Bipolar and smoking

If you have a severe mental illness (SMI), such as bipolar, you’re more likely to smoke than someone without a SMI, and less likely to want to stop. On this page, you can find some practical strategies to help you quit whenever you’re ready…

Bipolar and smoking – the facts

While smoking is harmful for everyone, it can be especially risky if you have bipolar. Research shows that smoking may:

  • Double the risk of psychotic symptoms
  • Increase the frequency and severity of both manic and depressive episodes
  • Contribute to rapid cycling
  • Increase suicidal thoughts and behaviours
  • Lead to longer hospital stays

Because of these risks, giving up smoking or vaping during a period of stability is worth considering.

Why is smoking so common for people with bipolar?

Up to seven in ten people with bipolar smoke, compared to about one in ten (12%) of the general adult population. This may be because:

  1. Nicotine affects neurotransmitters (chemical messengers) in the brain, increasing the release of ‘happy hormones’ such as dopamine and serotonin. This can offer short-term relief from symptoms of anxiety or depression – a kind of self-medication.
  2. Research suggests there may be a genetic link between bipolar and nicotine dependence. Nicotine is the main substance in cigarettes and vapes that makes them addictive.
  3. People in our community have told us that it’s common to start vaping during a period of hospitalisation because the daily routine includes periods of ‘garden time’ that patients often call ‘vape time’.

Chain smoking and bipolar

Some people with bipolar report an intense urge to smoke or vape, sometimes constantly (chain smoking), during both episodes of mania and hypomania, and depression. While there’s limited research about chain smoking and bipolar, some experts believe it may be a comfort-seeking behaviour.

Top 3 reasons to quit smoking or vaping if you have bipolar

There are many benefits to quitting smoking or vaping, especially if you’re living with bipolar, and the results can start sooner than you might think.

1. Improved mood stability

Research shows that stopping smoking is linked to less depression, anxiety and stress, and improved positive mood and quality of life, compared with continuing to smoke.
While cravings can be difficult at first, many people say their mood improves once the withdrawal symptoms stop.

Cravings usually ease off after about 28 days. And people who quit often report feeling less anxious after just a few weeks.

2. Better physical health

Every cigarette floods your body with thousands of toxic chemicals. Every vape exposes you to harmful chemicals and heavy metals like lead and nickel.

But there is good news if you stop. Within hours, your heart rate and blood pressure begin to return to normal. Within days, your lungs start to clear. Over time, your risk of serious illness, like heart disease, stroke and cancer, drops dramatically.

3. More money

Smoking is expensive. The average smoker spends £49 a week on cigarettes. That's more than £2,500 a year!

Quitting means more money in your pocket for the things that really matter.

Are there risks to quitting smoking or vaping if you have bipolar?

Quitting smoking or vaping can sometimes increase the risk of a mood episode or relapse. This is because many people find nicotine withdrawal symptoms stressful – and stress can be a common trigger of bipolar symptoms.

It can take a while for your brain to get used to working without nicotine. That is why it is strongly recommended to try quitting during a period of stability and with the support of a healthcare professional.

Strategies for quitting smoking if you have bipolar

Quitting smoking is one of the best things you can do for your health. The sooner you stop, the more you’ll benefit. But it's never too late. Whatever your age or however long you’ve smoked, quitting can make a real difference.

If you’re thinking about stopping, using two types of treatment to quit smoking can mean you’re more than five times as likely to quit for good.

  • Nicotine Replacement Therapy (NRT) can help ease physical cravings and withdrawal symptoms
  • Prescription medication can help to reduce the pleasure you get from smoking

Nicotine replacement therapy (NRT)

NRT gives your body small amounts of nicotine without the harmful chemicals in cigarettes. It helps reduce cravings and withdrawal symptoms while you adjust to life without cigarettes or vapes.

Types of NRT:

  • Patches
  • Gum
  • Lozenges
  • Sprays for your nose or mouth
  • Inhalers

NRT is safe, widely used, and backed by strong evidence. It can double your chances of quitting long term.

You can buy NRT over the counter in pharmacies, supermarkets and some shops, or you may be able to get it through your GP or free local Stop Smoking Service.

Medication to help give up smoking or vaping

Some prescription medicines can help reduce cravings and withdrawal symptoms when you’re quitting smoking. These treatments don’t contain nicotine, but work by changing how your brain responds to smoking.

If you live with bipolar disorder, it’s important to speak to your doctor before starting any stop-smoking medication. Some commonly used medicines, such as bupropion or varenicline, may not be suitable for everyone with a history of mood disorders.

Your healthcare team can help you find the safest and most effective option for you.

Top tips for quitting smoking if you have bipolar

1. Choose the right time

Plan to quit during a period of mood stability. Quitting during a high or low phase can make it more difficult and increase your risk of relapse.

2. Talk to your GP or mental health team

Speak to your GP or mental health team about quitting. They can help you make a plan that supports both your mental health and your goal to stop smoking or vaping.

3. Avoid triggers where you can

Is there a pattern to your smoking? For example, do you smoke when you're stressed, bored or drinking? Try to plan for those moments.

4. Set realistic goals

Start small and take it one step at a time. For example, try saying to yourself, ‘I’m not going to smoke for the next hour’. Then you can work your way up to a day, a week, and beyond.

5. Be kind to yourself

Quitting is hard, especially when you’re also managing your bipolar. If you slip up, don’t give up. Try again, maybe with a different treatment or type of Nicotine Replacement Therapy (NRT).

6. Get extra support

Talking to people who understand what you're going through can really help. Try a Local Peer Support Group, Bipolar UK’s Online Community or our Peer Support Line.

7. Reward yourself

Celebrate your milestones, however small, by rewarding yourself. Why not use some of the money you’ve saved for a trip to the cinema, lunch out with a friend or a relaxing massage.

Bipolar and sleep

If you live with bipolar, getting good quality sleep is one of your key protective factors.

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Bipolar and money

Here’s a practical guide to preventing and managing money problems – and getting the support you need.

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Other conditions

It’s common to have a ‘dual diagnosis’ and live with another condition alongside bipolar.

Learn more