Normal depressive reaction or a real organic depressive episode


7:49 PM - Jul 14, 2001#1

I see we had some recent issues with quitting and depression and anger at the board. The fact is everyone who ever quit smoking faced these issues to some degree. I am creating a string here that covers depression from a number of angles. Some of these letters were written to my clinic graduates and others were specific answers to people who wrote questions with background histories. I think they will give everyone an overview of different physical and emotional issues around depression while quitting.

Again, some of the emotional reactions are a simple adjustment period. But some people have histories of emotional problems that may take more than the individual alone to overcome. The people involved may need to be working very closely with their doctors and medical professionals. These articles should give a little overview of those issues too.


The first letter here is in response to someone who wrote me a question regarding depression who had a past history of depression.

I take it from your post that you had been on medication for depression prior to smoking cessation. While becoming depressed upon smoking cessation is common, this depression normally subsides over time. But, when depression is a preexisting condition there are special considerations that need to be addressed. First, you may have been on a medication that initially took time to adjust, to find the right dosage for you. Now, when you quit smoking and stay on that dosage you can initially become depressed as part of the normal separation process from smoking, in a sense, feeling bad but not thinking anything is wrong. But when it doesn't subside over time you may assume that nothing can be done, its part of not smoking, you are already on an adjusted dose of depression medication and you just have to put up with it. This is a wrong assumption. Chances are even though you are on your normal dosage of medication, that dose was set while you were a smoker. This may not be the proper (normal dose) for you as an ex-smoker.

This dosing issue is not just about depression. People with many conditions may find that after cessation they must find what is normal for them. A person who is diabetic or on thyroid medications often find that the dose required as a smoker needs to be adjusted after quitting. Anyone who is on various medications that effect mood, hormonal and blood sugar levels needs to pay special attention to symptoms. Once through the first few days, and especially into the second week, if physical symptoms normally attributed to withdrawal are still manifesting, it is advisable that their doctor checks out those individuals.

I have put a few articles on the board here that I suspect you saw. There are others that I am not sure I put here or not, they were written to individuals who wrote with specific questions. While they may not apply to your specific situation, they cover a range of different depression issues. I am going to attach a string of letters here that were written to a few such individuals. If you have read part of them, keep going further down there may be more that you hadn't seen yet.

One other thing I would like to note that applies to emotions when quitting. If anyone lets emotions solely dictate actions, nobody would quit smoking. Part of the skill needed by all ex-smokers is the ability to override normal emotions, desires, impulses or urges, whatever we want to call it, the individuals wanting a cigarette or just a puff. Everyone feels it from time to time. It is going to be your intellect that is going to override the craving. That is where keeping your ammunition and focus of why you quit smoking is paramount. You have to keep remembering what smoking was doing to you making you sick and tired enough to go through initial quitting. Then you have to remember what continued smoking was capable of doing to you in the future, thoroughly capable of robbing you of your health and your life. When in emotional turmoil it is harder to keep that perspective. It is hard for everyone when in such turmoil but it is a skill that has to be honed day by day by everyone. Life will throw curves throwing people into despair. But smoking won't solve any of these curves. Smoking can cause problems that will throw your life further into despair and if left unchecked will throw your loved ones life into a premature loss of you.

Keep focused on this fact that quitting smoking is a fight for survival. It may be hard at times, but it is worth the effort. Bad times may make it harder to see this, but bad times will pass. You've experienced them before and you know they got better. Hang on to those memories that they do get better.

Again, talk to your doctor letting him or her know you have quit and have questions on the medications. Keep focused on your quit. One other thing to consider too, considering you were on medications before, you were depressed as a smoker. Never delude yourself into thinking life was always perfect before. Smoking didn't cure your depression before and it won't do it now either. For you, other medications were necessary to help with those feelings, smoking was not able to do it. Anyway, the following articles deal a little with the medication issues. Again, they may not all apply to you but kind of covers a range of reactions.

Hope this helps.


The following is another article written to a specific person who was experiencing a longer-term depression. This person was being encouraged by his or her doctor to go on an antidepressant but was resistant to the idea of needing medication.

Depression is normal in the cessation process. Almost everyone feels it to a degree, and the period of time that it lasts varies from person to person. Unlike the physical withdrawal, which is quite predictable in duration, the psychological reactions have tremendous individual variability.

I am attaching a letter here about the emotional phases of cessation. But since your reaction has been going for so long now, I would advise checking with your doctor. While quitting can be causing depression, it is possible that you do have an organic basis for depression that in a sense you were self-medicating with cigarettes for years.

If your doctor feels this is a possibility he or she may want to prescribe something for it. There are a lot of medications out there that are effective. As for safety or side effects, considering you may have been using smoking for this therapeutic purpose, a product that kills 50% of its users, the prescribed alternatives will pose minimal risks in contrast.

Or, the other hand, there may be some emotional conflicts in your life that have never been adequately addressed that are manifesting for the first time since quitting. I am attaching another letter I wrote to another person a few weeks ago that had some serious losses and was having some exaggerated reactions since quitting. I had more of a history on this person making me able to write this with some feeling that it really applied to this persons situation. I don't know if it applies to yours, but maybe in reading it you will see if it strikes a chord.

Anyway, hope this helps.


Understanding the emotional loss experienced when quitting smoking
In her 1969 book, On Death and Dying, Elizabeth Kubler-Ross identified five distinct phases which a dying person encounters. These stages are "denial," "anger," "bargaining," "depression," and finally, "acceptance." These are the exact same stages that are felt by those mourning the loss of a loved one as well.

Denial can be recognized as the state of disbelief: "This isn't really happening to me," or "The doctor doesn't know what he is talking about." The same feelings are often expressed by family members and friends.

Once denial ceases and the realization of impending death is acknowledged anger develops. "Why me?" or "Why them?" in the case of the significant others. Anger may be felt toward the doctors, toward God, toward family and friends. Anger, though, doesn't change the person's fate. They are still in the process of dying. So next comes bargaining.

In bargaining, the person may become religious, trying to repent for all the sins that may be bringing about their early demise. "If you let me live, I will be a better person, I will help mankind. Please let me live, and I will make it worth your while." This stage, too, will come to an end.

Now the patient, becoming aware he is helpless to prevent his impending fate, enters depression. The patient begins to isolate himself from his surroundings. He relinquishes his responsibilities and begins a period of self mourning. He becomes preoccupied with the fact that his life is coming to an end. Symptoms of depression are obvious to anyone having contact with the patient in this stage. When the patient finally overcomes this depression he will enter the last stage, acceptance.

The patient now reaches what can be seen as an emotionally neutral stage. He almost seems devoid of feelings. Instead of death being viewed as a terrifying or horrible experience, he now peacefully accepts his fate.

As stated above, these stages are not only seen in the dying person but likewise in the family members mourning the loss of a loved one. However, on careful observation we can see these same stages in people who lose anything. It doesn't have to be the loss of a loved one. It could be the loss of a pet, the loss of a job, and even the loss of an inanimate object. Yes, even when a person loses her keys, she may go through the five stages of dying.

First, she denies the loss of the keys. "Oh, I know they are around here somewhere." She patiently looks in her pockets and through her dressers knowing any minute she will find the keys. But soon, she begins to realize she has searched out all of the logical locations. Now you begin to see anger. Slamming the drawers, throwing the pillow of the couch, swearing at those darned keys for disappearing. Then comes bargaining: "If I ever find those keys I will never misplace them again. I will put them in a nice safe place." It is almost like she is asking the keys to come out and assuring them she will never abuse them again. Soon, she realizes the keys are gone. She is depressed. How will she ever again survive in this world without her keys? Then, she finally accepts the fact the keys are gone. She goes out and has a new set made. Life goes on. A week later the lost keys are forgotten.

What does all this have to do with why people don't quit smoking? People who attempt to give up smoking go through these five stages. They must successfully overcome each specific phase to deal with the next. Some people have particular difficulty conquering a specific phase, causing them to relapse back to smoking. Let's analyze these specific phases as encountered by the abstaining smoker.

The first question asked of the group during the smoking clinic was, "How many of you feel that you will never smoke again?" Do you remember the underwhelming response to that question? It is remarkable for even one or two people to raise their hands. For the most part the entire group is in a state of denial-they will not quit smoking. Other prevalent manifestations of denial are: "I don't want to quit smoking," or "I am perfectly healthy while smoking, so why should I stop," or "I am different, I can control my smoking at one or two a day." These people, through their denial, set up obstacles to even attempt quitting and hence have very little chance of success.

Those who successfully overcome denial progress to anger. We hear so many stories of how difficult it is to live with a recovering smoker. Your friends avoid you, your employer sends you home, sometimes permanently, and you are generally no fun to be with. Most smokers do successfully beat this stage.

Bargaining is probably the most dangerous stage in the effort to stop smoking. "Oh boy, I could sneak this one and nobody will ever know it." "Things are really tough today, I will just have one to help me over this problem, no more after that." "Maybe I'll just smoke today, and quit again tomorrow." It may be months before these people even attempt to quit again.

Depression usually follows once you successfully overcome bargaining without taking that first drag. For the first time you start to believe you may actually quit smoking. But instead of being overjoyed, you start to feel like you are giving up your best friend. You remember the good times with cigarettes and disregard the detrimental effects of this dangerous and dirty habit and addiction. At this point more than ever "one day at a time" becomes a life saver. Because tomorrow may bring acceptance.

Once you reach the stage of acceptance, you get a true perspective of what smoking was doing to you and what not smoking can do for you. Within two weeks the addiction is broken and, hopefully, the stages are successfully overcome and, finally, life goes on.

Life becomes much simpler, happier and more manageable as an ex-smoker. Your self esteem is greatly boosted. Your physical state is much better than it would ever have been if you continued to smoke. It is a marvelous state of freedom. Anyone can break the addiction and beat the stages. Then all you must do to maintain this freedom is simply remember, NEVER TAKE ANOTHER PUFF!

© Joel Spitzer 1982

The letter to the other person mentioned above.

Dealing with emotional loss has similarities to dealing with anger in regards to smoking cessation and its aftermath. When a smoker encounters a person or situation that angers them, they initially feel the frustration of the moment, making them, depending on the severity of the situation, churn in side. This effect in non-smokers or even ex-smokers is annoying to say the least. The only thing that resolves the internal conflict for a person not in the midst of an active addiction is resolution of the situation or, in the case of a situation which doesn't lend itself to a quick resolution, time to assimilate the frustration and in a sense move on. An active smoker though, facing the exact same stress has an additional complication which even though they don't recognize it, it creates real significant implications to their smoking behavior and belief structures regarding the benefit of smoking.

When a person encounters stress, it has a physiological effect causing acidification of urine. In a non-smoker or non-nicotine user, the level of urine acidity has no real perceivable effect. It is something that internally happens and they don't know it, and actually, probably don't care to know. Nicotine users are more complex. When a person maintaining any level of nicotine in their body encounters stress, the urine acidifies and this process causes nicotine to be pulled from the blood stream, not even becoming metabolized, and into the urinary bladder. This then in fact drops the brain supply of nicotine, throwing the smoker into drug withdrawal. Now they are really churning inside, not just from the initial stress, but also from the withdrawal effect itself. Interesting enough, even if the stress is resolved, the smoker generally is still not going to feel good. The withdrawal doesn't ease up by the conflict resolution, only by re-administration of nicotine, or, even better, riding out the withdrawal for 72 hours totally eradicating nicotine via excretion from the body of metabolizing it into bi-products which don't cause withdrawal. Most of the time, the active smoker more often uses the first method to alleviate withdrawal, taking another cigarette. While it calms them down for the moment, its effect is short lived, basically having to be redone ever 20 minutes to half hour for the rest of the smokers life to permanently stave off the symptoms.

Even though this is a false calming effect, since it doesn't really calm the stress, it just replaces the nicotine loss from the stress, the smoker feels it helped them deal with the conflict. It became what they viewed as an effective crutch. But the implications of that crutch are more far reaching than just making initial stress effects more severe. It effects how the person may deal with conflict and sadness in a way not real obvious, but real serious. In a way, it effects their ability to communicate and maybe even in someway, grow from the experience.

Here is simple example of what I mean. Let's say you don't like the way a significant other in your life squeezes toothpaste. If you point out the way it's a problem to you in a calm rational manner, maybe the person will change and do it a way that is not disturbing to you. By communicating your feeling you make a minor annoyance basically disappear. But now lets say you're a smoker who sees the tube of toothpaste, get a little upset, and are about to say something, again, address the problem. But wait, because you are a little annoyed, you lose nicotine, go into withdrawal, and before you are going to deal with the problem, you have to go smoke. You smoke, alleviate the withdrawal, in-fact, you feel better. At the same time, you put a little time between you and the toothpaste situation and on further evaluation, you decide its not that big of a deal, forget it. Sounds like and feels like you resolved the stress. But in fact, you didn't. You suppressed the feeling. It still there, not resolved, not communicated. Next time it happens again, you again get mad. You go into withdrawal. You have to smoke. You repeat the cycle, again not communicating and not resolving the conflict. Over and over again, maybe for years this pattern is repeated.

One day you quit smoking. You may in fact be off for weeks, maybe months. All of a sudden, one day the exact problem presents itself again, they annoying toothpaste. You don't have an automatic withdrawal kicked in pulling you away from the situation. You see it, nothing else effecting you and you blow up. If the person is within earshot, you may explode. When you look back in retrospect, you feel you have blown up inappropriately, the reaction was greatly exaggerated for the situation. You faced it hundreds of times before and nothing like this ever happened. You begin to question what happened to you to turn you into such a horrible or explosive person. Understand what happened. You are not blowing up at what just happened, you are blowing up for what has been bothering you for years and now, because of the build up of frustration, you are blowing up much more severe than you ever would have if you addressed it early on. It is like pulling a cork out of a shaken carbonated bottle, the more shaken the worse the explosion.

What smoking had done over the years was stopped you from dealing early on with feelings, making them fester and grow to a point where when the came out, it was more severe than when initially encountered. Understand something though, if you had not quit smoking, the feelings sooner or later would manifest. Either by a similar reaction as the blow up or by physical manifestations which ongoing unresolved stress has the full potential of causing. Many a relationships end because of claming up early on effectively shutting down conflict resolution by communication between partners.

As I said, anger is not the only emotion effecting urine acidity. Sadness does this too. The losses of your family members likely increased your smoking consumption at the time. By smoking you too may have suppressed numerous feelings and emotions during the losses. In a sense, not only did smoking impact your communication with others, but also maybe with yourself, coming to grips with certain feelings. In a sense, you may have interfered to some degree with your own personal growth at the time. And now, by quitting, these feeling are manifesting. While it may hurt at the time, it may be essential that these feeling are coming out. Beneficial in fact, making you face feelings in a way more constructive than smoking and suppressing them. And again, understand, if they are there deep seated all this time, if they didn't come out now, they were going to come out eventually. In what manner no one can predict. But the sooner you deal with the feelings, the less severe the reactions will generally be.

This above text doesn't resolve the feelings, it may just help you understand the possible problem. Talk with people here if that helps. Maybe there are more personal issues, you may find it more helpful to talk to a local professional, a doctor or therapist. Whatever you do and who ever you work with, understand, everyone will have greater interest in helping you than cigarettes will.

I know people who are afraid to take medications for mood disorders but will smoke in its place. No matter what drug would be prescribed for them, none of them would carry the risk that self-medicating oneself by nicotine carries. Smoking is lethal. Don't give cigarettes the legitimacy to treat feelings. They don't. They make them worse. They in effect minimize your ability to communicate and grow. Growth may hurt, but it beats carrying on unresolved feelings that slowly may deteriorate the quality of your life.

Hope this helps explain why it hurts so much but also helps you to understand why it is still so important not to smoke.

Will talk to you again soon.



I don't want to give the impression that the majority of people become clinically depressed or need medications to deal with the normal depression phase that accompanies initial smoking cessation. The fact is that only a small percentage of people will have a full-blown organic depression occurring just after quitting smoking. But that fact is not important if you are one of these individuals. What is important is that if you believe you are organically depressed get checked out by your doctor.

Especially if you are a person with a past history of treatment for depression or if your depressive episode is lasting more than a week and is causing a real disruption in your life, get checked out. You may indeed benefit from treatment or maybe your physician will just give you the reassurance that you are really okay. Either way it doesn't hurt to get the situation professionally assessed.


The following "Depression Basicis" article was 
created by the
Tobacco Control Research Branch
of the National Cancer Institute.

Depression Basics
NOTE: This information is not meant to tell you for sure if you have major depression. It cannot take the place of seeing a mental health professional.

It is common for people who are feeling bad to think about hurting themselves or dying. If you or someone you know is having these feelings, they are in crisis. Get help now. Call 1-800-273-TALK (8255) or 1-800-SUICIDE (1-800-784-2433) to reach a 24-hour crisis center or dial 911.

Both 1-800 numbers are open all the time to give free, private help to people in crisis. The Substance Abuse and Mental Health Services Administration (SAMHSA), a part of the U.S. Department of Health and Human Services, runs both crisis centers. For more information, go to

Para obtener asistencia en español durante las 24 horas, llame al 1-888-628-9454.

What is depression? Depression is more than feeling sad or having a bad day. People with depression usually feel down, blue, or sad, and they have other signs, such as:
  • Feeling sad all the time
  • Not wanting to do things that used to be fun
  • Grumpy, easily frustrated, restless
  • Changes in sleep—trouble falling asleep or staying asleep, waking up too early, or sleeping too much
  • Eating more or less than they used to
  • Trouble thinking
  • Feeling tired, even after sleeping well
  • Feeling worthless
  • Thinking about dying or hurting themselves
You may have depression if:
  • You have 5 or more of the signs listed above.
  • These signs have lasted 2 weeks or more.
Use our depression screening quiz to see if you are depressed. You should consider seeing your doctor or a qualified mental health professional, especially if these problems are getting in the way of your life or are making you stressed.

What causes depression? There are many things that increase a person’s chance of getting depressed. Everyone is different, but here are some common things that can lead to depression:
  • Feeling lots of stress
  • Going through a difficult life event
  • A big life change, even if it was planned
  • Medical problem
  • Taking a medication that is known to cause depression
  • Using alcohol or drugs
  • Having blood relatives who have had depression
How is depression different from sadness? Everyone has down days and times when they feel sad. Sadness could turn into depression, but depression and sadness are different in these ways:
  • How long the feelings last: Depression is felt every day (or most days) and lasts at least 2 weeks, usually much longer.
  • How bad the symptoms are (how much they get in the way of your life): Depression makes it hard for you to do things (like work or family duties) and it can stop you from doing the things you want to do.
How is this different from withdrawal from smoking? Mood changes are common after quitting smoking. You might be irritable, restless, or feel down or blue.
Changes in mood from quitting smoking (withdrawal) usually get better in 1 or 2 weeks, and they are not as serious.

If you find that you are feeling very down after quitting smoking, then you should talk about this with friends and family, and also call your doctor. This is also true if you have symptoms from the list above. See "What is depression?" and the depression screening quiz.

Who gets depression? In general, about 1 out of every 6 adults will have depression at some time in their life.
Depression affects about 15,000,000 American adults every year.

Anyone can get depressed. Depression can happen at any age and to any type of person.
But some types of people seem more likely to get depressed than others. For example,
  • Women
  • Smokers
  • People with medical problems
  • People who are stressed
Your race, ethnicity, or how much money you make doesn’t change your chance of getting depression.

Why is depression more common in smokers? Nobody knows why smokers are more likely to have depression than non-smokers, but there a number of guesses. People who have depression might smoke to feel better. Or smokers might get depression more easily because they smoke. Other ideas are also possible. More research is needed to find out for sure.
No matter what the cause, there are treatments that work for both depression and smoking.

If I get depressed after quitting smoking, should I start smoking again? No. You should look for ways to get help with your depression. Smoking does not treat depression. Remember that smoking is linked to many serious health problems for both the smokers and the people around them. Finding ways to help your depression and quit smoking are the best way to go.

How long does it last? Will this go on forever? Everyone is different. For some people, it will only last a few weeks, some for many months if not treated.
For many people, depression is only a problem during really stressful times (like a divorce or the death of a loved one). For other people, depression happens off and on through their life.

But, for both groups of people, there are treatments for depression that can help reduce the symptoms and shorten how long the feelings last.

Is it worth getting treatment for depression? Yes! Treatment almost always helps to reduce symptoms and shorten how long the depression lasts. A common problem is that too few people get help. Many people think that depression is not a real problem, can’t be all that serious, or is a sign that they are simply not tough enough to deal with life. None of these are true.

You do not need to feel shy or embarrassed about talking openly and honestly about your feelings and worries. This is an important part of getting better, working on ways to help your mood.

Many people benefit from treatment for depression, even if the symptoms are not serious. So you don’t need to have a lot of symptoms of depression before talking to your doctor or a qualified mental health professional (see "Who provides therapy?") about getting treatment.

If you find that you have 5 or more signs from the list above (see "What is depression?" or the depression screening quiz), you should talk with your doctor or a qualified mental health professional. This is especially true if the feelings have lasted 2 weeks or more, are making you worried, or are getting in the way of your daily life.

What are the treatments for depression? There are many good treatments for depression, and more than 8 out of every 10 people who use them get better. Treatment usually means getting psychotherapy/counseling, taking medications, or doing both. Your doctor or a qualified mental health professional can help you figure out what treatment is best for you.

About therapy (counseling, talk therapy, psychotherapy) Therapy has shown to be quite helpful and is often an important part of treatment for depression.
Getting therapy does not mean you will be in treatment forever. Most talk therapy is for a short time. Depending on how serious your feelings are, it can mean meeting only a few times with a therapist. Most talk therapy focuses on thoughts, feelings, and issues that are happening in your life now. In some cases, understanding your past can help, but finding ways to address what is happening in your life now can help you cope and be ready for challenges in the future.

Therapy is more than just telling your therapist about your problems. It means working with your therapist to improve coping with the things happening in your life, change behaviors that are causing problems, and find solutions. Your therapist may give you some homework in between meetings; things for you to think about and work on. This might include making a list of situations that give you negative thoughts and feelings, or looking at things in a different way. 

Some common goals of therapy:
  • Get healthier
  • Get over fears or insecurities
  • Cope with stress
  • Make sense of past painful events
  • Identify things that make your depression worse
  • Have better relationships with family and friends
  • Make a plan for dealing with a crisis
  • Understand why something bothers you and what you can do about it
Who provides therapy? There are many kinds of people who have been trained to give therapy and help you. These include:
  • Psychiatrists (they write “MD” after their name)
  • Psychologists (they write PhD, PsyD, EdD, or MS after their name)
  • Social workers (they write DSW, MSW, LCSW, LICSW, or CCSW after their name)
  • Counselors (they write MA, MS, LMFT, or LCPC after their name)
  • Psychiatric nurses (they write APRN or PMHN after their name)
More important than their training, you should find someone you can talk with honestly and openly. Your therapist won’t have all the answers, but the key is to find someone you can work with as a partner to help you find answers.

About medications Many people with depression find that taking medication is a useful tool in improving their mood and coping. Medications for depression are called antidepressants. Antidepressants cannot solve all your problems like magic, but they can help you to even out your mood and be more able to handle events in your life that are making your mood worse.

Antidepressants are prescription medications, so talk to your doctor if you want to take them. If your doctor writes you a prescription for an antidepressant, ask exactly how you should take the medication.
There are many medications, so you and your doctor have options to choose from. Sometimes it takes trying a couple different medications to find the best one for you, so be patient. If you are worried about cost, ask your doctor or pharmacist if the medication comes in a generic form. Generic medications can cost less than brand names.

When taking these medications, it is important to stick with them for awhile. Many people start feeling better a few days after starting the medication, but it often takes 1–2 weeks of taking it to feel a big difference, and 4 weeks to feel the most benefit. It is also common to have to change the dose, so you will want to work closely with your doctor.

How long a person takes antidepressants is very different from person to person. Many people are on them for 6–12 months, and some people take them for longer. Again, you and your doctor will want to talk about what is best for you.

Antidepressants are safe and work well for most people, but it is still important to talk with your doctor about side effects you may get. Side effects usually do not get in the way of daily life, and they go away as your body gets used to the medication.

If you notice that your mood is getting worse, especially if you have thoughts about hurting yourself, it is important to call your doctor right away.

Taking care of you There are many things you can do to help lift your mood and improve feelings of depression.
  • Exercise. Stay active. This can include something as simple as taking a fast walk or as involved as going to the gym or joining a team sport. The type of exercise depends on how fit you are, but any kind of activity can help. If you need to, start small and build over time. This can be hard to do when you are down or depressed because feeling down saps all your energy. But making the effort will pay off! It will help you feel better.
  • Structure your day. Create a plan to stay busy. It is especially important to get out of the house whenever you can.
  • Talk and do things with other people. Many people who are feeling depressed are cut off from other people. Having daily contact with other people will help your mood.
  • Build rewards into your life. For many who are depressed, rewards and fun activities are missing from life. It is helpful to find ways to reward yourself. Even small things add up and can help your mood.
  • Do what used to be fun, even if does not seem fun right now. One of the common signs of depression is not wanting to do activities that used to be fun. It may take a little time, but doing fun activities again will help improve your mood. Some people like to make a list of fun events and then do at least one a day.
  • Talk with friends and loved ones. Their support is a key to your feeling better. Having a chance to tell them your concerns can help things seem less scary.
Videos related to quitting smoking and mental health:

Quitting smoking and mental health
The emotional stages of loss
Going back to normal after quitting smoking
"Will this get better?"
Medication adjustments that may be necessary after smoking cessation
Using cigarettes to self medicate pre-existing conditions
Quitting smoking can make you calmer, happier and healthier
Last edited by Joel on 1:45 PM - May 09, 2015, edited 3 times in total.


10:42 PM - Jul 14, 2001#2

Thanks Joel, I seriously needed to (again) read this post. Been on anti-depressants for years, things were reasonably stable but my quit seemed to amplify some uncool things like mood swings. Things seem to be leveling out a lot however, and what I'm beginning to experience a new sense of calmness I've never known before. I also see the need to keep a journal or log so that I might have something intelligable to report to my doctor. I guess the key thing is just knowing that I am not alone, that certain reactions are "normal" and to take some common sense action. i.e. check in w/medical professionals to determine any required changes in dosage, etc. Thanks again Joel. I don't believe it possible to have lasted 50 days without smoking without the help of Freedom. Also, I do not believe it possible for me to ever keep a quit again, one more puff and I know, at age 58, I'll be out of quits forever. That's why, One Day at a Time, I hang on to this quit like a dog with a bone!!! Everytime I catch that slick ol' Nicodemon sneaking around I tear him a new one. I read a lot and post when the spirit moves me, sometimes even when I don't want to. Never Take Another Puff NO MATTER WHAT!!!!

Hijacking this post to add in videos addressing concepts discussed in this string.

Quitting smoking and mental health
Quitting smoking can make you calmer, happier and healthier
Using cigarettes to self medicate pre-existing conditions
"Is this a symptom of quitting smoking?" (part 2)

Also just noticed that this post referred to "nicodemon"

See string Once and for all, there is no Nicodemon
Last edited by Robert2(Bronze) on 1:05 PM - May 11, 2015, edited 6 times in total.

mirigirl (silver)

6:58 PM - Jul 15, 2001#3

Hey Joel - thanks so much for bringing up this issue.
I think it is a very important one and something for all quitters to be aware of. As you know I went into quite a severe depression after my quit. Something that I'd never experienced before in my life but I'm also a (sober) alcoholic so there maybe some link there.
Some part of me knew that what I was experiencing, was more than the normal grieving process that you talk about, when identifying the stages of grief from Elizabeth Kubler Ross (Actually by the by, I love her work and when I saw it here, in one of your articles I knew, that you knew, what you were talking about). It makes sense to me that as ex-smokers we would go though such a grieving process, but that generally this should be short lived and not totally immobilising.
After weeks of being totally wtihout any motivation, feeling miserable all the time and getting to a point where there didn't seem to be much hope in my life - I knew there was something definitely wrong! So I did a number of things that have helped this situation change, and I just want to post them if it might help someone.....
  • I read all the posts about depression on this site
  • I saw my doctor a number of times and talked about what was happening to me. She told me that some people (probably less than 10%?) mask a clinical depression by smoking.
  • I emailed to you and Zep and got some really helpful replies, which I am very grateful for. You have both been so helpful and considerate.
  • I started to separate my depression from quitting and see them as two separate healing processes. I believe organic depression is different from the normal feeling of being "depressed" that is part of grieving. Maybe that sort of depression is more like feeling blue or down or sad for a little while, but it is definitely not clinical depression which certainly needs professional intervention.
  • Through it all I hung close to Freedom and did my best to concentrate on quitting, which actually helped my depression, because at least it was something positive happening in my life and the positive posts of other people often lifted my mood.
  • Through it all I remembered to NEVER TAKE ANOTHER PUFF!! and to feel some gratitude that I was some-free.
And so today, here I am still smoke-free and so proud of myself. The depression has largely lifted although I have to continue to look after myself. i don't carve or even want a cigarette. I can walk and breath and care about what I eat and I can smile and I love reading all the posts at Freedom and posting when I can too, to encourage others.

If we can make our Quit our top priority, avail ourselves of all the education and support here at Freedom, and also get help for any other problems that reveal themselves in our healing journey, then I reckon we are truely on our way to Freedom.

I'm truely grateful to Freedom for ignitng the flame of Freedom in me and being around to help keep it burning!

Ring that bell!!:-))

yqs Maz


Five months, three weeks, three days, 20 hours, 57 minutes and 36 seconds of FREEDOM!!

4396 cigarettes not smoked, saving $1,407.32. Life saved: 2 weeks, 1 day, 6 hours, 20 minutes.
Last edited by mirigirl (silver) on 1:39 AM - Mar 17, 2009, edited 1 time in total.


11:47 PM - Jul 15, 2001#4

Thank you Robert and Maz for sharing your personal experiences and insight to this issue. Many people think because they have problems with depression or anxiety or other emotional conditions that quitting smoking is too big of a task to ever be accomplished. But your stories illustrate that this is not the case.

Even in the event that these problems do exist, quitting is possible and still extremely important. For using such conditions as an excuse for smoking can result in conditions that are so dangerous, it will often cost the smoker his or her life. These emotional conditions can be devastating for a time period, but with treatment and sometimes with just time the body and mind can be healed and the person can resume a normal state of happiness and health. But cigarettes cause conditions that often cannot be healed, even with the best treatments available. Cigarettes cause diseases that literally progress over time until it finally kills the smoker. This is not a rare circumstance either; smoking if left unchecked will go on to kill half the people who do it. It cripples many of the others that it does not actually kill.

So whether happy or sad from other events in your life or from other medical conditions causing emotional upheavals, still always remember that even in the worst of times, to one day get back to normal your handling of bad times should still include sticking with your commitment to never take another puff!


Patticake (Gold)

7:08 AM - Jul 18, 2001#5

Joel I will never tire of reading your threads. No matter how much I read I always learn something new. Fortunately during my life, with the exception of the death of my first husband, I've not suffered from the malay of depression. However when I first quit I did experience severe mood swings. Like someone said on a thread the other day, somedays I was the windshield, somedays I was the bug. I had a lot of difficulty staying focused and at one point almost gave up. But I kept seeing all the threads addressing exactly what I was feeling and I just kept ticking off the days. However, I could tell there were others who even though they were giving it all they simply wasn't enough. Those posts I more often than not avoided as I'am in no way qualified to help. I can understand though the depression of fighting the addiction, it seemed overpowering at times, I really felt like I was going around in a fog. So I always felt it was important for some of our quitters to seek professional help as quitting was only adding another stone for them to carry around. Only with the help of this board was I able to manage. I beg of all new quitters to read and read and then read some more. At least if there isn't an answer here there is enough information to to head one in the right direction. Antonia


3:47 AM - Aug 10, 2001#6

Just have a few seconds here and saw Zep just pulled up one of my depression articles. I figured I would bring up this particular string since it covers the depression aspects from a number of angles. Again, some depression is part of the normal grieving process often encountered when people are first feeling that they are "giving up" cigarettes. This reaction is normally temporary and usually will be replaced with a certain degree of happiness and satisfaction as the feeling shifts from giving up smoking to getting rid of the nicotine addiction.

But there are also those who may have true organic depressions that may manifest when quitting. This by not means is the majority of people who quit, but in the event that emotional reactions continue for a longer than expected time period or are particularly strong it doesn't hurt to get some medical assessment to either reassure you that things are really okay or consider treatment if your physician feels it is warranted.

I will check in later when I have more time to see what prompted the raising of this issue.



8:39 PM - Aug 14, 2001#7

I saw depression was touched on by a member today. This string really covers depression from a number of fronts, from the normal stage of depression as part of the the stages of loss encountered by many people quitting, to people who have a long history of depression more indicative of a chemical or genetic basis.

Whatever the cause, depression can be effectively treated in ex-smokers as well as in current smokers. If very pronounced or prolonged seek medical advice from your doctor. Even in times when you find yourself down though try to keep perspective that there is one thing you should be happy about or at least pleased with yourself for. You have taken control back of your life in regards to smoking. To keep that control and feelings of self-satisfaction that should come with it always remember to never take another puff!



7:42 PM - Sep 24, 2001#8

I saw that a couple of people who quit within the past month were talking about depressive kind of feelings. I thought this string would help shed some light on the issue. It is ironic but the string was last brought up on September 10, one day before the tragic events at the WTC. Within a few days of the attack, I saw some news reports that said up to 70% of the American population reported some degree of depression symptoms since the attack. This is truly one of those times when the reasons for feeling depressed are quit obvious.

Ex-smokers must use real caution when thinking that somehow the reason they are feeling bad at the time was because they put down smoking recently. People who are ex-smoker, people who are never smokers, and people who smoke ten to one hundred cigarettes a day may all be experiencing depressive feelings from current events.

The first two groups will feel better as time progresses and their lives start to get back to some semblance of normal. The last group too will start to feel better as far a depression goes too, probably at about the same pace. Unfortunately for them though, while they will adjust to the events of the day, they will still be destroying more and more lung, overworking their heart and assaulting their circulatory systems, depositing cancer causing chemicals throughout their body, smelling offensive, spending thousands of dollars a year, being socially ostracized, and dealing with chronic withdrawal every half hour or so for the rest of their lives.

So while this initial cause of depression will slowly dissipate, they will have plenty of more reasons to be depressed from their smoking as their life progresses. An ex-smokers life will have depressing times, so will a never smokers and so will a continuing smoker. The continuing smoker just has a lot more to be depressed about. For not only are they facing their real world events that are often beyond their control and comprehension, but they are facing their own life threatening behaviors that they too do not seem to have control over. You have control of an addiction that they do not, and to keep that control it is imperative that you always remember to never take another puff!



10:08 PM - Oct 21, 2001#9

This string covers the medication issue discussed in the string earlier today on anxiety. I thought it would add a little extra perspective on the fears of medication being less warranted than the fears of smoking. Smoking risks are real and terrifying. To minimize these risks simply entails knowing now to never take another puff!



1:00 AM - Oct 27, 2001#10

Hi all, I wrote yesterday because I was depressed so I read everything I could about why and what could I do.

I take an anti-depressive, atfer reading I realized I just might have to increase my medication. Well I called my doctor, he wanted to give me zapan, or nicotine gum or the patch. This did not make me happy. I told him, I am addicted to nicotine, why would I want to take something with nicotine in it. He said, it might help me. Unbelievable. I have been nicotine free for 12 days, not including the 72 hours it told to become free of it.

Finally I said all I want is to increase my prozac by 10 mg. He did finally agree.

Cheers, Robin


Patticake (Gold)

9:32 AM - Oct 31, 2001#11

Joel, I read my post of 7/17 and I guess I need to update it. I injured my leg last summer and didn't get to do any of the things I love to do. I'm fine now, still doing the therapy thing but am okay. August was a really bad month, nothing I could pinpoint just felt blue and out of sorts, no energy, no appetite, no nothing............had a whole lot of triggers. September was even worse, really thought I was backtracking. I had started teaching three days a week hoping some outside activity would help....didn't. Finally made an appointment for a complete physical and have been diagnosed with a chemical imbalance commonly labeled depression. Am taking medication and am beginning to feel much better. I am having no triggers and as a matter of fact was around a smoker the other day and absolutely thought I would barf. My doctor is thrilled I have quit and said he sees no connection between my quitting and my diagnosis. He said he felt my inactivity and confinement from the leg injury, considering I'm normally a very active person, probably has been the culprit. This is one more check to add to my reasons for quitting. To think I could have disabled myself from the nicotine addiction, and to think there isn't a pill in the world to have given me my life back only makes me more determined in my commitment to stay nicotine free. Hopefully around the first of the year I can again climb aboard my beloved horse, run through the pastures with my dogs, take the stairs two at a time, dance with my husband, other words live my life that I have been so blessed with to have a second chance.


8:00 PM - Oct 31, 2001#12

Hello Patticakes:

Sorry you have encountered depression but as your doctor has pointed out, this is not an uncommon situation when an active person is all of a sudden sidetracked to an inactive lifestyle due to illness or injury. It is great that you have been able to isolate your feelings toward smoking from your feelings of depression.

So many times people blame everything on not smoking, relapse in the belief that becoming a smoker again will somehow solve their other problems and be gravely disappointed at the eventual outcome--they have the same bad feelings as before and are stuck smoking again.

The real irony is if they did it in a case such as yours--where they likely became depressed because of physical limitations due to illness or injury--they almost assuredly increased their risks of having such limitations over their lifetime because smoking can cause crippling illnesses and even slow healing of non-smoking caused conditions.

So the way to a happier and healthier life is minimizing your risks of being impaired and being able to do life affirming and health sustaining activities over your lifetime--and the first and often the most powerful step in being able to do these activies is to know to never take another puff!


4:20 AM - Jun 17, 2002#13

"Smoking is lethal. Don't give cigarettes the legitimacy to treat feelings. They don't. They make them worse. They in effect minimize your ability to communicate and grow. Growth may hurt, but it beats carrying on unresolved feelings that slowly may deteriorate the quality of your life."

Hello. This quote from the article by Joel that starts this thread touches
on an issue I'm really trying to deal with -- instead of hide from.

Also, this from JennyG, in another thread :
"But quitting is just the first step, maybe not even the most important one. What I mean is you can white knuckle your way through physical withdrawl but if this is all you do, in the long run, you are likely to fail. Why? You haven't fixed your thinking. Your body might be healing, but in your heart and mind you are still a junkie."

Nearly every day of late, at some point I find myself feeling lost and empty and wistful and sad -- and thinking about how smoking was so comforting at such times. And a friend has pointed out to me that this is the Nicodemon sneaking in sideways, putting little subtle lies in my head. In short, it's junkie thinking. I'm thinking of a quick fix, rather than wanting to address what's really causing these feelings in my life. Smoking kept me a prisoner, a slave to my addiction -- I KNOW this. But, still I'm wishing for the magic wand to make all my uncomfortable feelings go away. And I even know that I had plenty of uncomfortable feelings as a smoker -- it's not like smoking actually made me happy -- I was miserable.
I am much happier to have quit!!!!

I have no intention of taking a puff. I am happy in my quit. I don't feel in danger of relapse. But, I am concerned that I have this stunted, immature, junkie way of thinking about my life, and I'm wondering how to grow into mature patterns of thought. How do I stop thinking like a junkie, and wearing rose colored glasses and putting vaseline on the lens when I look at smoking? Is it just a matter of again and again and again making sure that I look at the whole truth -- reminding myself that there's no wonderful smoking experience waiting in the wings, that it's the whole smelly disgusting life in smoking prison that I'm getting so stupidly misty about? Is there some leap in understanding that will get me past this kind of thinking?

Sophy, nicotine addict in Day 37 of recovery
1,058 sickerettes not smoked. $209.11 not burned up poisoning myself

Toast (GOLD )

5:58 AM - Jun 17, 2002#14

Hi Sophy,

As Richard points out, you're still pretty early on. Grieving can be a real surprise when you quit. Amazing process, no??!! Look how far you've come already!

You know, most of us started smoking when we were teenagers. And we know smoking tends to really neutralize some emotions, nicotine running in ahead of our own neurotransmitters and blocking so much of the chemistry of thoughts and feelings. In many ways, the You that is emerging from the smoke is a You that you haven't seen in a long time. She's a You that hasn't had much of a chance to speak up, cry out, or even grow up in some ways.

And the process of relearning how to live w/o cigarettes, just the routine alone, can throw us back into a very self-conscious position. In certain circles it's called "conscious incompetence." Remember when you start a new job and can't find anything and every day is a challenge of trying to bear a lot of new info in mind? It's the same process, except for w/smoking, you've had the chance to hammer the routine down 20+ times a day times 365 a year times ? many years, plus you get the chemical "payload" of nicotine.

So, you see there are many possibilities of things that could be affecting you just now - grief, conscious incompetence, and a surge in feelings in a way you haven't felt in literally years. Real depression is also a possibility. None of these things are bad or permanent, just possible and sometimes part of withdrawal &/or learning to live past addiction. If you have any concerns, your MD is the place to turn first.

Hope you're feeling better soon! 37 Days is a tremendous accomplishment!

The Gold Club

blondie (green )

8:31 PM - Jun 17, 2002#15

Hi Sophy,
I just read your post from yesterday... I wanted you to know that I am feeling the same way. I have felt this way from the beginning and some days are much worse than others. And I think it's getting better although it's still present in my mind.

I also have no intention of taking a puff. But, have the same concerns about immature thinking, junkie thinking and generally being an unhappy person who doesn't smoke, rather than a person who should be thrilled to pieces that she's a non smoker. And, I am really. But, I still have these thoughts.

Do you understand? I think you do.

I believe that this is going to be a long, slow process for me to readjust my thinking. I need to reaffirm my belief in the "evils" of smoking and redirect my thoughts to the positives of non smoking which are many.

I'm fairly sure that I've always hid from problems and smoking just masked that. So now that the mask is gone I have to face problems head on. I'm 48 years old and now I need to learn how to be me. Wow, that's heavy. I think it's gonna take longer than a month and a few days.

I'm always being told I need to have more patience and so I think I can safe give myself that advice. I need to have patience. Maybe we both do.

I wish you well Sophy. I'm so sure that things will get better for us. They already have.

1 month 1 week now

My3Sons (Green)

4:35 AM - Jun 18, 2002#16

Sophy and Blondie,

I've recently learned I can't really give you any advice but what I can tell you is that I was right where you both are 1 week ago (I think someone referred to it as the Green Wall). It's strange but I've noticed a lot of posts like this between green and one week, many of the other more experienced quitters have said the same.

I can only tell you that I am doing much better now and I'm glad I pulled through. Do whatever you would have done for depression before you quit smoking ie: walks, movies, etc... whatever worked before should work for you know and see if it gets better for you. If it doesn't, maybe talk with your Doc, I know a straight A physical cheered me up as well!

I'm at green and two weeks, things are looking much better for me now! Hang on!

blondie (green )

7:31 PM - Jun 18, 2002#17

Hi Colleen,
Thanks so much for your post. I hadn't noticed others hitting this "wall" at about this time. What a strange process... I just read another thread about becoming an ex-smoker. I can really relate to that as well.

Thanks for sharing your experience with me. I hope that I'm right behind you in getting over this bump.


misha (Gold )

9:04 PM - Jun 18, 2002#18

I am amazed by the "green wall" thank God! I thought it was me!!!! I mean, I thought that it was something in me, like missing smoking, that was bringing back all those feelings I had when I first quit......
I know that I do not want to smoke, so I didn't know where the feelings were coming makes so much more sense now. Thank you for this thread. I always see something here that I need.
misha your quit sister
1 month 1 week 1 day
Last edited by misha (Gold ) on 4:23 AM - Apr 19, 2009, edited 1 time in total.


1:09 AM - Jun 19, 2002#19

For a more indepth look at the concept of a "green wall," see post 39 in the string The Terrible 3's .
Last edited by Joel on 9:42 AM - Apr 16, 2009, edited 1 time in total.

John (Gold)

2:35 AM - Jun 19, 2002#20

Study: Smoking may be cause
of some psychiatric disorders
By Michael Woods, Toledo Blade For Scripps Howard News Service
June 17, 2002
Experts long have known that psychological disorders are unusually common among cigarette smokers.
One 2000 Harvard University study, for instance, concluded that almost half of all cigarette smokers in the United States have some form of mental illness.
The researchers found that many smokers have symptoms that fit neatly into the standard psychiatric definitions of major depression, anxiety disorder, phobias, alcohol or other drug dependence, and antisocial personality.
Other studies show that almost 90 percent of people with the most serious mental disorders, such as schizophrenia, smoke cigarettes. Individuals with mental illness also are among the heaviest smokers.
So what started first, the illness or the smoking?
Mental illness occurs first, according to the time-honored theory. People with mental illness start smoking, and smoke more because nicotine relieves their symptoms and makes them feel better. In addition, they may be more psychologically vulnerable to nicotine addiction or the allure of tobacco advertising.
New studies, however, are suggesting cigarette smoking is the cause - not the consequence - of some psychiatric disorders, including common conditions that involve depression and anxiety.
Tons of scientific evidence during the past 60 years have unmasked tobacco's role in heart attacks, lung cancer and other physical diseases. Cigarette smoking causes more than 430,000 deaths annually, according to the U. S. Centers for Disease Control and Prevention. That's one in every five deaths.
Suspicion that tobacco may cause mental illness arose in the 1990s. Yet it still gets little attention, compared to tobacco's effects on physical health.
Some of the first hints emerged from a 1998 study on teenage smokers headed by Dr. Naomi Breslau, a psychiatrist at the Henry Ford Health Systems in Detroit.
Her five-year study of 1,000 young adults found that smoking increased the risk for developing depression. People who smoked before the study began had twice the risk of developing major depression during the following five years as nonsmokers.
Larger studies have bolstered the link. A University of Cincinnati study of 8,704 teenagers, for instance, found that mentally healthy teenagers who start smoking are four times more likely to develop depression than their nonsmoking peers.
Harvard University researchers studied cigarette smoking and mental health in 4,500 adolescents and adults. Mentally healthy teenagers who smoked at least one pack a day faced a 16-fold greater risk of developing panic attacks, a seven-fold risk of developing serious phobias and five times the risk of anxiety attacks than peers who smoked less than one pack.
How could cigarette smoking cause mental illness?
Experts don't know.
Some suspect that the nicotine and other chemicals in cigarette smoke may damage or change the normal activity of brain cells. Others think that nicotine and high levels of carbon monoxide in cigarette smoke work together to cause symptoms of psychological illness.
Nicotine's stimulant action keeps smokers in a state of heightened alertness. With minds racing, hearts pounding and blood pressure up, they are more likely to overreact to body sensations and situations in the environment.
Carbon monoxide may cause breathing disorders responsible for one sensation - a false sense of suffocation - that triggers many panic and anxiety attacks. One attack then engenders fear of others and causes changes in behavior.


3:53 PM - Jun 19, 2002#21

As so often happens, after you really crystallize and articulate something that's been bugging you, this whole thing is bothering me less now. I think Melissa (Toast) hit upon it in saying I'm "relearning how to live w/o cigarettes." I've been consciously working on sitting with uncomfortable feelings as they arise instead of thinking I have to make them go away immediately (which I used to do by ... smoking, of course ). Thanks also to Richard and Colleen for the kind words and to Joel and John for the useful information. And blondie (Ruth) and Misha, it's good to have company on this journey. I guess, we will be through with this weird sensation (at least for a while), if we follow Colleen's example. I've been reflecting that I used sickerettes to make all of my uncomfortable feelings and empty moments go away (or at least distract me from them). Now I am experimenting with what to do at those times, how to actually live without escaping like the junkie I was. Some former smokers say they grew and changed through quitting -- this must be part of that growth.

Sophy, 1 month, 1week, 23 hours

IrishLotus GOLD

1:00 AM - Apr 01, 2003#22

This morning I was pondering the question: "Which came first, the addiction or the depression?". I knew I had read something about that here at Freedom, and sure enough, here it is...offered as advice for another depressed Freedomite.

Since I am now able to step from behind the "smoke screen" and look a bit more logically at my addictions and the cause/effect way in which they intermingle with my personal happiness, such questions come to mind often. For those of you concerned, I have already contacted my physician, and as it turns out, I DO seem to be having some anxiety attacks and depressive episodes as related to an organic psychological disorder. A recent outbreak of anxiety related hives, has given me a physical manifestation of my condition as well as proof that I am not "crazy" (well, you get the point). I am actually looking forward to "medicating myself" in a more constructive way in the future, although I am getting a bit more anxious about releasing my other, non-healthy coping mechanisms. I am hoping that alcohol and other mood altering "self-medications" will be effectively replaced with clinically prescribed counter-parts, but I will be certain to check in here if I need any help facing these other addictions. I may not be around very often as I head on this journey, but I will be sure to check in if I ever feel my quit is in jeopardy, as well as keep on reading to reinforce my motivation to remain quit. Thank for all of this great information....

6 Months, 1 Week


4:42 AM - Apr 01, 2003#23

Slowly but surely it's starting to dawn on me. . .

All of this sadness can't be just from quitting smoking, BUT it is not a sufficient excuse to go back to smoking. I was diagnosed with clinical depression six years ago, before I was a smoker, but I hated the medication I was given and soon found cigarettes an excellent substitute in many unfortunate ways. I have never really made the connection between the events until now, but I did start smoking at almost the exact same time that I quit taking my medication.

Smoking used to help with my depression a lot. It took me out of stressful situations for fifteen minutes, calmed me down, and made me feel like the problem had gone away. What a great little tool. Facing the actual problems is so much more difficult, and for the last few weeks I have been blaming all of my unhappiness on quitting as a way to try to continue using cigarettes to avoid this problem.

Lotus, I really hear you and applaud your courage. Cigarettes were the easy way out and quitting has been rather desperate for me because going to a doctor, getting diagnosed, and having to DEAL is just obnoxious as **** compared to buying a pack every day or so and ignoring this problem. The hard thing to do is often the right thing to do, though. It certainly is in this case.

I've made an appointment, loathe as I was to do it. I hope I'll be able to be more positive on the board (as in life) in the future. I can definitely say that although quitting has been extremely difficult for me, the act of quitting has been a lifeline for me during the last month's reacquaintance with organic depression. In some cases it has really been the only thing I have to grasp at for hope, and I have guarded it pretty jealously because of that. I truly hope and believe I will never take another puff.

I have chosen not to smoke for 1 Month 2 Weeks 3 Days 22 Hours 12 Minutes 55 Seconds. Cigarettes not smoked: 734. Money saved: $183.70.


5:24 AM - Apr 01, 2003#24

There are some people who are depressed from an organic basis and medications may be indicated and beneficial for them. What is the difference between taking a prescribed medication to treat depression as opposed to using cigarettes to treat it? First, a prescribed medication must be approved by the FDA and must show some record of being SAFE and EFFECTIVE for treating a specific ailment. Being effective means that it has been shown to clinically help people who have depression-being safe means that there are generally low risk of dangerous side effects and that it is generally not a life threatening treatment. Using cigarettes to treat depression is not likely to be as effective as a prescribed medication and more importantly, carries a mortality rate of 1 in 2. No drug for any purpose would be prescribed that killed one in two people who use it, or even one in one hundred or a thousand if it were not being used to treat a life threatening illness treatable by other less dangerous means. Depression can be a chemical imbalance in some people, just as some other mental illness like schizophrenia or bipolar diseases can be caused from improper balances of certain substances normally present in people who don't have such illnesses. Using medication for these people may be as necessary as a diabetic needing insulin to treat what is basically a chemical imbalance causing a medical condition as opposed to mental illness.

It cannot be determined online by anyone whether an individual is in fact experiencing a normal adjustment period or an organic based depression and so it is imperative that if the question is raised by an individual that he or she may be depressed that he or she gets attention from a person in the real world who has more to go on that words written on a bulletin board. Nobody is qualified to make a definitive diagnosis of mental illness or any diseases without getting more information both history wise and possibly physical measures only available by a physician who actually can test the patient.

John (Gold)

5:54 AM - Apr 01, 2003#25

There was a new depression/cessation study just released and this seems like a perfect opportunity to share the results. Having a bit of perspective on how rare or common a condition actually is can sometimes in and of itself be reassuring. Although just 4% of participants in the below study experienced the onset of major depression we each need to be alert to the possibility that 4% of our members may need medical help. It's not a large percentage but a very real percentage for which treatment - not nicotine - is warranted!

Addictive Behaviors 2003 May-Jun;28(3):461-70

Onset of major depression during treatment for nicotine dependence.

Killen JD, Fortmann SP, Schatzberg A, Hayward C, Varady A.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1000 Welch Road, 94304, Palo Alto, CA, USA

We monitored the emergence of major depression (MDD) during treatment for nicotine dependence among 224 smokers.
MDD was assessed on three occasions during the course of treatment with the mood disorders portion of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID), fourth edition (DSM-IV).
Out of 224 participants, 20% had suffered a past episode of MDD, 18% of males and 22% of females. Four percent (n=10) experienced onset of MDD during the course of the study, four males and six females. Only 2 of the 10 cases managed to achieve abstinence at end of treatment. Those who reported large increases in depression symptoms between baseline and end of treatment (Week 10) were less likely to be abstinent at 26-week follow-up.
The evidence indicates that those who treat nicotine dependence must be prepared to monitor and respond to the emergence of depression associated with treatment.

PMID: 12628619 [PubMed - in process]