Q:  Mania & Quitting Smoking

I was diagnosed with bipolar disorder in 1986 and am 56 years old.  I have been taking Lithium since that time.

I have had two episodes of mania since then which occured simultaneously with quitting smoking.  (one month - no cigarettes the 1st time, 10 months the 2nd) The last time I tried to quit smoking I felt the symptoms of mania returning and then started to smoke again.

It seems as if this happened too many times to be a coincidence.  I have talked to my doctor a few times about this, but she has heard of this happening to no one else.

I need/want to quit smoking; however, I am fearful.

Have you heard of this or do you have any suggestions?
 

Dear Julie -- 
Never heard that one before, but I don't say that to cast doubt on your observation. I'm afraid I have no particular suggestions beyond the ones I imagine you've already considered: first, an ultra-slow taper on the cigarettes, say, 1 cigarette less, per day, per month or so (wouldn't you think that would be just about unnoticeable to your system? especially if you even tapered off the one cigarette each time you decreased, e.g. when you go from 7 per day to 6, spend half the month decreasing the amount you smoke of that 7th cigarette (maybe chop off a percentage of it in advance!))

Second, a temporary increase in mood stabilizers during the taper-off period.  That could (should?) include an increase in "regularity", which appears to be a "mood stabilizer" of sorts:  very regular go-to-bed and get-out-of-bed times, even on weekends, and a regular exercise program.

Good luck -- getting off those cigarettes is still a very worthy goal!

Dr. Phelps

Published October, 2005