Q:  Quitting Smoking & BP Symptoms

 
Dr. The last time I quit smoking, I used the nicotine patch and gum. However, after about a week of being smoke free, my BP symptoms came back. During the week, I followed my usual schedule, ate right and exercised. There was no additional, or unusual stress. The only thing that I could figure was that the lack of nicotine somehow contributed. Given that, I bought a pack of cigarettes and after smoking a couple, the symptoms went away. If I try to quit again, what should I do to make sure that the BP symptoms do not return?
 

Dear Mr. M' -- 
Sorry to take so long in getting back to you. By now you may have learned more about this. I've never heard this described, but it makes some sense in one way -- though I'm not sure if this applies to you. Two ways, maybe. Here they are, and you can decide if either makes any more sense of your experience. 

1. Nicotine withdrawal/stress:  in regular smokers, nicotine lowers anxiety. So without it, you might experience somewhat higher levels of stress. Stress (pretty vague term) makes bipolar disorder worse sometimes. It can trigger episodes of mood change. On top of that, depending on when you stopped the patch, there could have been a stress of nicotine withdrawal as well. 

2. Bipolar I can have psychotic symptoms. It is often mistaken for schizophrenia, which also has psychotic symptoms. In fact, the two conditions are clearly related. They share several of the same genes (that is, the same gene differences are found in both; though there are also some gene differences that belong only to bipolar disorder, and only to schizophrenia). One of the genes involved in schizophrenia involves the nicotine receptor. Turns out that smoking cigarettes, for the nicotine, is actually a treatment of sorts for one aspect of schizophrenia (no wonder over 80% of people with that illness smoke cigarettes). If you had that gene, and if your version of bipolar disorder is more like Bipolar I and thus more like schizophrenia, then you might have been getting a sort of treatment effect from the cigarettes (this is long-shot theory, I'll grant you). 

What to do to keep from having this experience again on your next quit attempt? Not sure. Haven't run into this before.  I'm afraid my logic on this would be no better than your doctor's (try the patch longer, look for stress lowering techniques, that kind of thing). Good luck with that. 

Dr. Phelps