Smoking vs OCD

August 9, 2007 7:31 AM

Smoking or suffering?

I have a friend, who smokes tobacco to control his psychological problems. He doesn't like the way it makes him smell or the expense and is somewhat worried about dying of lung cancer down the road -- family history is inconclusive, most people die of alcoholism or diabetes. On the other hand, without smoking, he suffers from diagnosed obsessive-compulsive disorder and manic-depression, as well as an intense and apparently psychosomatic gastrointestinal disorder. He harbors intense sexual appetite but is entirely without outlet, and the tobacco keeps that under control as well.

Which is the saner option? Is there a third option he's not seeing, something safe and effective?

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posted by anonymous to health (18 comments total)

He harbors intense sexual appetite but is entirely without outlet

He has hands, yes?
posted by kmennie at 7:43 AM on August 9, 2007

He could, and should, speak to a physician to see if he can be prescribed medication for his spectrum of afflictions - unless for some reason he has already rejected that solution as being unsafe or ineffective.
posted by contessa at 7:43 AM on August 9, 2007

Third option: antidepressants. Fourth option: nicotine gum.
posted by M.C. Lo-Carb! at 7:52 AM on August 9, 2007

IANAD.

I've known two people who have done the OCD->smoking tradeoff and it seems to work for them. Of course, this is a damned if you do and damned if you don't type of situation, but if the smoking is keeping it in check then I say 'continue'.

David Sedaris writes about using smoking to overcome OCD.
posted by unixrat at 7:52 AM on August 9, 2007

Yes, I think the third answer is appropriate medication. Anecdotally, my Aunt smoked for years and years (like, 35) to self medicate for the depression, anxiety and OCD tendencies that run in our family, and had great success with taking Zyban (Welbutrin) as a combination stop-smoking aid and anti-depressant.

Really though, your friend told you he smokes to keep his "intense sexual appetite" under control? That seems just a bit... odd.
posted by crabintheocean at 7:54 AM on August 9, 2007

The Patch or Gum would be much better than actual smoking, but since he's counting on the peripheral effects I don't know if that would still work. That being said, a doctor would probably have better advice and with the proper medication he might be actually get much closer to having a comfortable level of health. (all of the listed problems sound controllable, but getting the dosages and combination of medications right can be a chore at first)
posted by milovoo at 8:01 AM on August 9, 2007

Well the constellation of symptoms/disorders he presents with is treated with pretty heavy mood-altering drugs, including so-called "atypical antipsychotics", including Abilify (aripiprazole), which has an indication for bipolar. Other antipsychotics are often used too, but they do not, AFAIK, have official approval from FDA and so can't advertise themselves as treatments for bipolar.

Mood stabilizers are also used - lithium is the classic mood stabilizer, but anti-seizure drugs like valproate and gabapentiin are also used. IANAD, these are a few pharmaceutical options. I can't say whether they are safe or effective for any particular person, but these are some pharamaceutical options to discuss with a doctor.
posted by Mister_A at 8:11 AM on August 9, 2007

It sounds like he's tried quitting and found it tough. But you don't mention if he's tried all the different quitting methods out there--including antidepressants and/or nicotine replacement.
He's gotta keep trying.
posted by alkupe at 8:27 AM on August 9, 2007

Here's a related previous thread, by someone who quit smoking and became very depressed.

Is your friend in the care of a doctor? Is he doing anything else besides smoking to address his symptoms? Medication as prescribed by a psychiatrist or family practitioner might well beat self-medication with tobacco.

(Smoking is common among bipolar people, who tend to try a lof self-medication. But it's hard for this layman to see how a stimulant would help a bipolar patient, and some quick web-searching doesn't yield any suggestion that it does.)
posted by Zed_Lopez at 8:43 AM on August 9, 2007

I know that the nicotine patch is prescribed by psychiatrists under certain circumstances in some cases of related-impulse control disorders (Tourette's, specifically). There is evidence that what you friend seems to know anecdotally is an actual medical benefit of nicotine. I'd suggest that the pursue that route with a doctor's guidance.
posted by thebrokedown at 8:51 AM on August 9, 2007

Let me be absolutely clear: If your friend is truly bipolar, taking an antidepressant, especially for a sustained course, may not be a good idea. Antidepressants precipitate manic episodes in some patients. However, antidepressants in combination with antipsychotics may be useful in treating depressive episodes (bipolar depression). Your friend probably should avoid antidepressants as monotherapy. Again, IANAD, but don't let your friend borrow someone's pep pills without a prescription.
posted by Mister_A at 8:55 AM on August 9, 2007

Welbutrin and the newer stop smoking drug Chantix both sound like options he should discuss with a physician with experience in smoking cessation. According to its prescribing info, Chantix has a 40% success rate in smoking cessation, which is very good. The other suggestions in this thread are good, too.
posted by TedW at 8:57 AM on August 9, 2007

You may want to point out to him what most of the "so what if I die 8 years sooner, I'll be old anyway" smokers don't take into account: the 12 or 15 years of suffering from chronic disease that precedes the early death.
posted by StickyCarpet at 9:15 AM on August 9, 2007

Hmm sounds like he's convinced himself that smoking is helping his other afflictions. While his other afflictions may increase while he is quitting (or at least become more apparent) I suspect that it will only be temporary. The mind of an addict is a funny thing; it tends to find any little excuse to keep on doing a drug.
posted by jeblis at 9:41 AM on August 9, 2007

Hey, I just stopped smoking (9 weeks) using Chantix. It hits the brain in all the right places.
posted by JohnR at 9:41 AM on August 9, 2007

Psychiatrist, pronto. This problem can be managed by a pro.
posted by Miko at 12:45 PM on August 9, 2007

Snus. All the nicotine, a lot less of the cancer.
posted by NortonDC at 6:27 PM on August 9, 2007

I can't imagine that the cigarettes are as effective as medication could be... he could find a whole lot more freedom with a professional.
posted by IndigoRain at 11:21 PM on August 9, 2007