Going Up in Smoke

Art by Rebekah Pawley.

From bleak adverts on the TV to black edged notices on cigarette packets, it is well known that smoking kills. However, little attention has been paid to its effects on mental health. General opinion has been that the mentally ill turn to smoking to alleviate short-term symptoms of anxiety and depression, but a more causal link has been investigated, based upon a study on teenage smokers by Dr Naomi Breslau at the Henry Ford Hospital, Detroit.The study analysed 1000 teenagers who had a history of daily smoking before the study began. Over a five-year period, the risk of these individuals developing severe depression approximately doubled, suggesting that smoking could pre-date mental illness.

In a later study, Breslau found that smokers are three times more likely to develop long-term panic disorders than non-smokers. This link was confirmed by large-scale studies (controlling for socio-demographic factors) showing that people who are anxious or depressed were twice as likely to smoke, and up to 80% of those with psychotic disorders (e.g. schizophrenia) are smokers.

A possible causal mechanism explaining this relationship between smoking and panic was suggested by Breslau’s co-worker Dr Donald Klein. He proposed that impaired lung function, inducing a feeling of suffocation, is caused by cigarette smoking, and triggers panic attacks. This “false suffocation” theory is principally psychological—a more physiological cause of mental illness may lie in the nicotine induced stimulation of two chemicals in the brain which cause an increase in heart rate and blood pressure, and at higher concentrations can set off panic attacks. It is probable that nicotine’s stimulant effect, combined with the carbon monoxide in smoke work together to cause the symptoms of psychological illness.

It is still a major concern that little is being done to help mentally ill smokers to quit, despite the fact around 50% of smokers in mental institutions wish to do so. The health profession must be made aware that nicotine dependence is potentially the most common, most deadly, most expensive, and yet most treatable cause of psychiatric disorders.