Nicotine and bipolar disorder don’t mix well. Here’s how to quit smoking for good.
Every smoker is familiar with the strong mix of feelings that nicotine addiction elicits: you long for that next cigarette, but you’re haunted by the knowledge that your habit is placing you—and your loved ones—at risk.
The health facts are indisputable. According to the World Health Organization (WHO), 5.4 million people globally die from smoking tobacco each year—an average of one death every six seconds. Smoking also substantially increases the risk of heart disease and lung diseases, such as emphysema.
The stakes are disproportionately high for people with bipolar. About 31 percent smoke compared to about 21 percent of the general population, according to the U.S. government-funded “Systematic Treatment Enhancement Program for Bipolar Disorder(STEP-BD),” the most in-depth study of its kind.
And while the average smoker has a one in four chance of quitting, a smoker with bipolar has a one in 10 chance, says Tony George, MD, professor in addiction psychiatry at the University of Toronto. George is working on developing effective medications for treating tobacco addiction in people with bipolar. “We need to learn how to treat it,” he says. “The lead reason why people with bipolar die is smoking-related illnesses.”
Nicotine is an addictive drug that acts on specific receptors on the brain to cause the release of neurotransmitters, such as serotonin or dopamine. Smoking may therefore interfere with the effectiveness of many medications for bipolar, since these drugs work by blocking the activity of the same neurotransmitters that are increased by smoking. As evidence of this, a 2008 study out of the University of Melbourne found that nonsmokers taking antipsychotic drugs for acute mania showed significantly greater improvement in symptoms than the smokers in the group.
The relationship between nicotine and mental illness is complex. George and colleagues found that nicotine eases some of the attention deficit that occurs with schizophrenia. A similar chemical interaction may occur with bipolar and nicotine, but there are other theories why people with bipolar smoke. Nicotine may reduce some of the unpleasant side effects of psychiatric medications. And the nature of bipolar may increase one’s vulnerability to smoking, says Ivan D. Montoya, MD, of the National Institute on Drug Abuse (NIDA).
During mania, people may increase alcohol intake, indulge in illicit drugs, and smoke more, says Montoya. As drugs or alcohol lower one’s inhibitions, health concerns about smoking may be reduced. Nicotine may also reduce the anxiety produced by mania, he adds. As for depression, the stimulation produced by nicotine can help a sluggish person get moving. They may find that smoking gives some structure to the day and reduces boredom, Montoya says.
Kicking the habit—again
Calvin of Ontario, was 12 when he smoked his first cigarette. Thirty-six years later, he still remembers lighting up with his pals in a neighbor’s backyard.
“It made me high. Even though I got sick, I enjoyed it. A couple of days later, I tried it again and I didn’t get sick.” Calvin was soon addicted. “I needed to have that smoke. It took away my nervousness. It was really important to me to fit in with some kind of crowd.”
Barb B. of Kansas, started smoking in high school, but it wasn’t until she got to college that she began smoking heavily. “It was stress and anxiety that made me turn to smoking,” Barb says. “Looking back, I’m sure the bipolar played an important part. When I smoked, I felt less confusion. I could concentrate better.”
Barb married, became a mother, and gave up cigarettes for almost 20 years. When her children became teenagers, she started graduate school and took a job. With the stress, she returned to her old habit. “Smoking was always there when I was up or down in my bipolar. It was something I turned to for security.” Each time she quit, she started again. Each time she resumed, she smoked more than the last time.
Many smokers quit multiple times before succeeding. Nicotine withdrawal is usually the culprit. Possible symptoms include irritability, craving, sleep disturbances, and increased appetite. “You have to learn how to surf through the urge to pick up a cigarette,” says William Riley of the National Institute of Mental Health. “If you can get through that 15 or 30 minutes, the urge will go away.”
There are steps you can take to increase your chances of quitting. For starters, pick a specific quit date, let loved ones know you’re quitting, and ask for their support. Instead of going it alone, George recommends using nicotine replacement therapy—such as sprays, gums, or a patch—or one of the newer smoking cessation drugs. It’s important to make your psychiatrist part of your team, as the absence of nicotine can destabilize one’s mood. It’s also recommended you attend an anti-smoking group for reinforcement.
George predicts that if every smoker with bipolar had these supports, the rate of success for smoking cessation would “probably quadruple.”
Answers to why we smoke
Calvin, who was diagnosed with bipolar disorder in 1998, regularly thinks about giving up cigarettes. But he’s not ready. Instead, he’s cut down from a pack a day to eight to 10 cigarettes.
Researchers are hopeful that there will be better solutions for smokers who want to quit. Studies are underway to determine why people with bipolar are more vulnerable to nicotine and what types of cessation medications and behavioral therapies might be most effective for them.
As for Barb, she quit last summer using a nicotine replacement therapy nasal spray. She’s hoping that, this time, it’s for good.
“I wanted to see my grandkids grow up, I didn’t want to smell like smoke around my husband, and I wanted to breathe better. I just didn’t want to be dependent on something like that anymore.”
Barb urges smokers not to beat themselves up if the first—or fifth—attempt to quit fails. “If you relapse, you can always try a different medication or patch or gum. The main thing is not to give up. It doesn’t mean you are worthless. You can always quit again.”
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Here are some strategies to overcome a nicotine addiction.
Distract yourself. When the urge to light up hits, keep your hands busy. Bowers distracted herself by cleaning her closets and cupboards, for example. Circle the date. It’s easier to have a fixed date for quitting. Get help. Your health care provider can direct you to what’s best for you. Change your habits. Instead of drinking caffeine or alcohol, which may spark a nicotine craving, switch to juice or water. Fight that fixation. Longing for a cigarette? Pop in sugarless gum, hard candy, carrot sticks, or sunflower seeds. De-stress. Exercise, take a hot bath, or read a book. Breathe deeply. Inhale and picture your lungs filling with clean air. This will not only relax you, but remind you of why you’re quitting.
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