Mental illness and tobacco use

Despite high rates of smoking, people with severe mental illness are less frequently offered help in managing their tobacco smoking, often due to the misconception that change is not possible in this populationProchaska, 2010Siru, 2009. Conditions such as schizophrenia are not contraindications to reducing or stopping smoking.

Patients may need closer monitoring for exacerbation of psychiatric symptoms as they reduce their smoking, particularly if nicotine withdrawal symptoms are not well-controlled. High doses of nicotine replacement therapy may be needed as nicotine dependence is more likely to be severe than in the general population. Varenicline is appropriate for the management of tobacco smoking in people whose psychiatric condition is stable; use bupropion with caution in people with bipolar disorder as there is a risk of mania.

Smoking promotes CYP1A2 metabolism of some psychotropic drugs, in particular clozapine; lower doses may be required for patients taking these drugs as they reduce their smoking. See the Quit website for a table of interactions and management advice.