Depression, anxiety and stress

Depression, anxiety and stress

Joined: November 11th, 2008, 7:22 pm

March 1st, 2014, 12:11 pm #1

Change in mental health
after smoking cessation:
systematic review and meta-analysis.

Journal: British Medical Journal, Feb. 13, 2014: BMJ 2014;348:g1151

Authors: Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P.



To investigate change in mental health after smoking cessation compared with continuing to smoke.


Systematic review and meta-analysis of observational studies.


Web of Science, Cochrane Central Register of Controlled Trials, Medline, Embase, and PsycINFO for relevant studies from inception to April 2012. Reference lists of included studies were hand searched, and authors were contacted when insufficient data were reported.


Longitudinal studies of adults that assessed mental health before smoking cessation and at least six weeks after cessation or baseline in healthy and clinical populations.


26 studies that assessed mental health with questionnaires designed to measure anxiety, depression, mixed anxiety and depression, psychological quality of life, positive affect, and stress were included. Follow-up mental health scores were measured between seven weeks and nine years after baseline. Anxiety, depression, mixed anxiety and depression, and stress significantly decreased between baseline and follow-up in quitters compared with continuing smokers: the standardised mean differences (95% confidence intervals) were anxiety -0.37 (95% confidence interval -0.70 to -0.03); depression -0.25 (-0.37 to -0.12); mixed anxiety and depression -0.31 (-0.47 to -0.14); stress -0.27 (-0.40 to -0.13). Both psychological quality of life and positive affect significantly increased between baseline and follow-up in quitters compared with continuing smokers 0.22 (0.09 to 0.36) and 0.40 (0.09 to 0.71), respectively). There was no evidence that the effect size differed between the general population and populations with physical or psychiatric disorders.


Smoking cessation is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke. The effect size seems as large for those with psychiatric disorders as those without. The effect sizes are equal or larger than those of antidepressant treatment for mood and anxiety disorders.

Link to study summary:

Link to free full-text copy of the study:

Researchers are just beginning to appreciate what ex-smokers have long known, that being free and back home is wonderful not horrible. Instead of Marlboro advertising "Come to where the flavor is" its logo should read, "Marlboro: let us destroy your mental health."

The above conclusion was reached after evaluation of 26 studies which had assessed mental health by way of questionnaires designed to measure anxiety, depression, mixed anxiety and depression, psychological quality of life, positive affect, and stress.

If still smoking why continue to keep yourself depressed, riddled with anxiety and stressed? Because you are being fooled by the collective tease of thousands of prior nicotine replenishments. It's likely that the  false message bantering about inside your mind is that use satisfies wanting. Truth is, the only way to bring the wanting, urges and craves to an end is to develop the courage to say "no" to them.
As for smoking reducing stress, as has taught for decades, it's one of the most deadly falsehoods of all. Smoking is NOT a stress-buster but makes highly stressful situations substantially worse by adding the onset of early withdrawal to them via urine acidification.

Both stress and alcohol turn urine more acidic. Your kidneys respond by accelerating removal of alkaloids from your bloodstream. Nicotine is an alkaloid. The more stressed you become, or the more alcohol you drink, the quicker the onset of wanting, urges, craves and early withdrawal.

Never once has nicotine replenishment fixed the stressful event. The tire was still flat, the bill unpaid, the relationship needed mending, the terrorist had still attacked, or your loved one was still sick or injured.

Visit and spend time inside Joel's Library as knowledge is power. Why stay depressed and in darkness when you can turn on the lights? Just one lesson at a time, yes you can!
Related Reading & Viewing
"I have to smoke because of all of my stress!" Freedom discussion:

Joel's video explanation of stresses impact upon smokers and ex-smokers: 

Joel's mental health video: 
Depression: a normal reaction or a real organic depressive effect?

Chapter 9 of FFN-TJH reviewing the symptoms of recovery, including depression:

Joined: November 13th, 2008, 2:04 pm

March 1st, 2014, 2:56 pm #2

Videos referred to above:
Quitting smoking and mental health
"I'll be a nervous wreck forever if I quit smoking"
Why do smokers smoke? ([font=ARIAL, GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]Section starting at the 12 minutes and 49 second mark explains the physiological interaction between smoking and increased stress reactions in smokers.)[/font]
Last edited by Joel Spitzer on March 1st, 2014, 3:06 pm, edited 1 time in total.

Joined: November 13th, 2008, 2:04 pm

March 1st, 2014, 3:04 pm #3

Related video:

Video introduction to our numerous resources explaining that quitting smoking doesn't only help people to get healthier, but also calmer and happier. Below are links to the resources we have made available explaining why former smokers do experience major benefits to their mental health.

"I'll be a nervous wreck forever if I quit smoking"
Video explores the fear that people have that they will become much more nervous when they quit smoking, and likely be more nervous the rest of their lives if they stay free. Despite these fears, most people become calmer as former smokers than they were when actually smoking. The video explains why this is usually the case.

"I am climbing the walls because I quit smoking"
Video discusses how recent quitters often erroneously blame normal stress and anxiety reactions to external circumstances on the fact that they had quit smoking.

The fear of quitting smoking
Video discusses two major fears people face when first considering quitting. First, the fear that they are not strong enough to succeed. The second and often the more intimidating is the fear that the person may actually quit smoking

Why do smokers smoke?
Video discusses how nicotine addiction causes cigarettes and nicotine products to incorporate into almost every aspect of a smoker's life. Section starting at the 12 minutes and 49 second mark explains the physiological interaction between smoking and increased stress reactions in smokers.

The emotional stages of loss
Video discusses the emotional stages of loss many people encounter when first quitting smoking. 

Quitting smoking and mental health
Video discusses how most people experience minor emotional reactions when first quitting, but also how people with pre-existing mental health issues may need physician assistance in dealing with problems that seem to be exacerbated after quitting.

Using cigarettes to self medicate pre-existing conditions
Some people find out that there smoking was treating, or actually more often, masking other pre-existing conditions. Sometimes they feel that this usage justifies smoking in their cases. This video addresses the issue of whether or not it is a good idea to use cigarettes to treat pre-existing conditions.

Medication adjustments that may be necessary after smoking cessation
Video discusses how many medications that were prescribed to people while they were still smoking may need to be adjusted after they quit.

Going back to normal after quitting smoking
Video discusses how after quitting smoking a person will eventually get back to normal. Normal does not mean going back to the normal they experienced when they were smoking but more accurately, what they were like before they ever took up smoking with effects of aging now thrown in.

All of the above videos have links in their descriptions to articles with related information.


March 5th, 2014, 4:23 pm #4

This is so true. My mental state was suicidal at the last stages of my smoking. Fear, anxiety, stress - it was really horrible and I don't want to forget it.  My mind is calm now and I am rarely stressed at all - I can handle everything so much better.