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Smoking Cessation, support groups and helplines are very much on the up in the Health Services at the moment, Scotland with the smoking ban already in place, and England with the ban coming in imminently.
The definition of “withdrawal symptoms” is
:- any physical or mental changes that occur following interruption or termination of drug use that are normally temporary.
:- a product of physical or psychological adaptation to long term drug use requiring a period of readjustment when the drug is no longer ingested.
Common withdrawal symptoms of stopping smoking include:
Irritability and aggression – this can last for up to 4 weeks and affects 50% of quitters
Light-headedness – lasts approx. 48 hours and affects 10% of quitters
Restlessness can last for up to 4 weeks and affects 60% of quitters
Depression can affect 60% and last for up to 4 weeks
Poor concentration, up to 2 weeks and affects 60%
Quitters may also experience a long term drop in heart rate and a short lived decrease in adrenalin.
I am assuming we all know the long term benefits of not smoking or stopping smoking, therefore I do not intend to preach that here. Feel free to go to Stop Smoking, Start Living if you want to know more about that.
I have recently been made aware of the effects on people who suffer from a Mental Health Disorder who stop smoking. (OSB please don’t shoot me down for my use of PC lingo, but I am a student and therefore meant to and be allowed to be PC and using the latest terminology!)
We are all aware of the chain-smoking that goes on in and out of wards, that is used as a coping mechanism, or even out of sheer boredom, but did you know (I never, so I want to share) the side effects on stopping smoking in relation to medications?
Some medications are metabolised at a greater rate when someone smokes, thus, if they cut out tobacco the medications will be metabolised slower and will need to have their therapy more closely monitored.
Some (but not all) of the medications for mental health affected include:
Some tricyclic antidepressants, other antidepressants such as fluvoxamine, benzodiazepines, some antipsychotics, including clozapine. propranolol and warfarin, may cause plasma levels to rise and increase side effects experienced by the user.
The dosage of the above may need to be reduced to avoid an increase in side-effects.
Nicotinell lozenges should not be used by anyone who is on Monoamine Oxidase Inhibitors (MAOIs) as they contain phenylalanine which may interact badly.
Insulin dependant diabetic patients should be aware that insulin absorbtion may be slowed down.
The dose of anti-diuretics may need to be reduced as nicotine is withdrawn.
I find this interesting as I never knew this, therefore I assume many others don’t know either, but if you or your patient are stopping smoking, it is useful to be made aware that side effects may increase at a time when many peoples anxiety levels are already higher.
On the plus side, smokers who have stopped for 4 weeks report a significant reduction in anxiety compared to before they stopped. So if you can hang on 4 weeks you will feel great!
Finally, do I need to reference this, cause I have them, but won’t bother unless I get in trouble!
um….
um……what?
go on.
“people who suffer from a Mental Health Disorder” eh? last time i checked, “suffer” was out, as was “disorder” – “people who experience mental distress” is the preferred terminology in one of the national charities that i do a bit of work for. “suffer” often feels more appropriate though!
and propanalol = beta blocker and warfarin = anti-coagulant, no? not anti-psychotic?
interesting post though. i did already know about the effect on clozapine levels, but not the other stuff about MAOIs and insulin.
Slightly off-topic, but I’m looking forward to the indoor smoking ban coming in (on April 2nd in Wales – is it the same date in England). I’m a social smoker rather than a full-time one, and these days the only place I smoke is in the pub. The only trouble is, when I get to the pub, I turn into a chain smoker. Fag, pint, fag, pint, fag, pint…
That said, from experience of holidays in Ireland, if I’m in a place where I’m not allowed to smoke in the pub, and I can’t smell smoke, and nobody around me is smoking…then I really can’t be bothered to go outside in the freezing cold for a cigarette. Hence I just don’t smoke.
My girlfriend’s birthday is April 2nd. She’s looking forward to a non-smoking boyfriend for her birthday.
On April the 1st tell her you are giving up
Then if you crack and start smoking again you can tell her it was an April Fool Joke … a very bad April Fool Joke.
My um comment was me in the preview post option. How mysterious I can write up the draft and Mental made it appear here!
Survivor worker – I just had the medicines grouped together without giving them their correct usage. As for the terminology, I was going from my lecturers. It is difficult to keep up!
sorry, I re-read my post. I have ommitted a full stop after clozapine.
Still it’s not bad for typos really!
Hi, Thanks for a interesting post. I’d really like to see the references you mention. Would you mind posting them?
Cheers
I hate the phrase ‘experience mental distres’. Makes me sound like I’m some emotional weakling who can’t cope with ordinairy life. I suffer with psychosis or mental illness. Call a spade a spade!
OK, here are the main 2 refs:
Hughes, JR, Higgins ST. 1994. Nicotine withdrawal versus other drug withrdrawal syndromes:similarities and dissimilarities
Zevin S, Benowitz NL. 1999. Drug interactions with tobacco smoking. An update.
Putting up a post must have been a bit of sphincter tightening experience Rosey, fair play to you!
I enjoyed reading it, found the bit about withdrawal symptoms interesting (sounds like me at work most days really)
Appreciate the post is about smoking and mental health but any thoughts about the difficulty in quitting when someone sees smoking as part of their identity
Bravo Rosey, much better than my first attempt at a post ( and better than my subsequent ones too ). Of course I will excuse your use of PC terminology – as long as you abandon it the moment you`re qualified.
Very interesting stuff. I will certainly flag it up to the medics. Usually, persuading them to reduce dosages is the nursing equivalent of turning the proverbial supertanker. It`s well worth a try though.
Come on Nel, let`s have a post of you.
Oh and proof reading your own stuff is surprisingly difficult.
I was about to scream “Plagiarism! This was on Rosey’s page yesterday!” but I now realise it is you Rosey. I’ll spare you a repetition of my comments.
I will pass your article onto my wife who works in a pharmacy (what OSB would call a chemists… or Malcolm might call Ye Olde Shoppe of Alchemy) particularly regarding diabetes and MAOIs
What are you talking about Mo ?. Malcolm wouldn`t use the term alchemy as it might prove offensive to those of us who believe base metals can be turned into gold. Nor would he put a pretentious e on the end of shopp either as that could be perceived as condescending to words without a silent ending. You`re perfectly correct about me though, it`s not called Boots THE CHEMIST for nothing.
OSB – you’re just being silly now.
Thanks for the encouragement Oldschool but commenting is enough for me and i would struggle with a theme tune to accompany my post. If i ever come across anything though i’ll let you know.
Shooby dooby dooby doo wah
Ahhhh, it’s the theme to The Archers….nice one Nel
It’s clearly not. Try adding some symbols
Symbols or cymbals ? I suppose I get to play the triangle again.
!”£$%^&*()@?…..mmmmm still sounds like the Archers to me…must be cymbals.