It is not easy for anyone to quit smoking, including those with mental disorders. Most attempts fail, especially the first time. Patients generally need to make multiple attempts to actually quit smoking for a significant period of time. However, there are a number of ways to help a patient quit smoking or using other tobacco products. These include:

• Behavior therapy. Helps patients monitor their smoking activity and identify and avoid factors that trigger or increase cravings. This therapy also teaches patients to deal with and prevent many symptoms of nicotine withdrawal.
  
  
• Nicotine replacement therapy. Uses products that contain nicotine (e.g., nicotine gum, nicotine patch, nicotine nasal spray, nicotine inhaler) to reduce withdrawal symptoms. The most effective way to quit smoking appears to be a combination of this nicotine replacement therapy and behavior therapy.
  
  
• Antidepressants. Various antidepressant medications may also help a patient quit smoking. Many of these drugs target specific withdrawal symptoms, such as depression and anxiety. One of these medications, bupropion, has been approved by the U.S. Food and Drug Administration (FDA) as an agent to help patients stop smoking. It works by reducing cigarette cravings.
  
  It is important to note that the FDA has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.

• Acupuncture and hypnosis. Acupuncture involves inserting very fine needles into specific points in the body to restore and maintain health. Hypnosis involves placing the patient in a trance-like state. When hypnotized, patients may be very susceptible to suggestion. These therapies have not been proven effective, but may be useful for some patients. In general, hypnosis appears to be more effective than acupuncture. If performed correctly, both carry little risk of side effects.

Patients with mental disorders generally have a much harder time quitting smoking than those without mental health conditions. The symptoms of nicotine withdrawal often mimic the symptoms of many disorders. Because of this, when patients with mental health disorders try to quit smoking, they often experience a temporary worsening of their symptoms. In some cases, this may end a patient’s remission. For example, patients with bipolar disorder may experience a manic or depressive episode when they try to stop smoking.

These exacerbations of mental health conditions can often be prevented by proper adjustments of mental health medications (e.g., Antidepressants). Patients are urged to inform their physician or mental health provider when they intend to quit smoking. In some cases, the drug prescriptions for these patients may be changed or their dosage levels altered.

However, the effects of some psychiatric medications, such as antipsychotic medications, are dampened by cigarette smoking due to the effects of nicotine on their metabolism. Quitting can cause an increase in the levels of these medications in the blood, which may also result in increased side effects, requiring an adjustment in the medication dosage level.

The chances that a patient will be able to successfully quit smoking improve greatly when their mental health conditions are identified and treated. For example, patients with depression may increase their odds of successfully quitting smoking to equal those of non-depressed people when they are undergoing effective antidepressant therapy.

Because of this, it may be recommended that other mental health disorders, including other substance abuse disorders (e.g., alcoholism, marijuana, cocaine or opioid addiction) are treated before the patient attempts to quit smoking. However, in some cases, smoking cessation may become a part of the treatment of other psychiatric conditions. The preference of treating other conditions, especially alcoholism, before or at the same time that a patient stops smoking varies from one program to another. For instance, treatment for smoking and alcohol abuse may occur together in some facilities.