Dear Alice,

I quit smoking cigarettes seven days ago. I've quit before and I understand that this horrible loneliness and depression are just some of the withdrawal symptoms, but I don't know how to lessen the depression. Most of my friends are smokers, so I'm not going out much and I live alone. Is there a treatment for this kind of depression? How long does this last? It lasted over a month the last time I tried to quit smoking.

Dear Reader,

Congratulations! Making the decision to quit is a big first step and learning to manage the withdrawal process is a challenging next one. Withdrawal symptoms can include headaches, irritability, mood swings, weight gain, difficulty concentrating, insomnia and, as you've seen all too clearly, depression. That being said, there is some research to indicate why people may experience feelings of depression when they quit smoking. These feelings of depression can vary based on the cause. While these symptoms may eventually pass, there are also additional resources you can turn to for additional support if you need them. Treatments such as MAO inhibitors or psychotherapy may be helpful.

There may be a biological explanation for why you’re experiencing feelings of depression when you quit smoking. The body has specific proteins called monoamine oxidase A (MAO-A) and monoamine oxidase B (MAO-B). These proteins regulate neurotransmitters such as dopamine, norepinephrine, and serotonin. Studies have indicated that people who smoke have lower MAO levels compared to people who don’t smoke. This is due to alkaloids in tobacco binding to the MAO enzymes, thereby reducing neurotransmitters. Over time, the body requires more neurotransmitters to match pre-smoking level mood regulation. When someone stops smoking, MAO levels may return to normal, but not the neurotransmitters. The body still needs the increased number of neurotransmitters to regulate mood, which may lead to feelings of depression.

You may also want to consider that the sadness you're feeling may not just be a withdrawal symptom but a pre-existing condition. Some smokers use nicotine to self-medicate depression, either whether they’re doing it consciously or not. In fact, reported lower MAO levels in smokers may not be caused by smoking. In other words, people who take up smoking may already be having feelings of depression when they start smoking. It may be a good idea to speak to a mental health professional about the feelings you’re experiencing. They can help you decide if talk or cognitive therapy would be helpful and if you’re a good candidate for an antidepressant medication, such as MAO inhibitors. 

Your health care provider would also be a great resource to talk through the options. Treating post-quitting depression bolsters the chances of successfully kicking the habit. You could also consider checking with them about tobacco cessation programs. There are some solutions in the meantime that may help alleviate withdrawal symptoms and mitigate your feelings of depression. Nicotine replacement therapy in the form of patches, gums, nasal sprays, and lozenges, when properly used, can reduce withdrawal symptoms. Healthier food choices and activities, such as physical activity, carrots, and gum (to help with the oral fixation) can help. If you're not sure which method is best for you, you could speak with your health care provider about a plan of treatment. You may also take a look at Smokefree.gov to find more information and locate resources near you.

As far as not being able to hang out with your friends who light up, perhaps you could involve yourself in some other activities you enjoy. Possibilities include going to the gym, volunteer work, joining a club that interests you, going on long walks, or whacking a few buckets of balls at the local driving range. Getting outside as much as possible helps since being cooped up might be a factor to your post-quitting blues. It can be helpful to keep your schedule busy, but it can also help to enjoy time with people you like and who make you feel comfortable. You may not have to dismiss your friends' company altogether, even if they’re chimneys. It may help to talk with them about your desire to quit smoking. You could ask them if they would try not to smoke as much around you, especially during the first few weeks or months of your non-smoking life. You might start by suggesting meeting up at a location that doesn’t have a smoking section.

You've already taken the first step toward a lifetime of smoke-free health. With some professional help, you can decide on the treatment plan that works best for you. Plus, maybe your friends will see your progress and join you — accountability among friends is a good incentive to abstain from smoking. Keep it up and you'll be thanking yourself and inspiring others for years to come!

Alice!

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