[costello]

A couple of days ago I noticed my son was acting "different." A little ... I don't know ... edgier? irritable? But at the same time ... manic? Kind of hard to put my finger on it.

I was starting to think he was spitting out the medication. I give it to him, and he seems to swallow it, but ... He's just been making more and more noises about not taking it anymore. Then he starts acting different. I thought maybe he was getting impatient with the slow pace of lowering the dosage and decided to take matters into his own hands. I haven't wanted to ask him for fear he'd get angry.

So, just now he called me. He's craving a cigarette he says. Apparently he hasn't smoked in two days. I had no idea. He's talked about quitting quite a bit, but I guess he decided to do it.

Is it possible what I took for med noncompliance was withdrawal from cigarettes?

[gma45]

Hi, I know when I stopped smoking I was on edge and irritable for a while. Everyone is different, sounds like it might be from not smoking though.

[alwaysrejoice]

Yes I just quit four months ago. The first few days are very difficult. Tell him it does get easier and he is making the right choice to quit.

[costello]

He commented last night that he's been feeling funny the last few days. I told him it was probably the cigarettes, that if he just stuck with it he'd feel better in a while.

[alwaysrejoice]

Good luck to him, quitting cigarettes is very difficult.

[Tsunamisurfer]

Sure sounds plausible to me. Any kind of change to our body chemistry can throw us into irritable mania, including starting or dropping coffee, alcohol, rapidly quitting an antidepressant, etc. (my experience).

I hope it passes soon.
TS

Originally Posted by costello

A couple of days ago I noticed my son was acting "different." A little ... I don't know ... edgier? irritable? But at the same time ... manic? Kind of hard to put my finger on it.
...
So, just now he called me. He's craving a cigarette he says. Apparently he hasn't smoked in two days. I had no idea. He's talked about quitting quite a bit, but I guess he decided to do it.

Is it possible what I took for med noncompliance was withdrawal from cigarettes?

[costello]

It's sad to me that as soon as my son starts getting a little too cheerful, I worry about mania.

I did suggest he might want to wait to quit smoking since he's having his Zyprexa dosage lowered now. But apparently the pdoc is going to want to leave him at 7.5 mg for at least 6 more weeks. Still it's a lot to take on at once.

I was reading about smoking cessation yesterday. Apparently smoking raises dopamine levels in the brain. Since anti-psychotics block dopamine receptors and the brain reacts by increasing dopamine, it makes sense to me that someone on a antipsychotic might crave a drug that would help raise the dopamine levels. Maybe that's one reason so many dx'd with sz smoke.

I do hope he succeeds. It'll be a boost to his self-confidence. And what I love about this is that it was his idea, not mine. Him taking control of his own life and health, not me trying to exert control over him.

[costello]

My son still isn't smoking. It's 2 weeks, 5 days today.

He had somewhat of a return of his akathisia last week. I did a bit of research and apparently there's some evidence that nicotine can help with akathisia. They used a nicotine patch on 16 non-smokers who had antipsychotic induced akathisia and found that it helped eased the symptoms. So, that may be another thing that drives people with sz to smoke.

There's also such a thing as nicotine-induced psychosis! Seems like lots of things can cause psychosis in high enough doses or in suspectible people.

[mgran]

Hi Costello! I'm so proud of him for stopping... that's wonderful. I do know that nicotine is a very common addiction for people with schizophrenia, and that it actually can diminish the severity of some symptoms in people, hence why they self medicate with it. Apparently up to ninety percent of people with schizophrenia have been smokers, opposed to 30 percent of the general population.

I always avoided nicotine because I was scared of it as a little girl, my brother had the most horrible astha, and used to go blue... I always knew it was related to people smoking the house. I think I've been lucky not to get hooked on it.

[costello]

Originally Posted by mgran

Hi Costello! I'm so proud of him for stopping... that's wonderful.

I'm proud of him too. Interestingly he didn't start smoking until he was well into his 20's. I definitely associate it with his mental illness in some way. Either it was combatting the effects of the medications or it was helping with symptoms of the illness itself. The fact that he quit when the dose of the antipsychotic is so low, and the fact that it seems to have been relatively easy for him to quit, and the fact that the akathisia reared it's ugly head again after he quit smoking, would all seem to argue in favor of the cigarettes as helping him deal with the side effects of the medication.

[mgran]

I've got a book called "Surviving Schizophrenia" by E Fuller Torrey with a section in it about the "cigarette" problem in schizophrenia. I can't quite precis the information for you, because it's a bit complex and I'm tired, but the gist of it is that nicotine actually does reduce some of the symptoms of schizophrenia, the voices and anxiety, and some of the side effects of the meds.

Has anyone else ever seen those electronic "cigarettes" that are available now? They look similar to "real" cigarettes, but the "smoke" is actually water vapour, and the amount of nicotine released is programmable. Apparently there is no increased risk of cancer with them, there are none of the risks of passive smoking, none of the smell etc. There are about a hundred different "flavours" people can choose. I'm not sure whether they'd be helpful or not, never having smoked, but I'd be interested to know what people think. Could be helpful for people who really struggle to stop.