you as an ex-smoker.
This dosing issue is not just about depression. People with many conditions may find that after cessation they must find what is normal for them. A person who is diabetic or on thyroid medications often find that the dose required as a smoker needs to be adjusted after quitting. Anyone who is on various medications that effect mood, hormonal and blood sugar levels needs to pay special attention to symptoms. Once through the first few days, and especially into the second week, if physical symptoms normally attributed to withdrawal are still manifesting, it is advisable that their doctor checks out those individuals.
I have put a few articles on the board here that I suspect you saw. There are others that I am not sure I put here or not, they were written to individuals who wrote with specific questions. While they may not apply to your specific situation, they cover a range of different depression issues. I am going to attach a string of letters here that were written to a few such individuals. If you have read part of them, keep going further down there may be more that you hadn't seen yet.
One other thing I would like to note that applies to emotions when quitting. If anyone lets emotions solely dictate actions, nobody would quit smoking. Part of the skill needed by all ex-smokers is the ability to override normal emotions, desires, impulses or urges, whatever we want to call it, the individuals wanting a cigarette or just a puff. Everyone feels it from time to time. It is going to be your intellect that is going to override the craving. That is where keeping your ammunition and focus of why you quit smoking is paramount. You have to keep remembering what smoking was doing to you making you sick and tired enough to go through initial quitting. Then you have to remember what continued smoking was capable of doing to you in the future, thoroughly capable of robbing you of your health and your life. When in emotional turmoil it is harder to keep that perspective. It is hard for everyone when in such turmoil but it is a skill that has to be honed day by day by everyone. Life will throw curves throwing people into despair. But smoking won't solve any of these curves. Smoking can cause problems that will throw your life further into despair and if left unchecked will throw your loved ones life into a premature loss of you.
Keep focused on this fact that quitting smoking is a fight for survival. It may be hard at times, but it is worth the effort. Bad times may make it harder to see this, but bad times will pass. You've experienced them before and you know they got better. Hang on to those memories that they do get better.
Again, talk to your doctor letting him or her know you have quit and have questions on the medications. Keep focused on your quit. One other thing to consider too, considering you were on medications before, you were depressed as a smoker. Never delude yourself into thinking life was always perfect before. Smoking didn't cure your depression before and it won't do it now either. For you, other medications were necessary to help with those feelings, smoking was not able to do it. Anyway, the following articles deal a little with the medication issues. Again, they may not all apply to you but kind of covers a range of reactions.
Hope this helps.
Joel
The following is another article written to a specific person who was experiencing a longer-term depression. This person was being encouraged by his or her doctor to go on an antidepressant but was resistant to the idea of needing medication.
Depression is normal in the cessation process. Almost everyone feels it to a degree, and the period of time that it lasts varies from person to person. Unlike the physical withdrawal, which is quite predictable in duration, the psychological reactions have tremendous individual variability.
I am attaching a letter here about the emotional phases of cessation. But since your reaction has been going for so long now, I would advise checking with your doctor. While quitting can be causing depression, it is possible that you do have an organic basis for depression that in a sense you were self-medicating with cigarettes for years.
If your doctor feels this is a possibility he or she may want to prescribe something for it. There are a lot of medications out there that are effective. As for safety or side effects, considering you may have been using smoking for this therapeutic purpose, a product that kills 50% of its users, the prescribed alternatives will pose minimal risks in contrast.
Or, the other hand, there may be some emotional conflicts in your life that have never been adequately addressed that are manifesting for the first time since quitting. I am attaching another letter I wrote to another person a few weeks ago that had some serious losses and was having some exaggerated reactions since quitting. I had more of a history on this person making me able to write this with some feeling that it really applied to this persons situation. I don't know if it applies to yours, but maybe in reading it you will see if it strikes a chord.
Anyway, hope this helps.
Joel
- Read Understanding the emotional loss experienced when quitting smoking, which reviews the five emotional stages associated with any significant sense of loss: denial, anger, bargaining, depression and acceptance.
- Read New reactions to anger as an ex-smoker, the letter to the person with exaggerated reactions mentioned above.
Summary:
I don't want to give the impression that the majority of people become clinically depressed or need medications to deal with the normal depression phase that accompanies initial smoking cessation. The fact is, only a small percentage of people will have a full-blown organic depression occurring just after quitting smoking. But that fact is not important if you are one of these individuals. What is important is that if you believe you are organically depressed get checked out by your doctor.
Especially if you are a person with a past history of treatment for depression or if your depressive episode is lasting more than a week and is causing a real disruption in your life, get checked out. You may indeed benefit from treatment or maybe your physician will just give you the reassurance that you are really okay. Either way it doesn't hurt to get the situation professionally assessed.
Joel
The following "Depression Basics" article was created by the Tobacco Control Research Branch of the National Cancer Institute.
Depression Basics
NOTE: This information is not meant to tell you for sure if you have major depression. It cannot take the place of seeing a mental health professional.
It is common for people who are feeling bad to think about hurting themselves or dying. If you or someone you know is having these feelings, they are in crisis. Get help now. Call 1-800-273-TALK (8255) or 1-800-SUICIDE (1-800-784-2433) to reach a 24-hour crisis center or dial 911.
Both 1-800 numbers are open all the time to give free, private help to people in crisis. The Substance Abuse and Mental Health Services Administration (SAMHSA), a part of the U.S. Department of Health and Human Services, runs both crisis centers. For more information, go to https://suicidepreventionlifeline.org/.
Para obtener asistencia en español durante las 24 horas, llame al 1-888-628-9454.
What is depression?
Depression is more than feeling sad or having a bad day. People with depression usually feel down, blue, or sad, and they have other signs, such as:
- Feeling sad all the time
- Not wanting to do things that used to be fun
- Grumpy, easily frustrated, restless
- Changes in sleep—trouble falling asleep or staying asleep, waking up too early, or sleeping too much
- Eating more or less than they used to
- Trouble thinking
- Feeling tired, even after sleeping well
- Feeling worthless
- Thinking about dying or hurting themselves
You may have depression if:
- You have 5 or more of the signs listed above.
- These signs have lasted 2 weeks or more.
Use our depression screening quiz to see if you are depressed. You should consider seeing your doctor or a qualified mental health professional, especially if these problems are getting in the way of your life or are making you stressed.
What causes depression?
There are many things that increase a person's chance of getting depressed. Everyone is different, but here are some common things that can lead to depression:
- Feeling lots of stress
- Going through a difficult life event
- A big life change, even if it was planned
- Medical problem
- Taking a medication that is known to cause depression
- Using alcohol or drugs
- Having blood relatives who have had depression
How is depression different from sadness?
Everyone has down days and times when they feel sad. Sadness could turn into depression, but depression and sadness are different in these ways:
- How long the feelings last: Depression is felt every day (or most days) and lasts at least 2 weeks, usually much longer.
- How bad the symptoms are (how much they get in the way of your life): Depression makes it hard for you to do things (like work or family duties) and it can stop you from doing the things you want to do.
How is this different from withdrawal from smoking?
Mood changes are common after quitting smoking. You might be irritable, restless, or feel down or blue. Changes in mood from quitting smoking (withdrawal) usually get better in 1 or 2 weeks, and they are not as serious.
If you find that you are feeling very down after quitting smoking, then you should talk about this with friends and family, and also call your doctor. This is also true if you have symptoms from the list above. See "What is depression?" and the depression screening quiz.
Who gets depression?
In general, about 1 out of every 6 adults will have depression at some time in their life. Depression affects about 15,000,000 American adults every year.
Anyone can get depressed. Depression can happen at any age and to any type of person. But some types of people seem more likely to get depressed than others. For example,
- Women
- Smokers
- People with medical problems
- People who are stressed
Your race, ethnicity, or how much money you make doesn't change your chance of getting depression.
Why is depression more common in smokers?
Nobody knows why smokers are more likely to have depression than non-smokers, but there a number of guesses. People who have depression might smoke to feel better. Or smokers might get depression more easily because they smoke. Other ideas are also possible. More research is needed to find out for sure. No matter what the cause, there are treatments that work for both depression and smoking.
If I get depressed after quitting smoking, should I start smoking again?
No. You should look for ways to get help with your depression. Smoking does not treat depression. Remember that smoking is linked to many serious health problems for both the smokers and the people around them. Finding ways to help your depression and quit smoking are the best way to go.
How long does it last? Will this go on forever?
Everyone is different. For some people, it will only last a few weeks, some for many months if not treated. For many people, depression is only a problem during really stressful times (like a divorce or the death of a loved one). For other people, depression happens off and on through their life.
But, for both groups of people, there are treatments for depression that can help reduce the symptoms and shorten how long the feelings last.
Is it worth getting treatment for depression?
Yes! Treatment almost always helps to reduce symptoms and shorten how long the depression lasts. A common problem is that too few people get help. Many people think that depression is not a real problem, can't be all that serious, or is a sign that they are simply not tough enough to deal with life. None of these are true.
You do not need to feel shy or embarrassed about talking openly and honestly about your feelings and worries. This is an important part of getting better, working on ways to help your mood.
Many people benefit from treatment for depression, even if the symptoms are not serious. So you don't need to have a lot of symptoms of depression before talking to your doctor or a qualified mental health professional (see "Who provides therapy?") about getting treatment.
If you find that you have 5 or more signs from the list above (see "What is depression?" or the depression screening quiz), you should talk with your doctor or a qualified mental health professional. This is especially true if the feelings have lasted 2 weeks or more, are making you worried, or are getting in the way of your daily life.
What are the treatments for depression?
There are many good treatments for depression, and more than 8 out of every 10 people who use them get better. Treatment usually means getting psychotherapy/counseling, taking medications, or doing both. Your doctor or a qualified mental health professional can help you figure out what treatment is best for you.
About therapy (counseling, talk therapy, psychotherapy)
Therapy has shown to be quite helpful and is often an important part of treatment for depression. Getting therapy does not mean you will be in treatment forever. Most talk therapy is for a short time. Depending on how serious your feelings are, it can mean meeting only a few times with a therapist. Most talk therapy focuses on thoughts, feelings, and issues that are happening in your life now. In some cases, understanding your past can help, but finding ways to address what is happening in your life now can help you cope and be ready for challenges in the future.
Therapy is more than just telling your therapist about your problems. It means working with your therapist to improve coping with the things happening in your life, change behaviors that are causing problems, and find solutions. Your therapist may give you some homework in between meetings; things for you to think about and work on. This might include making a list of situations that give you negative thoughts and feelings, or looking at things in a different way.
Some common goals of therapy:
- Get healthier
- Get over fears or insecurities
- Cope with stress
- Make sense of past painful events
- Identify things that make your depression worse
- Have better relationships with family and friends
- Make a plan for dealing with a crisis
- Understand why something bothers you and what you can do about it
Who provides therapy?
There are many kinds of people who have been trained to give therapy and help you. These include:
- Psychiatrists (they write "MD" after their name)
- Psychologists (they write PhD, PsyD, EdD, or MS after their name)
- Social workers (they write DSW, MSW, LCSW, LICSW, or CCSW after their name)
- Counselors (they write MA, MS, LMFT, or LCPC after their name)
- Psychiatric nurses (they write APRN or PMHN after their name)
More important than their training, you should find someone you can talk with honestly and openly. Your therapist won't have all the answers, but the key is to find someone you can work with as a partner to help you find answers.
About medications
Many people with depression find that taking medication is a useful tool in improving their mood and coping. Medications for depression are called antidepressants. Antidepressants cannot solve all your problems like magic, but they can help you to even out your mood and be more able to handle events in your life that are making your mood worse.
Antidepressants are prescription medications, so talk to your doctor if you want to take them. If your doctor writes you a prescription for an antidepressant, ask exactly how you should take the medication. There are many medications, so you and your doctor have options to choose from. Sometimes it takes trying a couple different medications to find the best one for you, so be patient. If you are worried about cost, ask your doctor or pharmacist if the medication comes in a generic form. Generic medications can cost less than brand names.
When taking these medications, it is important to stick with them for awhile. Many people start feeling better a few days after starting the medication, but it often takes 1–2 weeks of taking it to feel a big difference, and 4 weeks to feel the most benefit. It is also common to have to change the dose, so you will want to work closely with your doctor.
How long a person takes antidepressants is very different from person to person. Many people are on them for 6–12 months, and some people take them for longer. Again, you and your doctor will want to talk about what is best for you.
Antidepressants are safe and work well for most people, but it is still important to talk with your doctor about side effects you may get. Side effects usually do not get in the way of daily life, and they go away as your body gets used to the medication.
If you notice that your mood is getting worse, especially if you have thoughts about hurting yourself, it is important to call your doctor right away.
Taking care of you
There are many things you can do to help lift your mood and improve feelings of depression.
- Exercise. Stay active. This can include something as simple as taking a fast walk or as involved as going to the gym or joining a team sport. The type of exercise depends on how fit you are, but any kind of activity can help. If you need to, start small and build over time. This can be hard to do when you are down or depressed because feeling down saps all your energy. But making the effort will pay off! It will help you feel better.
- Structure your day. Create a plan to stay busy. It is especially important to get out of the house whenever you can.
- Talk and do things with other people. Many people who are feeling depressed are cut off from other people. Having daily contact with other people will help your mood.
- Build rewards into your life. For many who are depressed, rewards and fun activities are missing from life. It is helpful to find ways to reward yourself. Even small things add up and can help your mood.
- Do what used to be fun, even if does not seem fun right now. One of the common signs of depression is not wanting to do activities that used to be fun. It may take a little time, but doing fun activities again will help improve your mood. Some people like to make a list of fun events and then do at least one a day.
- Talk with friends and loved ones. Their support is a key to your feeling better. Having a chance to tell them your concerns can help things seem less scary.
Resources related to quitting smoking and mental health:
- Understanding the emotional loss experienced when quitting smoking
- Going back to normal after quitting
- Will this get better?
- Medication adjustments that may be necessary after quitting smoking
- Using cigarettes to self medicate pre-existing conditions
- Quitting smoking can make you calmer, happier and healthier
- Life goes on without smoking
- "Is this a symptom of quitting smoking?" (part 2)
