Quitting Smoking has triggered a Major Depressive episode. What to do?
September 6, 2005 10:59 AM   Subscribe

Quitting Smoking has triggered a Major Depressive episode. What to do?

So, I have a history of depression. I'm on antidepressants (not the kind that's used for help in quitting smoking, though). I have been nicotine free for almost 6 days and it's getting worse, not better. I'm seriously very very depressed. Has anyone had any experience with this? I did read the thread about how long before one's brain seems to work again, but I don't know if that is the same as when dealing with depression. Should I go back to smoking and try to switch my antidepressant to Zyban/Wellbutrin? Should I just wait and the depression will go away just like other withdrawal symptoms? I realize I should probably be asking an MD about this stuff, but I want to hear if anyone's had a similar experience at all.
posted by INTPLibrarian to Health & Fitness (30 answers total)
Don't start smoking again. Go for a brief jog or do some jumping jacks. Eat something hot like a jalapeno or some Indian food. Watch a funny movie or read something on the web that will make you belly-laugh. These things will help your body release endorphins that might help you feel better.

Also, drink water, chew gum and sleep more if you can.

Good luck!
posted by mds35 at 11:12 AM on September 6, 2005

Also, if you begin to feel like you want to hurt yourself, or even someone else, don't hesitate to call a hotline.
posted by mds35 at 11:23 AM on September 6, 2005

Response by poster: Thanks for the encouragement, but I think I need to clarify what I mean by major depression.... I can't function. If it weren't for the fact that I was raised Catholic and some of the brainwashing still has a hold on me, I'd be suicidal at this point. A funny movie or a jog isn't going to help. (Though I think that's good advice for getting through the urges.) I think I can hold out and not smoke if I _know_ this, too, shall pass. But, I'm wondering if maybe it won't pass without a change in medication.
posted by INTPLibrarian at 11:24 AM on September 6, 2005

Get busy with some obsessive hobbies, immerse yourself in social interaction (devoid of smoking), begin working with a craft, get stuff done around the house, or take part in other escapist yet productive activities. Other tricks in shaking oneself out of a heavy depression besides taking up active endeavours, is sleeping less. If you are sleeping more than 8 hours a day, a strange trick is to sleep less, for about three days in a row. It tends to snap me out of a strong depression, and is usually what I try to do when I get too deep into a depression (i.e. that listless lethargic feel of meaningless life sets in.) I don't know how it works, but it does.
posted by TwelveTwo at 11:30 AM on September 6, 2005

The medication issue is something you MUST discuss with your physician or therapist.

If you didn't have a history of depression, then I would assure you that this, too, would pass. But I have no experience with clinical depression. If it's something other than the smoking, you'll do well to seek a professional.
posted by mds35 at 11:31 AM on September 6, 2005

But to summarize: get busy enough that you don't get time to think, and/or sleep for six hours for more than three days in a row.
posted by TwelveTwo at 11:32 AM on September 6, 2005

I only have personal secondhand experience, with my roommate. He quit smoking 5 years ago while he happened to be on Wellbutrin for depression. Quitting went fine, and he made it through without problems. He restarted smoking while working in Europe a couple of years later, and re-quit three weeks ago, figuring it would go just like the last time (though he is no longer on depression meds). He spent the first two weeks without cigarettes absolutely miserable, the blackest mood I have ever seen. When it didn't lift at the end of two weeks, he decided to have one cigarette to see if it fixed how he was feeling. Apparently it did, and he is now back to smoking full-time. (Not to say that Wellbutrin alone would make quitting go smoothly -- my roommate had a girlfriend and was in college when he quit the first time, and now has no girlfriend and just work, which is a major difference in support-structure too.)
posted by xo at 11:34 AM on September 6, 2005

Go to see a doctor. Don't start smoking again. Fight hard or die.
posted by ewkpates at 11:39 AM on September 6, 2005

Talk to your doc about modifying your meds. Maybe a switch to Wellbutrin would change things, although not for any reason associated with its (supposed) anti-smoking properties, but rather because it is more activating than many simple SSRIs and so might replace some of the stimulation you used to get from nicotine. Of course you might already be on an anti-depressant that would do this, so you really need to talk to your doc. Don't start smoking again.
posted by OmieWise at 11:54 AM on September 6, 2005

I know you'll hear a lot people say "don't start smoking again," but I'll tell you what: Go ahead, light up. Smoke and regain your mental composure, then go see a doctor about quitting smoking on Wellbutrin/Zyban. If you're non-functional, you can't commit to a quit, so you need to get functional first -- if that means smoking, an extra hour off the end of your life in exchange for some mental acuity is worth it.

This from someone who's been smoke free for over a year, and faced nearly exactly what you're going through.
posted by Merdryn at 11:56 AM on September 6, 2005

If you know that the smoking is the only variable that has changed, I would definitely deal with the proximate symptom first and light up. I suspect that the people suggesting you stay off the weed are either non-smokers or people that have never endured depression. The most important thing right now is that you can function normally, and if you can only do that by smoking, then smoke. For the moment.

Then I would see your doctor immediately about strategies to use that will allow you to avoid this problem the next time you try to stop. Go over all the options and do it under medical supervision.

Stay committed to quitting smoking, for sure. Just don't do that at the expense of your mental health. Take the steps that you must in order to do it AND stay in good condition emotionally. Quitting smoking isn't a one-shot deal, you're not going to wreck your only good chance by going back at this point.
posted by mikel at 11:57 AM on September 6, 2005

A few general points:

1) It is not uncommon for many people to develop acute mood imbalances while withdrawing from nicotine dependence. Typically withdrawal symptoms peak at about 2-3 days following discontinuation and may take up to 3-4 weeks to completely resolve. I'm sure that sounds like a long time, but it *will* pass.

2) As was already noted, if at any time you do feel like wanting to harm yourself or others, seek immediate medical care.

3) For several reasons, I would be hesitant about stopping treatment with your current antidepressant (again speaking generally, as you don't say what you are taking). Discontinuing these medications can often lead to further withdrawal symptoms, which are probably the last thing you need, and stopping one and starting another immediately will likely not cover for this additional withdrawal, and may also cause additional symptoms from the initiation-phase side-effects of many of these medications.

4) That said, there are many people who do take wellbutrin/zyban in addition to an SSRI, and there are some studies that suggest additional benefit from combination therapy over SSRIs alone in treating refractory depression.

However ultimately, any such decision should of course be discussed with your physician, who has full appreciation of your medical history. So naturally, see your doctor.
posted by drpynchon at 11:58 AM on September 6, 2005

I've had severe clinical depression. From what I learned then, it's a truism that all clinical depression will pass, no matter what the cause (for some folks, it sadly comes back all the time, but it is never a permanent state. It comes and goes). It's a very rare thing for depression to be anything resembling permanent. Chronic, maybe, but not permanent.

So yes, this will pass. My sister just quit, and had something very similar happen to her. Anxiety, depression, agitation, sleeping problems, etc. It all started to go away after a couple of weeks of hell.

Also, from my experience with depression: don't give in. It may sound trite, but going for a jog, or otherwise exercising, everyday, makes a huge difference. Strictly not allowing yourself to stay home and do nothing is required, even though it is painful as hell to live your life. I found the Feeling Good Handbook to be full of great advice. To reiterate: don't underestimate the power of exercise. I seem to remember studies showing regular exercise was just as effective as anti-depressants.

And by all means, call your doctor today. Right now.
posted by teece at 11:58 AM on September 6, 2005

what about nicorette? is it possible to get nicotine gum without a prescription? if it's the nicotine withdrawal, there are ways of getting nicotine without smoking...like dip (I don't know what the technical term is for tobacco you chew). If you are seriously that bad, and it sounds like you are, then managing the nicotine withdrawal by dipping or chewing nicorette is going to keep you functional while you investigate better ways of managing the addiction with your doctor.
posted by spicynuts at 11:58 AM on September 6, 2005

Try about 3000 mg of fish oil or flax oil (Omega 3) a day. Extra potassium is also helpful, but only if you're not getting enough in the first place.
posted by doctor_negative at 12:13 PM on September 6, 2005

Best answer: I would say wait a month or two before doing anything. Assuming it's possible to survive that long, I mean. You're probably going to be pretty much non-functional for the first month no matter what, depression or no. I sure was, anyway. Anyway, 6 days is nothing. At least give it another couple weeks.

this, too, shall pass.

You can be pretty much certain that it will get a lot better, at least: after only 6 days you're not even close to whatever your brain might eventually stabilse at without nicotine. The only way to find out whether it's worth it in the long run is to wait and see.
posted by sfenders at 12:14 PM on September 6, 2005

This is not an AskMetafilter question. You need to see a doctor. Do not wait any longer.
posted by ThePinkSuperhero at 12:19 PM on September 6, 2005 [1 favorite]

Nicotine has been found to be more addictive than Cocaine.
When I quit, I kinda shook at times, and also just wanted to pick the phone up to call people I know and bitch at them.
If you are really off center because of your withdrawal, because you were addicted (there are reasons why so many people smoke a pack day...) then see a doctor; or at least get a nicotine gum fix and back off slowly from the addiction.
BTW, once you are off the cigs for a while, a piece of nicotine gum may be all it takes to send you back for a fresh pack of smokes. Not recommended.
posted by buzzman at 12:27 PM on September 6, 2005

Don't dismiss exercise. I've only had one major depression episode in my adult years, and jogging was invaluable to me during that period and after. I would run until the pain in my legs and lungs drowned out the pain in my head, and the physiological results of exercise were a great boon. Best of all, I came out of it in great physical shape which helped against a relapse.

If you were a heavy smoker you will cough up copius amounts of nasty black stuff, but keep tabs on your progress and you will be astounded, and gratified, at how quickly you recover physical ability.

I'm not into antidepressant medication, if avoidable, but therapy with a skilled counselor was extremely helpful to me during that period as well.

Good luck, don't relapse, and if you do, don't worry about it. Just get rid of any temptation, and know that the physical addiction will disappear in weeks. Relapsing will prolong the suffering, but as long as you are cutting back, the addiction is losing.
posted by Manjusri at 12:36 PM on September 6, 2005

It makes perfect sense. Quitting smoking isn't about stopping the physical act of smoking it is about stopping all the functions that smoking had for you. The help to wake up in the morning cig.. the relax after a meal cig... the smoke to relieve stress cig... the feeling social cig .. and on and on and on. You just quit one thing that had ALL these very positive functions for you... no wonder you are depressed. You took a particular way of quiting that gave up the act and its functions for you together. You don't need to. You can have these same functions in other ways, and the best way to deal with that is subconsciously because consciously you are just lost right now. My recommendation is to go to a hypnotherapist that specializes in this kind of stuff and work out how your new post-cigarettes self will be like.
posted by blueyellow at 12:40 PM on September 6, 2005

I tried to quit cold turkey a couple times and failed, which aggravated my depression. I recommend substituting another form of nicotine, like gum or patches. Patches worked for me. After a few months I was able to go off the patches; if you don't have a history of clinical depression it might just be withdrawal so you might not need heavy medications. One good thing about the patches is the step-down in dosage: I started out at the maximum (21 mg I think) and when I finally decided to quit spending money on it I'd gotten down to the 7 mg ones.

For me quitting smoking was about being hooked on nicotine: after a few days on the patches the "behavioral triggers" faded by themselves. And it might indeed help to get your meds switched to the kind that are used for quitting smoking too.

I might also point out that nicotine by itself ain't that bad for you, it's inhaling burning crap that's bad. If you wind up on the patches for a long time your lungs will still thank you.

Of course I obviously can't guarantee that anything I've tried will cure rambling incoherence.
posted by davy at 1:19 PM on September 6, 2005

As someone who despises smoking from the smell to the butts everywhere to... everything about it I agree with the people above: if you just can't find any other way to soldier forward, pick up the pack and light up. The joke goes "Quitting isn't hard, it's easy: I've done it dozens of times." You can quit again after consulting with your doctor.

That said, you -are- 6 days in and already taking mediation for your depression so you're not doing this completely without a net. You've gone through the week one suffering already so if you can manage to continue you don't have to go through that again. Perhaps your doctor can work you in immediately if you call up and state your case - s/he wants you to quit so perhaps an emergency visit is possible.

Good luck, and no matter which way you go I congratuate you on deciding to do something difficult and making it this far. It's not a small achievement.
posted by phearlez at 1:31 PM on September 6, 2005

Response by poster: I want to thank everyone for their advice/comments/shared experiences/etc. For various reasons that could be an entire thread on its own, getting to see a doctor immediately is more difficult than it should be. I feel like I should be more specific about what exactly in the answers here was helpful, but for those of you who have experienced quitting, I suppose you can understand that my thoughts aren't very coherent right now.

Anyway, you all were a lot more helpful than the online support groups that are either full of cheery "everything is wonderful the second you quit smoking" BS or the "you'll go to hell if you ever pick up a cigarette again" BS. ;-)
posted by INTPLibrarian at 2:09 PM on September 6, 2005

I'm about 3 weeks in to quitting, unable to sleep more than 4 hours a night and bitchy. Been reading a lot. Also been drinking tons of water.

Could not think at all for about the first week. That has mostly cleared up. Getting more and more angry, though. Not depressed, but I expect it when the anger runs out (that would fit my patterns). When it hits, plan to walk lots. If I can walk, I can survive just about any depression.

Good luck.
posted by QIbHom at 2:54 PM on September 6, 2005

I highly recommend not quitting cold turkey.

First cure the habit, then the addiction. To cure the habit, use the patch. Seriously. I tried and tried and tried and tried cold turkey and was a complete and total asshole every time. Then I put on the patch, and I was to my old self. The patch comes in three flavors, high, medium, low. Start on high (if you're a heavy smoker), one patch per day. When that box runs out, buy the medium. When that box runs out, buy the low.

When the low runs out, you'll still be addicted to nicotine, but not as badly,and by then your habit should be gone (we're talking about 2 months of not smoking, here). Once the habit is gone, quitting the addiction is much much easier.

YMMV,of course. I'm not a doctor, lawyer, etc. I am a recovering nicotine addict, though.
posted by jaded at 4:26 PM on September 6, 2005

Quitting smoking was one of the most difficult things I've ever done, and my lungs were getting so bad I couldn't climb a flight of stairs without stopping to wheeze -- at 37 years old and 155 lbs. Now at age 42 I'm 10 pounds heavier and look a few years older, but at least I can breathe.

When DID nicotine patches go over-the-counter anyway? I won't endorse any particular brand unless they pay me, but they did make it much easier. I didn't even get arrested! (Yeah QIbHom and jaded, I understand withdrawal-related anger problems.)
posted by davy at 7:24 PM on September 6, 2005

I love INTPs and I love librarians. That means I love you double, and I am very sorry to hear that you're not feeling right. I'm also aware that you're not thinking straight, because you told me so.

So I will remind you of this - you are a wonderful person and you are deeply needed in this world. It is not acceptable to go on feeling this way. Do whatever you have to do to feel better, including taking up smoking again.

But see a mental health professional, immediately. Please. There is help for you.

If you have any use for a San Francisco neurologist, or you just want to vent, my email's in my profile.
posted by ikkyu2 at 11:20 PM on September 6, 2005

If you are feeling that badly (and you obviously are), then do anything that you think might make you feel better, smoke if you think it will help. As others have said, there's no reason this time HAS to be the once-and-for-all quit, and if you're feeling like this, now is not the time to push it, and this is not the way to do it. See your doc asap (tomorrow if you can) and talk it over. If you start feeling worse, seek help right away, call a helpline, go to the emergency room, anything. This will pass, you can quit, but quitting is not worth making yourself feel like this, and you need to get the depression under control again before you work on the smoking. Good luck and hang in there.

(and ikkyu2, you are the man)
posted by biscotti at 12:32 AM on September 7, 2005

Patches rock. Exercise rocks. The combination is truly astounding, assuming you're an inactive lump, like myself. When I quit, I lost weight at the same time, since exercise was the only thing that got me through some evenings after work, without having to smoke.

The depression I didn't have, but I engineered a LOT of changes in my life for the quitting time. I was stimulated by life a lot more than had been my recent norm.

Endorphins rock too. The advice about hot food is good. I myself used Jolly Rancher 'Fire Candy' (cinnamon hard candy). Amazing how that helped! I hate pepper hot stuff.

Otherwise, like they said, see a doc. It sucks when that's difficult.
posted by Goofyy at 5:25 AM on September 7, 2005

A couple of things to add to all the good advice above, from my own experience, take what you like.

I've stopped smoking many times (no role model here) and the decision has never been from a 'blue sky'. I usually stop because I'm having some quite profound negative feelings about myself and my smoking is the most obvious, most public, most apparently fixable thing to attack. I'm suggesting that stopping smoking can be a symptom of depression. Not to worry, it's still worth doing. Bear in mind that every time is different, sometimes it's surprisingly easy, sometimes intimidatingly hard, there's no way of telling. Either way, quitting plays havoc with sleep and that certainly doesn't help.

Zyban is great, but it's effectively ruled out if you're on other anti-depressants. The doctor absolutely won't want to mix antidepressants (there are enough scare stories with Zyban on its own), so you'll have to come off your current meds, stabilise without any meds at all for a period, then start on the Zyban. The period will be up to your doctor but I think you'll find them very reluctant to go down that path. Then when you're done, of course, you'll have to reverse the process. For a lot of people Zyban just doesn't work and many find it unpleasant - I loved it but that's no guide.

Nevertheless, when you do stop smoking you'll have shown you can choose a difficult course of action and carry it off. That's a good base from which to conquer the rest of the world and fix all the stuff that needs fixing. While you're waiting, a couple of side effects are immediately enjoyable - being noticeably fitter and having a little extra cash. Treat yourself to something you wouldn't otherwise consider affordable and, yes, ride that bike, climb that mountain.

Here's a perceptive take on depression.
posted by grahamwell at 7:17 AM on September 7, 2005

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