Can You Quit Smoking If You Have Schizophrenia or Bipolar Disorder? (2026 Evidence)

Yes — you can quit smoking even with schizophrenia or bipolar disorder, and the evidence is now firmly on your side. The landmark EAGLES trial, published in The Lancet in 2016 with more than 8,000 participants, confirmed that the leading cessation medications are neuropsychiatrically safe in people with stable psychiatric conditions. People living with mental illness have every reason — and every right — to expect effective quit support.

Tobacco use is disproportionately high among people with serious mental illness. Research published by the National Institute on Drug Abuse (NIDA) estimates that as many as 70–85% of people with schizophrenia smoke, compared with roughly 14% of the general US population. Yet for too long, this population was excluded from cessation trials and told that quitting was too risky or disruptive. The science has moved on.

Why Are Smoking Rates So High in Mental Illness?

Nicotine produces temporary improvements in attention, working memory, and sensory gating — functions that are often impaired in schizophrenia. Research suggests people with schizophrenia may smoke partly as a form of self-medication, using nicotine to stimulate nicotinic acetylcholine receptors in the prefrontal cortex. This creates a deeply reinforced pattern that goes beyond habit into neurobiological dependency.

For people with bipolar disorder, nicotine’s stimulant effect during depressive phases and its role in social rituals both reinforce use. Older antipsychotic medications that cause sedation, high-stress living environments, and limited access to cessation support within mental health services have all historically compounded the problem. Understanding this context matters: it explains why willpower-only approaches consistently fail and why structured pharmacological and behavioural support is essential.

What Does the EAGLES Trial Actually Show?

The EAGLES trial (Lancet, 2016) is the most important piece of evidence for anyone with a psychiatric condition considering cessation medication. It enrolled 8,144 adult smokers across 140 sites in 16 countries, split equally between those with and without a diagnosed psychiatric condition (including schizophrenia, bipolar disorder, major depression, and anxiety disorders).

The primary finding: varenicline and bupropion did not significantly increase the incidence of serious neuropsychiatric adverse events compared to nicotine patch or placebo, even in the psychiatric cohort. All three active treatments outperformed placebo for abstinence. Varenicline produced the highest quit rates in both psychiatric and non-psychiatric groups. Based on this evidence, the US FDA removed the black-box neuropsychiatric warning from both varenicline and bupropion in December 2016.

A subsequent subgroup analysis published in Psychiatric Services (2021) examined specifically the schizophrenia spectrum subgroup within EAGLES. Varenicline significantly outperformed placebo for achieving continuous abstinence, confirming that people with schizophrenia spectrum disorders benefit from the same first-line pharmacotherapy available to the general population.

Which Medications Are Safe and Effective?

Is varenicline right for you?

Varenicline (brand names Champix in the UK/Australia, Chantix in the US) is the most effective single cessation medication available, approximately tripling quit rates compared to placebo according to Cochrane meta-analyses. The EAGLES evidence confirms its neuropsychiatric safety in stable psychiatric conditions. You should discuss it with your prescriber — not skip it out of unfounded fear.

Important: “stable psychiatric condition” means your symptoms are adequately managed and you are not in acute crisis. Always tell your prescriber your full psychiatric history and current medications. Never start or stop psychiatric medications without your psychiatrist’s guidance.

Is bupropion appropriate?

Bupropion (Zyban) is a second effective option confirmed safe by EAGLES in stable psychiatric conditions. However, bupropion is contraindicated in people with a history of seizure disorders, current or past anorexia or bulimia nervosa, and should be used with caution alongside certain antidepressants (particularly MAOIs). Always disclose your full medical history to your prescriber before starting bupropion.

What about nicotine replacement therapy?

NRT — patches, gum, lozenges, inhalers, and nasal spray — is safe for people with any psychiatric condition and carries no neuropsychiatric risk. The NHS recommends combining a slow-release patch (worn 16–24 hours) with a fast-acting form such as gum or lozenge for maximum effect. NRT is often a good starting point while discussing longer-term pharmacotherapy with your prescriber. You can read a detailed comparison in our guide on the best NRT options compared.

Does Quitting Change How Your Psychiatric Medication Works?

This is one of the most clinically important — and most overlooked — aspects of quitting with a psychiatric condition. Smoking induces the liver enzyme CYP1A2, which metabolises several widely used psychiatric medications including clozapine, olanzapine, fluvoxamine, and haloperidol. When you stop smoking, CYP1A2 activity decreases and blood levels of these medications can rise significantly.

For clozapine in particular, blood levels can increase by 50% or more after quitting. This can lead to side effects including sedation, dizziness, and increased seizure risk if not managed proactively. Your psychiatrist should be informed of your quit date so they can monitor drug levels and adjust doses as needed. Never change your psychiatric medication dose yourself. This is a clinical conversation, not something to manage alone.

Does Quitting Smoking Worsen Mental Health?

The widespread belief that quitting smoking harms mental health is not supported by good evidence. A 2014 meta-analysis of 26 studies published in the BMJ found that smoking cessation was associated with significantly reduced anxiety, depression, and stress compared to continuing to smoke. The effect sizes were comparable to those achieved by antidepressants.

What is real, however, is that the first two to four weeks of withdrawal include mood disruption, irritability, and difficulty concentrating. These are temporary withdrawal symptoms, not a permanent worsening of your underlying condition. Having your mental health team monitor you through this period, rather than avoiding cessation altogether, is the evidence-based approach. You can learn what to expect week by week in our complete nicotine withdrawal timeline.

What Support Strategies Work Best?

What is integrated cessation care?

The strongest evidence points to integrated care — where smoking cessation support is delivered within mental health settings rather than via a separate referral. When your care coordinator or psychiatric team initiates and supports the quit attempt, engagement and retention are significantly higher. If your mental health service does not currently offer this, ask your psychiatrist or care coordinator for a referral to a specialist tobacco cessation service.

How does behavioural support help?

Cognitive-behavioural therapy (CBT) adapted for psychosis — focusing on identifying smoking cues, building coping responses, and managing withdrawal-related thought distortions — has the best evidence base among psychological interventions. Group-based support in mental health settings also builds peer accountability. The American Lung Association maintains a directory of specialist cessation resources for people with behavioural health conditions.

How can a quit-smoking app help?

Apps like iQuit provide between-appointment craving tracking, motivational coaching, and real-time health milestone updates. For people with serious mental illness who may have irregular access to in-person support, an always-available digital tool that logs cravings and celebrates progress can bridge the gap between clinical contacts. Apps complement but do not replace medication and professional support.

Understanding your triggers is critical to a successful quit. Our guide on smoking triggers and how to avoid them covers the identification and management techniques most relevant to high-stress situations common in mental illness.

Why Quitting Is So Urgent for People With Serious Mental Illness

NIDA research estimates that tobacco-related diseases account for approximately 53% of deaths among people with schizophrenia and 48% among people with bipolar disorder. This mortality gap is one of the most significant and most preventable health disparities in psychiatry. People with serious mental illness die on average 10–25 years earlier than the general population, and smoking is the single largest modifiable contributor to that gap.

Framing cessation support as an optional add-on within mental health care is no longer clinically defensible. Addressing tobacco use is a core component of holistic psychiatric care in 2026. If your mental health provider has not raised smoking cessation with you, you are empowered to raise it with them. You deserve the same access to effective quit support as anyone else.

For a broader view of how your body begins recovering the moment you stop smoking, see our article on what happens when you quit smoking.

Frequently Asked Questions