Hi XXXXXXX

Welcome to Healthcare Magic and thanks for your question...

Firstly, I appreciate you for gathering the motivation to stop smoking. Taking the initiative and seeking help is an important step in the path of success. I'm glad that you are already aware of the harmful effects and consequences of smoking.

Now, in your case, you have mentioned that stress, low mood / depression are major precipitating factors for your smoking. It appears that you are using smoking as a substitute to 'cope up' with difficult situations. So, we need to incorporate this factor also in therapy.

Now, the first step in quitting is to set a date for quitting and mentally prepare yourself for it. It is usually advisable to stop completely because reducing gradually may last only temporarily.

The second step is to deal with the initial phase of 'withdrawal'. Withdrawal phase is usually the first few days when a person can have psychological symptoms (craving to smoke, irritability, tension, etc.) and physical symptoms (headache, disturbed sleep, increased appetite, etc.) because the body may have become used to the chemical. One of the effective ways of dealing with these withdrawal symptoms is Nicotine Replacement Therapy (NRT). In NRT, nicotine chewing gums or sprays or skin patches are used to partially replace the chemical, so that the person stays comfortable without withdrawal symptoms, at the same time is able to refrain from smoking. The nicotine replacement is later on gradually reduced and stopped.

The third and most important step is to prevent 'relapse' (i.e. re-starting the habit). Treatment for this can be with medication or with counselling. There are certain medication (like bupropion, varenicline) which are known to reduce the craving for smoking. There are a wide variety of psychological techniques (counselling) to enhance the person's motivation, to teach him strategies to control craving and hence prevent relapses. A combination of medication and counselling has been found to give the best results.

The fourth step is lifestyle modification. It is important to remember that smoking is not just a physical habit but often becomes intertwinned with your lifestyle. So, appropriate personal and social modifications like planning your activities, avoiding social situations where you are likely to be tempted, finding alternative forms of relaxation, etc. are essential.

Finally, in your case, learning to handle difficult situations and improving your coping skills is also important. If you feel that your periods of stress and depressed mood are prominent, frequent and disabling, then you should seek the help of a psychiatrist in order to have a detailed psychological assessment and further specific treatment.

I hope I have answered your query satisfactorily.
Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist

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