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Smoking Cessation and Mental Health: Improving Psychiatric Medication Effectiveness

By Marlena Parson, PMHNP-BC, Duke Smoking Cessation Program

A photo of Marlena Parson, PMH-NP, Duke Smoking Cessation Program and Duke-UNC Tobacco Treatment Specialist Training Program
Marlena Parson, PMH-NP, Duke Smoking Cessation Program and Duke-UNC Tobacco Treatment Specialist Training Program

Smoking cessation has long been heralded as a pivotal step towards better health and well-being. While the physical benefits of quitting smoking are widely acknowledged, emerging research suggests a crucial connection between smoking cessation and the effectiveness of psychiatric medication. I would like to review some of my observations as a clinician who has the opportunity to dedicate my career to the field of tobacco treatment.

The Complex Relationship Between Smoking and Mental Health


The link between smoking and mental health has been documented extensively. Individuals with mental health conditions such as depression, anxiety, schizophrenia, and bipolar disorder are more likely to smoke than the general population. The reasons behind this complex relationship are multifaceted, with factors like self-medication, coping mechanisms, familial patterns, and genetics playing a role.

Learn more about our upcoming Intensive Behavioral Health Approaches to Tobacco Treatment Short Course on October 12, 2023!

Pharmacokinetic Interactions


Research indicates that smoking can alter the pharmacokinetics of psychiatric medications. Smoking accelerates the metabolism of certain medications, leading to reduced drug levels in the bloodstream. This can undermine the intended therapeutic effects of the medications. By quitting smoking, patients can potentially achieve more stable and effective drug concentrations, thus maximizing the benefits of their psychiatric treatment.

Enhanced Neuroplasticity


Smoking has been linked to neuroinflammation and oxidative stress, which can impact brain function and plasticity. Neuroplasticity is crucial for the brain's ability to adapt and rewire itself, a process often targeted by psychiatric medications. By quitting smoking, individuals may mitigate neuroinflammatory processes and improve neuroplasticity, potentially increasing the brain's receptivity to treatment.

Mood Stabilization

Click the image to learn more about how quitting smoking improved Rebecca M.'s mental health in the CDC Tips From Former Smokers Campaign.
Click the image to learn more about how quitting smoking improved Rebecca M.'s mental health in the CDC Tips From Former Smokers Campaign.

Nicotine's effects on mood regulation are well-known. However, the transient mood elevation experienced after smoking is often followed by withdrawal symptoms and mood dysregulation. Psychiatric medications aim to stabilize mood and manage symptoms, but the cycle of nicotine addiction can interfere with these efforts. Smoking cessation can lead to more stable mood states, which may complement the action of psychiatric medications.

Summary


The connection between smoking cessation and the effectiveness of psychiatric medication is an intriguing area of research and can empower clients to pursue smoking cessation as a way of increasing emotional wellness while letting go of a familiar source of comfort. While more studies are needed to fully understand the mechanisms at play, the existing evidence suggests a symbiotic relationship between quitting smoking and optimizing the benefits of mental health treatment. As healthcare providers increasingly recognize the importance of a comprehensive approach to mental health, integrating smoking cessation strategies with psychiatric interventions could lead to improved patient outcomes and a more optimistic outlook for those managing mental health conditions.


For more information on treating tobacco use in behavioral health settings, don’t miss our upcoming short course--Intensive Behavioral Health Approaches to Tobacco Treatment--on October 12, 2023. Visit https://www.dukeunctts.com/short courses to learn more and register!


About the Author


Marlena Parson, PMHNP-BC, is a psychiatric nurse practitioner with the Duke Smoking Cessation Program. She has extensive experience helping adults who are new to smoking cessation understand their treatment options. She enjoys forming long-term therapeutic alliances with her patients to help them quit tobacco use and live healthier lives.



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