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People with bipolar disorder are at a higher risk of nicotine dependency and other substance use disorders (SUDs) than the general population.

Research has linked smoking to more frequent and severe manic episodes, and with an overall worsening in bipolar symptoms. This is in addition to the other well-known health risks of smoking, including lung cancer.

Avoiding or ceasing smoking may help people with bipolar disorder manage their symptoms and it will benefit their overall well-being.

We’ll go over what we know so far about the link between nicotine use and bipolar disorder, potential health risks, and tips for stopping smoking, known as smoking cessation.

Data shows that people with bipolar disorder and other mental health conditions are more likely to be smokers than people without them.

In 2016 research on the link between smoking and bipolar disorder, it was found that smoking is associated with worsening of the disorder’s hallmark symptoms, referring to depression, mania, and its milder form, hypomania.

A study from 2015 identified people with bipolar disorder as being two to three times more likely to smoke than the general population.

This was especially true for people experiencing manic episodes, who were more than three times more likely to be dependent on tobacco than people with other psychiatric disorders.

People with bipolar disorder who smoke may have a harder time managing mood episodes, which can result in more frequent, and longer, stays in mental health facilities.

Additionally, smoking can have adverse interactions with certain bipolar medications. Earlier 2012 research found that some mood stabilizing drugs (such as topiramate) may increase nicotine metabolism.

This means people with bipolar disorder taking these medications may have a tendency to smoke more and have more difficulty stopping.

Finding the link between nicotine and bipolar disorder

Research suggests a complicated relationship between smoking and bipolar disorder.

Some researchers speculate that age plays a role. According to the Centers for Disease Control and Prevention (CDC), most smokers have their first cigarette by age 18, but bipolar disorder generally first develops when people are in their early 20s.

However, other research has found there might be a direct link between smoking and developing bipolar disorder. More research is still needed.

For now, it’s difficult to determine what about bipolar disorder might be increasing the chances of smoking or what about smoking might increase the risk of developing bipolar disorder.

Smoking is most commonly thought of as linked to lung health and other respiratory health concerns. This link is supported by research, but it’s not the only way smoking can harm your health. There are a wide range of health risks associated with smoking.

Cancer risks

Lung cancer is the most common cancer associated with smoking. Smoking is a contributing factor in 80% to 90% of lung cancer deaths in the United States.

However, smoking is a risk factor in other cancers as well, including pancreatic, cervical, gastrointestinal, and kidney cancer and leukemia.

Chronic conditions

The use of nicotine has documented effects on the immune system. This impacts both acute and chronic illnesses. Smokers are at a higher risk of infections (including lung infections) than nonsmokers and may experience slower recovery and healing.

Chronic conditions associated with nicotine use include:

Other health effects

Smoking can have very visible, physical effects on the body over time.

These may look like:

Nicotine use can also impact sexual and reproductive health. This includes risks of reduced fertility, pregnancy complications, and erectile dysfunction in some people.

For many people who smoke, quitting smoking is a challenge that takes preparation, commitment, and social support. Nicotine is a substance that causes dependency (often called an addictive substance), meaning it actually changes chemical pathways in your brain.

The challenge of stopping nicotine use is worth it, as it has many health benefits.

Even after a few days without smoking, your body will begin to heal. After years of being smoke free, you can substantially reduce your risk of serious health conditions.

Check out a full timeline of the health benefits of quitting smoking.

If you’re ready to stop smoking, these tips can help:

  • Make a plan: A quitting plan is a tool you can use to set goals, track your progress, monitor your health, and more. You can create a plan for free at
  • Make a list: Writing out a list of reasons you want to quit smoking can be very motivating. It can help you stay focused and remind you why you made this commitment.
  • Tell your friends and family: Telling the people around you that you plan to quit can encourage you to stick with it. Plus, you’ll have support along the way.
  • Pick a start date: It’s a good idea to give yourself a few days to prepare to quit smoking. Picking a quit date can give you time and can help you set your first goal.
  • Keep track of your triggers: Smoking triggers are the things and situations that make you crave a cigarette. For example, being around certain people, exposed to certain situations, or in certain locations can all trigger cravings. Knowing your triggers can help you avoid, prepare for, and manage cravings.
  • Throw out any remaining cigarettes: Keeping cigarettes around can make the temptation to smoke again stronger. Removing temptations from your home can help you stick with your plan.
  • Be prepared for withdrawal symptoms: Quitting has a wide range of health benefits, but withdrawal symptoms can be difficult to handle. You might experience depression, anxiety, or irritability or have trouble sleeping and focusing. Nicotine replacement therapy, such as gums, inhalers, and patches, can help minimize symptoms.
  • Find support: In addition to friends and family, you can turn to specialized support resources for smokers. These resources are designed to help you quit. You can find apps, websites, online chats, and more by checking out the resources page on
  • Take it one day at a time: Every day you don’t have a cigarette is a victory. Focusing on making it through each day can help make quitting feel manageable.
  • Stay active: It’s always a good idea to exercise and stay active. When you’re trying to quit smoking, it can help more than ever. Not only can it help improve your health, but it can also keep your mind off smoking.
  • Stock up on gum and candies: Having gum, candy, or another substitute can help you resist cravings.
  • Switch out coffee for water: Caffeine can make cravings worse. Plus, it’s important to stay hydrated while you’re in withdrawal.
  • Get plenty of rest: Being tired can trigger cigarette cravings. Getting plenty of rest and practicing self-care as you quit can be a big help.
You can do this!

Many smokers attempt to quit several times before successfully quitting for good. But remember: you’re not alone, and achieving smoking cessation is completely possible with the right planning and support.

Bipolar is a chronic condition, meaning it needs to be managed throughout your life. However, bipolar disorder is treatable. If you smoke, treatment for smoking cessation will likely be a part of your overall bipolar treatment plan.

Treatments to manage bipolar disorder include:

  • Medication: There are several different classes of medication available for bipolar disorder. You might need to try several before you find one that best manages your symptoms. Options include mood stabilizers, antidepressants, antipsychotics, anti-anxiety medication, and combinations of these.
  • Therapy: Therapy is considered a gold standard component of any bipolar disorder treatment plan. There are multiple types of therapy that can help with bipolar disorder. These include talk therapy, family counseling, cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy, and group therapy.
  • Medication with therapy: For many people, a combination of therapy types in addition to medication is the most effective approach to managing bipolar disorder.
  • Lifestyle changes: Steps such as eating a balanced diet, sticking to a routine, and keeping a journal or mood chart can help you manage your symptoms. Getting regular physical activity is also important. It’s also a good idea to surround yourself with supportive people and positive relationships.
  • Quitting substances: If you smoke, drink alcohol, or use other substances, a doctor might advise you to cease. You might be referred to a SUD treatment program to guide and support you in this process.
  • Day treatment programs: If you need more help and support managing your symptoms, a doctor might suggest that you attend a day program. Day programs can give you a safe and supportive place to go as you manage your symptoms.
  • Inpatient treatment programs: For more intensive treatment, a doctor may suggest an inpatient stay. Inpatient hospital stays can help stabilize your mood if you’re having challenging symptoms such as feeling suicidal or experiencing aggressive urges, very risky and impulsive behaviors, or psychosis.
  • Electroconvulsive therapy (ECT): This treatment sends electric currents through your brain and has been shown to help lessen mood episodes, but it’s not considered a first-line treatment for bipolar disorder. ECT is usually only recommended if other approaches haven’t worked, if you can’t take medications due to pregnancy or health conditions, or if your symptoms are very severe.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

People with bipolar disorder have a higher risk of smoking than both the general population and people with other mental health conditions.

The exact relationship between smoking and bipolar disorder isn’t completely understood, but it’s known that smoking is linked to more intense mood episodes.

Quitting smoking can help you manage your bipolar disorder and improve your overall health. In fact, prioritizing smoking cessation and the use of other substances is often a core part of any treatment plan for bipolar disorder.

This part of your treatment may include setting goals, building social support, nicotine replacement therapies, and entering specific programs for smoking cessation.