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Question:

Is it common for people who give up smoking to suffer increased depression or anxiety, over and above the physical cravings? I gave up five months ago, and after about a month became very depressed, and started suffering panic attacks. This lasted about a month and gradually got better. But I've heard of this happening to other people, and it was suggested to me that it may be part of the rebalancing process of the various hormones that affect brain function. I had no other major stresses in my life when this happened, and was well over the physical craving stage of giving up, which really only lasts a few days.

Answered by: Lirio Covey

Increases in psychological symptoms, including agitation, anxiety, restlessness, irritability, and some listlessness, often occur when giving up smoking. These changes in psychological states, referred to as tobacco or nicotine withdrawal, are not unexpected and are considered part of the re-adjustment in brain function when giving up smoking, as has been suggested to you. These symptoms, including craving, can begin within hours of stopping smoking, be most severe during the first week of not smoking, and usually diminish over the following weeks. The duration of withdrawal symptoms varies among different individuals depending on smoking history (usual amount of tobacco smoked before stopping) as well as the physical and psychological history of the ex-smoker. Typically, withdrawal symptoms return to pre-cessation levels by the end of four to six weeks after quitting. Severe depressive states lasting a month or more have been seen to occur following smoking cessation. Our research has suggested that such sequelae tend to occur among persons who have a past history of major depressive illness. There have been some reports of panic attacks after smoking cessation; in my experience, these also resolve over time. That the depression and anxiety you experienced after giving up smoking got better after a month suggests to me that these occurred as a natural consequence of tobacco and nicotine withdrawal. On the other hand, if those symptoms had been severe, impaired your ability to function on a day-to-day basis, and were persistent, seeking treatment for them would have been a consideration. It would not imply, however, that a return to smoking is warranted.