Quitting with Mental Health Conditions

Why this group is different

Rates of smoking are higher among people with mental health conditions, dependence tends to be stronger, and there has been a longstanding — now largely debunked — worry that quitting worsens mental health. Reviews of cohort studies show the opposite on average: quitting is associated with improvements in depression, anxiety and stress. The real differences are practical: medication selection needs psychiatric review, and mood changes in early withdrawal may need monitoring.

Recommended approach

• Use the same evidence-based tools as anyone else: medication plus behavioral support works in this group
• Varenicline and bupropion have been studied in people with psychiatric conditions and are generally usable with monitoring
• Coordinate with mental health providers, especially when adjusting psychiatric medication
• Expect a hard first weeks emotionally; withdrawal itself can mimic or worsen low mood temporarily
• Seek help if low mood is persistent or severe — quitting support and mental health care can run in parallel

What the evidence says

Cochrane and BMJ systematic reviews (e.g., Taylor et al. 2014 and updates) found quitting smoking is associated with subsequent improvements in depression, anxiety and stress. Trials of varenicline and bupropion in psychiatric populations support effectiveness with monitoring. The EAGLES trial found no significant excess of neuropsychiatric adverse events on varenicline or bupropion versus placebo and NRT, including in participants with psychiatric disorders.

Evidence strength: Strong

Medication notes

The EAGLES trial provides the key safety data: varenicline and bupropion did not increase neuropsychiatric adverse events compared with placebo or NRT, even among participants with stable psychiatric disorders. Individual prescribing should still be reviewed with the treating clinician. NRT is the lowest-interaction option.

Community experience

Community reports frequently describe mood dips in the first weeks that then lift, with many reporting feeling mentally better overall after months. Some describe quitting while managing depression as 'harder, but the most worth it'.