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Cited by 266Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesCardiac Health and Mental Health

Smoking cessation for improving mental health

Open access
Taylor, Gemma MJ, Lindson, Nicola, Farley, Amanda, Leinberger-Jabari, Andrea, Sawyer, Katherine, te Water Naudé, Rebecca, Theodoulou, Annika, King, Naomi +2 more·2021·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd013522.pub2PMC PMC8121093
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Abstract

BACKGROUND: There is a common perception that smoking generally helps people to manage stress, and may be a form of 'self-medication' in people with mental health conditions. However, there are biologically plausible reasons why smoking may worsen mental health through neuroadaptations arising from chronic smoking, leading to frequent nicotine withdrawal symptoms (e.g. anxiety, depression, irritability), in which case smoking cessation may help to improve rather than worsen mental health. OBJECTIVES: To examine the association between tobacco smoking cessation and change in mental health. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and the trial registries clinicaltrials.gov and the International Clinical Trials Registry Platform, from 14 April 2012 to 07 January 2020. These were updated searches of a previously-conducted non-Cochrane review where searches were conducted from database inception to 13 April 2012. SELECTION CRITERIA: We included controlled before-after studies, including randomised controlled trials (RCTs) analysed by smoking status at follow-up, and longitudinal cohort studies. In order to be eligible for inclusion studies had to recruit adults who smoked tobacco, and assess whether they quit or continued smoking during the study. They also had to measure a mental health outcome at baseline and at least six weeks later. DATA COLLECTION AND ANALYSIS: . We conducted subgroup analyses to investigate any differences in associations between sub-populations, i.e. unselected people with mental illness, people with physical chronic diseases. We assessed the certainty of evidence for our primary outcomes (depression, anxiety, and mixed depression and anxiety) and our secondary social impact outcome using the eight GRADE considerations relevant to non-randomised studies (risk of bias, inconsistency, imprecision, indirectness, publication bias, magnitude of the effect, the influence of all plausible residual confounding, the presence of a dose-response gradient). MAIN RESULTS: = 87%). AUTHORS' CONCLUSIONS: Taken together, these data provide evidence that mental health does not worsen as a result of quitting smoking, and very low- to moderate-certainty evidence that smoking cessation is associated with small to moderate improvements in mental health. These improvements are seen in both unselected samples and in subpopulations, including people diagnosed with mental health conditions. Additional studies that use more advanced methods to overcome time-varying confounding would strengthen the evidence in this area.

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  • Nicotine affects dopamine release, providing temporary pleasure and reinforcing the perception that smoking alleviates mental health symptoms, despite actually worsening these symptoms in the long-term.

    “Nicotine affects dopamine release, providing temporary pleasure and reinforcing the perception that smoking alleviates mental health symptoms, despite actually worsening these symptoms in the long-term [12, 13, 14, 15].”

    From Can an Acceptance and Commitment Therapy-Based Smartphone App Help Individuals with Mental Health Disorders Quit Smoking? (2024) · cites this paper as [15]

    “How the intervention might work” (page unavailable) says smoking briefly relieves withdrawal symptoms, which people mistake for relief of mental-health symptoms. “Quality of the evidence” says this withdrawal cycle could worsen mental health over time. The copy does not support the specific dopamine-release or temporary-pleasure mechanism, and it presents long-term worsening as a possibility rather than an established effect. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Once withdrawal symptoms have abated, cessation is generally associated with improved mental health.

    “Once withdrawal symptoms have abated, cessation is generally associated with improved mental health (Taylor 2014; Taylor 2021)”

    From Mindfulness for smoking cessation (2022) · cites this paper as Taylor 2021

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Research works printed but not linked: 10

  1. Bakhshaie 2015 {published data only}10.1016/ j.comppsych.2014.10.012 · DOI
  2. Balduyck 2011 {published and unpublished data}10.1016/ j.ejcts.2011.03.004 · DOI
  3. Balfour 2017 {published data only}10.1080/09540121.2016.1201195 · DOI
  4. Bekele 2017 {published data only}10.1089/apc.2016.0174 · DOI
  5. Bolliger 2002 {published data only (unpublished sought but not used)}10.1080/1462220021000018380 · DOI
  6. Breslau 1998 {published data only}10.1001/archpsyc.55.2.161 · DOI
  7. Brody 2017 {published data only}10.1093/ntr/ntw190 · DOI
  8. Brook DW, Rubenstone E, Zhang C, Brook JS. Trajectories of cigarette smoking in adulthood predict insomnia among women in late mid-life. Sleep Medicine 2012;13(9):1130-7. [DOI: 10.1016/j.sleep.2012.05.008] References to ongoing studies Allen 2017 {published data only (unpublished sought but not used)}10.1186/s12889-016-3946-4 · DOI
  9. Bernstein 2016 {published data only (unpublished sought but not used)}10.1111/acem.12990 · DOI
  10. Bunker JM, Reddel HK, Dennis SM, Middleton S, Van Schayck C, Crockett AJ, et al. A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams: Study Protocol. Implementation Science 2012;7:83. [PMID: 10.1186/1748-5908-7-83] 0.06 [-0.18, 0.30] · DOI

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Authors
Taylor, G. M., Lindson, N., Farley, A., Leinberger-Jabari, A., Sawyer, K., te Water Naudé, R., Theodoulou, A., King, N., Burke, C., & Aveyard, P.
Affiliations
  • University of Bath (GB)
  • University of Oxford (GB)
  • University of Birmingham (GB)
  • New York University Abu Dhabi (AE)
  • Medical Sciences Division; University of Oxford; Oxford UK
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2021-03-09
Volume
2021
Issue
3
Pages
CD013522-CD013522
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd013522.pub2
PMC
PMC8121093
OpenAlex
W2999720558
Cited by
266
References
238
Citations by year
2026: 22 · 2025: 78 · 2024: 62 · 2023: 50 · 2022: 41 · 2021: 12 · 2020: 1
FWCI
5.51
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Pure (University of Bath) (publishedVersion, other-oa)
  • Bristol Research (University of Bristol) (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
  • Explore Bristol Research (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs (1IK2CX000718)
  • Robert Wood Johnson Foundation
  • John D. and Catherine T. MacArthur Foundation (P01‐AG020166)
  • Eli Lilly and Company
  • Pfizer
  • AstraZeneca
  • GlaxoSmithKline
  • Sanofi
  • Heart and Stroke Foundation of Canada
  • Office of Research and Development
  • University of Pennsylvania
  • Ministerio de Ciencia, Innovación y Universidades (FPU15)
  • Amsterdam University Medical Centers
  • Cancer Research UK (21330, C1417, C1417/A14135)
  • ZonMw (10-000-1001)
  • Universiteit Maastricht
  • Erasmus Medisch Centrum
  • GGZ inGeest
  • Rivierduinen
  • GGZ Friesland
  • GGZ Drenthe
  • Ministerio de Economía y Competitividad (PI14/, BES-2012-053988, BES-2016-076663)
  • Universidad de Navarra
  • Maastricht Universitair Medisch Centrum
  • Ministerio de Ciencia e Innovación (PSI-2011-23395, PI10/02293, G03/140, PSI2011-22804, PI13/00615, PSI2011-22804 and PSI2011-23395, PSI2012, PI14/01798, PSI2015, PI10/02658)
  • Shanghai Jiao Tong University
  • Universitair Medisch Centrum Groningen
  • Universiteit Antwerpen
  • H. Lundbeck A/S
  • Tasmanian Community Fund (D0013808)
  • National Institutes of Health (/ NCI R01, and K24, CA- 016672, P50 NS19632, P50-CA148596)
  • Agency for Healthcare Research and Quality
  • University of Texas MD Anderson Cancer Center (R25T CA057730, (CA016672), P30-CA-016672)
  • Center for AIDS Research, University of Washington
  • Heart And Stroke Foundation Of Quebec (NCT64989)
  • Canadian Institutes of Health Research (NCT64989)
  • Medical Research Council
  • National Health and Medical Research Council (544923, 1008299, 211316)
  • European Regional Development Fund (PSI2015-64371-P, BES-2016-076663, PI14/01798, (RD 06/0045, PI10/02658, G03/140, PI13/00615, PI10/02293, 45/2011)
  • National Institute on Aging (AG020166, P01AG020166)
  • National Heart, Lung, and Blood Institute (R01HL111821)
  • National Institute of Mental Health (MH097488, P01-AG020166, P30MH097488)
  • National Institute on Drug Abuse (R01 DA16708, DA045244, DA022549, R01DA023051, DA023051, DA16708, R01DA033681, K24DA030443, R01DA022549, K24DA045244)
  • National Cancer Institute (R01CA184211, CA057730, CA 016672, R25T-CA057730, P50CA148596, CA016672 to, R01CA152062, CA152062, R01CA165001, R25CA057730, P30CA016672)
  • National Institute of Allergy and Infectious Diseases (P30AI045008)
  • National Institute of Neurological Disorders and Stroke (P50NS19632, NS-19632)
  • Cilag
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
smoking cessation, smoking, mental health, depression, anxiety, nicotine withdrawal symptoms, self-medication, mental illness, neural adaptation
MeSH terms
Social Interaction, Affect, Anxiety, Mental Disorders, Depression, Humans, Mental Health, Middle Aged, Quality of Life, Smoking, Stress, Psychological, Incidence, Confidence Intervals, Smoking Cessation, Tobacco Use Cessation, Controlled Before-After Studies

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