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Question:

I was told by a psychiatrist once that smoking would help the kind of depression that I have. So, I tried to get rid of my depression by chain smoking. Instead of helping, my depression worsened and I developed a pulmonary condition. I guess he doesn't subscribe to the doctrine "above all else, cause no harm" . Do you think that psychiatrists should tell their patients not to smoke? Or do you think that there are certain psychiatric conditions that benifit from smoking and outway the major and likely risk of dying from lung cancer, stroke or heart disease?

Answered by: Lirio Covey

When you smoke you are ingesting nicotine, the main pharmacological ingredient in tobacco. Nicotine affects mood in various ways. This occurs because nicotine affects levels of many neurotransmitters in the brain, including those involved in depression.

Smoking can improve mood momentarily, but the amount of nicotine involved in daily smoking is unlikely to be sufficient to significantly alleviate depressive mood or depressive illness, particularly in the long-term.

On the other hand, cigarette smoking is a major risk factor for respiratory, cardiovascular, and many other medical problems, as it seems you have experienced. This effect of cigarette smoking, is due, not to nicotine, but to other byproducts of tobacco and smoking including nitrosamines which can cause cancer, and carbon monoxide which causes damage to the respiratory system.

Research has suggested that there may be some psychiatric conditions that benefit from nicotine (not cigarette smoking). Some nicotine replacement products, such as nicotine patch for Tourette's syndrome, nicotine gum for depressed mood, and recently, nicotine patch for depressed mood in non-smokers, have been found to be helpful.

Also, there have been well-designed studies which found that smokers with schizophrenia were helped in their efforts to stop smoking when given nicotine replacement therapy (or the non-nicotine medication bupropion), without adverse consequences on schizophrenia symptoms.

Yes, I think psychiatrists should tell their patients not to smoke; stopping smoking will reduce their patients risk of multiple medical conditions. However, when they do so, the advice should be accompanied by information on how to stop smoking given directly by themselves or through a referral to other clinicians who offer smoking cessation treatment.