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General : Why am I tired and depressed?  
 Message 1 of 5 in Discussion 
From: Joel  (Original Message)Sent: 12/24/2005 12:15 PM
Hi, Joel
My name is Kim and I quit smoking cold turkey November 9th 2005.     I am exhausted, emotionaly drained and depressed.  How long does this last.  I am happy that I quit, but I have never felt so disoriented and in a daze before.  I almost feel like I am  having a outer body experience sometimes.   Is this normal or am I crazy
Please help
I got to never take another puff! 

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 Message 2 of 5 in Discussion 
From: JoelSent: 12/24/2005 12:28 PM
Hello Kim:
Being that you have been quit for well over a month now, it is no longer safe to assume that the symptoms that you are having are simple reactions to quitting smoking. Being tired and depressed can be normal reactions in the first few days of withdrawal, but after this time period there are likely other factors involved.
Below is my general commentary about any symptoms lasting longer than a few days or weeks. Also I am going to attach a series of commentaries addressing general quitting and depression issues. I will add that as an additional post, for there is a size limitation to how many characters are allowed in one post on MSN boards.
It is time to speak to your doctor to explore specifically what may be happening to you. Hope this information helps.
Life goes on without smoking:

It is important for all people who quit smoking to recognize that life goes on without smoking. Over time after a person quits smoking there will be changes: medical, psychological, professional, economic, life roles, relationships, etc. What is important to recognize though is that most of these changes would have occurred whether you had quit smoking or not or even whether or not you ever smoked. As many of my friends are now in their mid-forties and fifties, it is amazing how we share stories of new ailments and new medications being introduced into our lives. Some of these people had quit smoking decades ago, some of them never smoked. None of the ex-smokers bring up a new disorder and say or think to themselves that it must be happening now because they quit smoking ten or twenty years ago. It would be like a person who never smoked who finds out they now have high blood pressure and then thinks to him or herself that it must be because he or she stopped using some product twenty years ago. As we age things happen—it is just the way things go.

If a person gets diagnosed with a smoking related ailment like emphysema or lung cancer years or decades after quitting it is likely that their mind is shifted to think about their past smoking. But medical and psychological conditions that are experienced by smokers and non-smokers alike, the concept of smoking or quitting should not be considered a primary focus anymore.

Smoking did not cause everything. It causes a whole lot of things though and many things that it does not cause, it makes worse. On the same token, quitting does not cause everything. Quitting is usually accompanied with many repairs, but there are also some adjustments (see Medication adjustments) that go on that may need a partnership with your physicians to get worked out.

My general rule of advice is whatever happens the first few days of a quit, whether it is physical or psychological reactions, blame it on not smoking. It is probably the cause of most early quit reactions. If it is a symptom to a condition that could be life threatening, such as severe chest pains or signs or symptoms of a stroke—contact your doctor immediately. While it is probably nothing and just a side effect of quitting, in the long shot that it is something else coincidentally happening the week you are quitting, you need to get it checked out.

Things happening weeks, months, years or decades after your quits though should not ever be assumed to be a quit smoking reaction. It is life going on without smoking. Some of these things may trigger smoking thoughts—especially if they are similar to conditions you did have in the past when you were a smoker. The situation now is a first time experience with a prior feeling where smoking was integrates thus creating smoking thoughts. But even in this case, the condition is creating a smoking thought, it is not that your smoking memories or your smoking past is creating the condition.

Life goes on without smoking. It is likely to go on longer and it is likely that you will be healthier at each and every stage than you would have been if you had continued smoking. Your life will continue to stay better and likely last long longer as long as you always remember to never take another puff!


For people who are off for weeks, months, years or decades and who are cranky, nervous, depressed, angry, have sore throats, heart burn, ear aches, backaches, headaches, eye strains, poor vision, hearing problems, broken bones, have stubbed their toes, have financial concerns, job stresses, or any other extraordinary issues going on in their lives at the moment. Don't blame every feeling, bad or good in your life on the fact that you happened to have quit smoking. Life goes on without smoking and as the closing paragraph in this article states:

"Life goes on without smoking. It is likely to go on longer and it is likely that you will be healthier at each and every stage than you would have been if you had continued smoking. Your life will continue to stay better and likely last long longer as long as you always remember to never take another puff!"



 Message 3 of 5 in Discussion 
From: JoelSent: 12/24/2005 12:30 PM

Normal depressive reaction or a real organic depressive episode

I see we had some recent issues with quitting and depression and anger at the board. The fact is everyone who ever quit smoking faced these issues to some degree. I am creating a string here that covers depression from a number of angles. Some of these letters were written to my clinic graduates and others were specific answers to people who wrote questions with background histories. I think they will give everyone an overview of different physical and emotional issues around depression while quitting.

Again, some of the emotional reactions are a simple adjustment period. But some people have histories of emotional problems that may take more than the individual alone to overcome. The people involved may need to be working very closely with their doctors and medical professionals. These articles should give a little overview of those issues too.


The first letter here is in response to someone who wrote me a question regarding depression who had a past history of depression.

I take it from your post that you had been on medication for depression prior to smoking cessation. While becoming depressed upon smoking cessation is common, this depression normally subsides over time. But, when depression is a preexisting condition there are special considerations that need to be addressed. First, you may have been on a medication that initially took time to adjust, to find the right dosage for you. Now, when you quit smoking and stay on that dosage you can initially become depressed as part of the normal separation process from smoking, in a sense, feeling bad but not thinking anything is wrong. But when it doesn't subside over time you may assume that nothing can be done, its part of not smoking, you are already on an adjusted dose of depression medication and you just have to put up with it. This is a wrong assumption. Chances are even though you are on your normal dosage of medication, that dose was set while you were a smoker. This may not be the proper (normal dose) for you as an ex-smoker.

This dosing issue is not just about depression. People with many conditions may find that after cessation they must find what is normal for them. A person who is diabetic or on thyroid medications often find that the dose required as a smoker needs to be adjusted after quitting. Anyone who is on various medications that effect mood, hormonal and blood sugar levels needs to pay special attention to symptoms. Once through the first few days, and especially into the second week, if physical symptoms normally attributed to withdrawal are still manifesting, it is advisable that their doctor checks out those individuals.

I have put a few articles on the board here that I suspect you saw. There are others that I am not sure I put here or not, they were written to individuals who wrote with specific questions. While they may not apply to your specific situation, they cover a range of different depression issues. I am going to attach a string of letters here that were written to a few such individuals. If you have read part of them, keep going further down there may be more that you hadn't seen yet.

One other thing I would like to note that applies to emotions when quitting. If anyone lets emotions solely dictate actions, nobody would quit smoking. Part of the skill needed by all ex-smokers is the ability to override normal emotions, desires, impulses or urges, whatever we want to call it, the individuals wanting a cigarette or just a puff. Everyone feels it from time to time. It is going to be your intellect that is going to override the craving. That is where keeping your ammunition and focus of why you quit smoking is paramount. You have to keep remembering what smoking was doing to you making you sick and tired enough to go through initial quitting. Then you have to remember what continued smoking was capable of doing to you in the future, thoroughly capable of robbing you of your health and your life. When in emotional turmoil it is harder to keep that perspective. It is hard for everyone when in such turmoil but it is a skill that has to be honed day by day by everyone. Life will throw curves throwing people into despair. But smoking won't solve any of these curves. Smoking can cause problems that will throw your life further into despair and if left unchecked will throw your loved ones life into a premature loss of you.

Keep focused on this fact that quitting smoking is a fight for survival. It may be hard at times, but it is worth the effort. Bad times may make it harder to see this, but bad times will pass. You've experienced them before and you know they got better. Hang on to those memories that they do get better.

Again, talk to your doctor letting him or her know you have quit and have questions on the medications. Keep focused on your quit. One other thing to consider too, considering you were on medications before, you were depressed as a smoker. Never delude yourself into thinking life was always perfect before. Smoking didn't cure your depression before and it won't do it now either. For you, other medications were necessary to help with those feelings, smoking was not able to do it. Anyway, the following articles deal a little with the medication issues. Again, they may not all apply to you but kind of covers a range of reactions.

Hope this helps.


The following is another article written to a specific person who was experiencing a longer-term depression. This person was being encouraged by his or her doctor to go on an antidepressant but was resistant to the idea of needing medication.

Depression is normal in the cessation process. Almost everyone feels it to a degree, and the period of time that it lasts varies from person to person. Unlike the physical withdrawal, which is quite predictable in duration, the psychological reactions have tremendous individual variability.

I am attaching a letter here about the emotional phases of cessation. But since your reaction has been going for so long now, I would advise checking with your doctor. While quitting can be causing depression, it is possible that you do have an organic basis for depression that in a sense you were self-medicating with cigarettes for years.

If your doctor feels this is a possibility he or she may want to prescribe something for it. There are a lot of medications out there that are effective. As for safety or side effects, considering you may have been using smoking for this therapeutic purpose, a product that kills 50% of its users, the prescribed alternatives will pose minimal risks in contrast.

Or, the other hand, there may be some emotional conflicts in your life that have never been adequately addressed that are manifesting for the first time since quitting. I am attaching another letter I wrote to another person a few weeks ago that had some serious losses and was having some exaggerated reactions since quitting. I had more of a history on this person making me able to write this with some feeling that it really applied to this persons situation. I don't know if it applies to yours, but maybe in reading it you will see if it strikes a chord.

Anyway, hope this helps.


Understanding the emotional loss experienced when quitting smoking.

In her 1969 book, On Death and Dying, Elizabeth Kubler-Ross identified five distinct phases which a dying person encounters. These stages are "denial," "anger," "bargaining," "depression," and finally, "acceptance." These are the exact same stages that are felt by those mourning the loss of a loved one as well.

Denial can be recognized as the state of disbelief: "This isn't really happening to me," or "The doctor doesn't know what he is talking about." The same feelings are often expressed by family members and friends.

Once denial ceases and the realization of impending death is acknowledged anger develops. "Why me?" or "Why them?" in the case of the significant others. Anger may be felt toward the doctors, toward God, toward family and friends. Anger, though, doesn't change the person's fate. They are still in the process of dying. So next comes bargaining.

In bargaining, the person may become religious, trying to repent for all the sins that may be bringing about their early demise. "If you let me live, I will be a better person, I will help mankind. Please let me live, and I will make it worth your while." This stage, too, will come to an end.

Now the patient, becoming aware he is helpless to prevent his impending fate, enters depression. The patient begins to isolate himself from his surroundings. He relinquishes his responsibilities and begins a period of self mourning. He becomes preoccupied with the fact that his life is coming to an end. Symptoms of depression are obvious to anyone having contact with the patient in this stage. When the patient finally overcomes this depression he will enter the last stage, acceptance.

The patient now reaches what can be seen as an emotionally neutral stage. He almost seems devoid of feelings. Instead of death being viewed as a terrifying or horrible experience, he now peacefully accepts his fate.

As stated above, these stages are not only seen in the dying person but likewise in the family members mourning the loss of a loved one. However, on careful observation we can see these same stages in people who lose anything. It doesn't have to be the loss of a loved one. It could be the loss of a pet, the loss of a job, and even the loss of an inanimate object. Yes, even when a person loses her keys, she may go through the five stages of dying.

First, she denies the loss of the keys. "Oh, I know they are around here somewhere." She patiently looks in her pockets and through her dressers knowing any minute she will find the keys. But soon, she begins to realize she has searched out all of the logical locations. Now you begin to see anger. Slamming the drawers, throwing the pillow of the couch, swearing at those darned keys for disappearing. Then comes bargaining: "If I ever find those keys I will never misplace them again. I will put them in a nice safe place." It is almost like she is asking the keys to come out and assuring them she will never abuse them again. Soon, she realizes the keys are gone. She is depressed. How will she ever again survive in this world without her keys? Then, she finally accepts the fact the keys are gone. She goes out and has a new set made. Life goes on. A week later the lost keys are forgotten.

What does all this have to do with why people don't quit smoking? People who attempt to give up smoking go through these five stages. They must successfully overcome each specific phase to deal with the next. Some people have particular difficulty conquering a specific phase, causing them to relapse back to smoking. Let's analyze these specific phases as encountered by the abstaining smoker.

The first question asked of the group during the smoking clinic was, "How many of you feel that you will never smoke again?" Do you remember the underwhelming response to that question? It is remarkable for even one or two people to raise their hands. For the most part the entire group is in a state of denial-they will not quit smoking. Other prevalent manifestations of denial are: "I don't want to quit smoking," or "I am perfectly healthy while smoking, so why should I stop," or "I am different, I can control my smoking at one or two a day." These people, through their denial, set up obstacles to even attempt quitting and hence have very little chance of success.

Those who successfully overcome denial progress to anger. We hear so many stories of how difficult it is to live with a recovering smoker. Your friends avoid you, your employer sends you home, sometimes permanently, and you are generally no fun to be with. Most smokers do successfully beat this stage.

Bargaining is probably the most dangerous stage in the effort to stop smoking. "Oh boy, I could sneak this one and nobody will ever know it." "Things are really tough today, I will just have one to help me over this problem, no more after that." "Maybe I'll just smoke today, and quit again tomorrow." It may be months before these people even attempt to quit again.

Depression usually follows once you successfully overcome bargaining without taking that first drag. For the first time you start to believe you may actually quit smoking. But instead of being overjoyed, you start to feel like you are giving up your best friend. You remember the good times with cigarettes and disregard the detrimental effects of this dangerous and dirty habit and addiction. At this point more than ever "one day at a time" becomes a life saver. Because tomorrow may bring acceptance.

Once you reach the stage of acceptance, you get a true perspective of what smoking was doing to you and what not smoking can do for you. Within two weeks the addiction is broken and, hopefully, the stages are successfully overcome and, finally, life goes on.

Life becomes much simpler, happier and more manageable as an ex-smoker. Your self esteem is greatly boosted. Your physical state is much better than it would ever have been if you continued to smoke. It is a marvelous state of freedom. Anyone can break the addiction and beat the stages. Then all you must do to maintain this freedom is simply remember, NEVER TAKE ANOTHER PUFF!

The letter to the other person mentioned above.

Dealing with emotional loss has similarities to dealing with anger in regards to smoking cessation and its aftermath. When a smoker encounters a person or situation that angers them, they initially feel the frustration of the moment, making them, depending on the severity of the situation, churn in side. This effect in non-smokers or even ex-smokers is annoying to say the least. The only thing that resolves the internal conflict for a person not in the midst of an active addiction is resolution of the situation or, in the case of a situation which doesn't lend itself to a quick resolution, time to assimilate the frustration and in a sense move on. An active smoker though, facing the exact same stress has an additional complication which even though they don't recognize it, it creates real significant implications to their smoking behavior and belief structures regarding the benefit of smoking.

When a person encounters stress, it has a physiological effect causing acidification of urine. In a non-smoker or non-nicotine user, the level of urine acidity has no real perceivable effect. It is something that internally happens and they don't know it, and actually, probably don't care to know. Nicotine users are more complex. When a person maintaining any level of nicotine in their body encounters stress, the urine acidifies and this process causes nicotine to be pulled from the blood stream, not even becoming metabolized, and into the urinary bladder. This then in fact drops the brain supply of nicotine, throwing the smoker into drug withdrawal. Now they are really churning inside, not just from the initial stress, but also from the withdrawal effect itself. Interesting enough, even if the stress is resolved, the smoker generally is still not going to feel good. The withdrawal doesn't ease up by the conflict resolution, only by re-administration of nicotine, or, even better, riding out the withdrawal for 72 hours totally eradicating nicotine via excretion from the body of metabolizing it into bi-products which don't cause withdrawal. Most of the time, the active smoker more often uses the first method to alleviate withdrawal, taking another cigarette. While it calms them down for the moment, its effect is short lived, basically having to be redone ever 20 minutes to half hour for the rest of the smokers life to permanently stave off the symptoms.

Even though this is a false calming effect, since it doesn't really calm the stress, it just replaces the nicotine loss from the stress, the smoker feels it helped them deal with the conflict. It became what they viewed as an effective crutch. But the implications of that crutch are more far reaching than just making initial stress effects more severe. It effects how the person may deal with conflict and sadness in a way not real obvious, but real serious. In a way, it effects their ability to communicate and maybe even in someway, grow from the experience.

Here is simple example of what I mean. Let's say you don't like the way a significant other in your life squeezes toothpaste. If you point out the way it's a problem to you in a calm rational manner, maybe the person will change and do it a way that is not disturbing to you. By communicating your feeling you make a minor annoyance basically disappear. But now lets say you're a smoker who sees the tube of toothpaste, get a little upset, and are about to say something, again, address the problem. But wait, because you are a little annoyed, you lose nicotine, go into withdrawal, and before you are going to deal with the problem, you have to go smoke. You smoke, alleviate the withdrawal, in-fact, you feel better. At the same time, you put a little time between you and the toothpaste situation and on further evaluation, you decide its not that big of a deal, forget it. Sounds like and feels like you resolved the stress. But in fact, you didn't. You suppressed the feeling. It still there, not resolved, not communicated. Next time it happens again, you again get mad. You go into withdrawal. You have to smoke. You repeat the cycle, again not communicating and not resolving the conflict. Over and over again, maybe for years this pattern is repeated.

One day you quit smoking. You may in fact be off for weeks, maybe months. All of a sudden, one day the exact problem presents itself again, they annoying toothpaste. You don't have an automatic withdrawal kicked in pulling you away from the situation. You see it, nothing else effecting you and you blow up. If the person is within earshot, you may explode. When you look back in retrospect, you feel you have blown up inappropriately, the reaction was greatly exaggerated for the situation. You faced it hundreds of times before and nothing like this ever happened. You begin to question what happened to you to turn you into such a horrible or explosive person. Understand what happened. You are not blowing up at what just happened, you are blowing up for what has been bothering you for years and now, because of the build up of frustration, you are blowing up much more severe than you ever would have if you addressed it early on. It is like pulling a cork out of a shaken carbonated bottle, the more shaken the worse the explosion.

What smoking had done over the years was stopped you from dealing early on with feelings, making them fester and grow to a point where when the came out, it was more severe than when initially encountered. Understand something though, if you had not quit smoking, the feelings sooner or later would manifest. Either by a similar reaction as the blow up or by physical manifestations which ongoing unresolved stress has the full potential of causing. Many a relationships end because of claming up early on effectively shutting down conflict resolution by communication between partners.

As I said, anger is not the only emotion effecting urine acidity. Sadness does this too. The losses of your family members likely increased your smoking consumption at the time. By smoking you too may have suppressed numerous feelings and emotions during the losses. In a sense, not only did smoking impact your communication with others, but also maybe with yourself, coming to grips with certain feelings. In a sense, you may have interfered to some degree with your own personal growth at the time. And now, by quitting, these feeling are manifesting. While it may hurt at the time, it may be essential that these feeling are coming out. Beneficial in fact, making you face feelings in a way more constructive than smoking and suppressing them. And again, understand, if they are there deep seated all this time, if they didn't come out now, they were going to come out eventually. In what manner no one can predict. But the sooner you deal with the feelings, the less severe the reactions will generally be.

This above text doesn't resolve the feelings, it may just help you understand the possible problem. Talk with people here if that helps. Maybe there are more personal issues, you may find it more helpful to talk to a local professional, a doctor or therapist. Whatever you do and who ever you work with, understand, everyone will have greater interest in helping you than cigarettes will.

I know people who are afraid to take medications for mood disorders but will smoke in its place. No matter what drug would be prescribed for them, none of them would carry the risk that self-medicating oneself by nicotine carries. Smoking is lethal. Don't give cigarettes the legitimacy to treat feelings. They don't. They make them worse. They in effect minimize your ability to communicate and grow. Growth may hurt, but it beats carrying on unresolved feelings that slowly may deteriorate the quality of your life.

Hope this helps explain why it hurts so much but also helps you to understand why it is still so important not to smoke.

Will talk to you again soon.



I don't want to give the impression that the majority of people become clinically depressed or need medications to deal with the normal depression phase that accompanies initial smoking cessation. The fact is that only a small percentage of people will have a full-blown organic depression occurring just after quitting smoking. But that fact is not important if you are one of these individuals. What is important is that if you believe you are organically depressed get checked out by your doctor.
Especially if you are a person with a past history of treatment for depression or if your depressive episode is lasting more than a week and is causing a real disruption in your life, get checked out. You may indeed benefit from treatment or maybe your physician will just give you the reassurance that you are really okay. Either way it doesn't hurt to get the situation professionally assessed.

 Message 4 of 5 in Discussion 
From: MSN NicknameBillW-GoldSent: 12/24/2005 1:42 PM
Hi Kim:
     I've been there myself, and I was one of those that needed a little medical help with depression.  Consider:
  • Nicotine addicts us through the brain's domamine pathway.  Dopamine is the brain's "feel good" chemical.
  • Pulling the plug on the aritifical addictive dopamine may lead to some readjusment....
  • The only thing that sort of helps quitting is an antidepressant......
  • weather the addiction caused the depression, or the other way (and people also get depressed at the holidays, or just in winter...) depression is a medical problem, and can be treated medically.

But there is also a stage where you've been successful for about a month or so... but get so tired of the battle.  Your armor is dented and your sword is notched from slaying all those triggers and temptations.   You are tired and sweaty and it almost seems you cant raise your sword for one more battle.   Let me point something out:

You are WINNING!

Tell yourself that!  You are not yet to where you become a "comfortable" ex-smoker, but you are well on your way!   On the Freedom boards let me recommend

  • Tell a newbie how many seconds a day you still want a cigarette  
  • Success stories: before and after
  • Both will let you see people who have been where you are, and are now past that point.  They are no different from you: just further along.

    And remember: YOU ARE WINNING!

    YQB BillW Three years, ten months, two weeks, one day. 42449 cigarettes not smoked, saving $8,383.80. Life saved: 21 weeks, 9 hours, 25 minutes.

     Message 5 of 5 in Discussion 
    From: JoelSent: 5/5/2007 9:39 PM
    Video Title
    The emotional stages of loss 3.05mb 30.4mb 1.23mb 08:18 09/28/06
    "Is this a symptom of quitting smoking?" 1.91mb 18.9mb  0.77mb 05:13 09/27/06
    Does smoking cause my headaches? 2.69mb 07.4mb   08:32 03/21/07

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