Does smoking cause mental illness?

By David Joel Miller.



The evidence is starting to pile up that smoking may be a cause of some mental illnesses.

We have known for some time now that the mentally ill were heavy smokers. Those with psychosis, schizophrenia, in particular, are frequently two pack a day or more smokers.

We also have seen studies that report from 44% to over 50% of the cigarettes consumed in America are consumed by those with a mental, emotional or behavioral disorder. Alcoholics and Drug Addicts are frequently heavy smokers.

Fully one in three adult smokers has some form of mental illness.

What most researchers have been reluctant to conclude is that smoking may be the cause of some of these mental illnesses. That is beginning to change.

One problem with the past studies has been the way the samples were drawn. A survey of the population can tell you how many people have a mental illness and how many smoked, but not which caused which or were they both caused by some third factor like poverty or trauma.

One particularly convincing study was done in Norway (Petersen et al. 2008.) They have good data on who was treated for what and why. This study was able to follow a large sample of youth beginning at age 13 and lasting 13 years until they were 27. They looked at who smoked at age 13, when they started and the results. They were also able to follow the person’s health and mental health treatment.

This longitudinal study allowed them to compare these who had a mental illness at age 13 with those who did not and these who smoked at age 13 with those who did not. Their data tells us that those with an early onset of mental illness were at high risk to become daily smokers with a nicotine dependency.

What was more startling was that those who had no mental health diagnosis at age 13 and smoked were more likely to develop a mental illness. The smoking appears to have preceded the development of the mental illness. Even more, evidence that a mental health issue is caused by not is the cause of, smoking was found in the effects of levels of nicotine dependency.

Those youth who were heavy smokers (nicotine dependent) developed more mental health problems regardless of the age at which they first started smoking. Someone who became a heavy smoker at age 20 with no history of mental illness was at high risk to have a mental illness at age 27.

Further evidence of the connection between smoking tobacco and mental illness comes from a study from South Australia (Bowden et al., 2001) which found that the more severe the level of mental illness the more likely the person was to smoke. The most seriously mentally ill had a smoking rate in excess of 51%.

This leads to the inescapable conclusion that smoking increases the risk of developing a mental illness in addition to the physical ones we already knew about.

How might smoking be increasing these risks?

One way smoking may increase the risk of developing a mental illness is Nicotine’s effect on the serotonin regulation in the brain. Nicotine impairs the serotonin function of the brain. Low serotonin has been postulated to be a major factor in Major Depressive Disorder. Selective Serotonin Reuptake Inhibitors (SSRI’s) that slow the breakdown of Serotonin and thereby increase the levels of serotonin in the brain are commonly used to treat depression. One antidepressant is also currently being marketed to help people stop smoking.

But there is more.

Smoking reduces the levels of oxygen in the bloodstream and the brain. This reduced oxygen is a factor in the presence of chronic pain and now appears to also be a factor in increasing depression and anxiety.

Social factors may also account for some of the difference in depression in non-smokers versus smokers. With societies shift to preferring nonsmokers, there are restrictions on smoking in public places. Smokers are finding it harder to get jobs and to be able to get off duty during the work day to smoke.

Not having a job, having few social friends and being socially undesirable all add to the reasons a smoker is more likely to be depressed than a nonsmoker.

In future posts, we will explore the connection between smoking and specific mental illnesses and look at how and when you should quit if you want to maximize your mental wellness.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at A list of books I have read and can recommend is over at  Recommended books.

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