Podcast: Does stopping smoking improve mental health?

Alongside its many reviews of interventions to help people quit smoking, the Cochrane Tobacco Addiction Group published a new review in March 2021 which looks at the effects of quitting smoking on mental health. Co-author, Dr Amanda Farley from the University of Birmingham in the UK tells us about the importance of the review and its findings in this podcast.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Alongside its many reviews of interventions to help people quit smoking, the Cochrane Tobacco Addiction Group published a new review in March 2021 which looks at the effects of quitting smoking on mental health. Co-author, Dr Amanda Farley from the University of Birmingham in the UK tells us about the importance of the review and its findings in this podcast.

Amanda: There is a common perception that smoking cigarettes helps people to deal with stress and to improve mood, but smoking might actually be making people feel worse. Regular smoking leads to changes in the brain that mean people start to experience withdrawal symptoms and strong cravings to smoke shortly after having a cigarette. These include feelings of depression, anxiety and irritability, which are eased when the person smokes the next cigarette. It may be that this alleviation makes it seem like smoking is helping with mental health, when, in fact, it was smoking and the beginnings of withdrawal which were having a detrimental effect on mental health in the first place. 
Led by Dr Gemma Taylor from the University of Bath, we conducted this Cochrane review to bring together the available research to investigate what happens to people's mental health after they quit smoking. To be eligible, studies needed to measure a construct of mental health at baseline and then again at least six weeks later, in order to see what happens to mental health after people are through the initial withdrawal period from smoking. We searched for articles published up to January 2020 and found 102 eligible studies, which included nearly 170,000 people in total. These studies either compared the change in mental health in quitters to those who continued to smoke or reported the risk of developing a new mental health condition. Across all the mental health outcomes we looked at, we found no evidence of deterioration in quitters compared to those who continued to smoke, and in fact quitters were reporting an improvement in mental health. There was also a reduced risk of developing anxiety and depression in quitters compared to smokers.
Another potential concern that smokers may have when they quit is that it will affect their social life. We also investigated this by looking at changes in the social quality of life of quitters compared to continuing smokers and found no evidence of a difference. This means that quitters were not reporting deterioration in the quality of their social relationships compared to those who continued to smoke. 
Because of the large amount of research available, we were able to assess whether the associations between quitting smoking, mental health and social quality of life were different for different groups of smokers. This revealed, interestingly, that the improvements in mental health were not only seen for people with pre-existing mental health conditions but that there were similar improvements for people with pre-existing physical conditions and just for the general population. This suggests that once people get through the initial withdrawal period from smoking, which usually lasts only for a short period of time, the potential longer term benefits of quitting for mental health can be experienced by all smokers.
One word of caution, however, is that because of the methods used in some of the studies, we cannot be sure of the exact size of the mental health benefits of quitting but what we can say is that we know that quitting smoking won't worsen mental health. And, if the benefits we found for mental health when people quit smoking are correct, these are likely to be meaningful because they are similar to the improvements in anxiety and depression reported by reviews of the effectiveness of antidepressants on these outcomes.”

Monaz: To find out more about the review and the more than 100 studies included within it, you can find the full review online at Cochrane Library dot com, with a simple search for 'smoking and mental health'.

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