Smoking cessation
Medication help to quit smoking, alongside your psychiatric care.
Quitting smoking is harder when you live with depression, anxiety, bipolar disorder, ADHD, or another mental health condition, and the reason is not a failure of effort. Nicotine works on the same brain chemistry your treatment is trying to steady, so an unaided quit attempt asks your symptoms to hold still while one of their supports is pulled out. What makes the difference is medication, chosen and adjusted by the prescriber who already manages your psychiatric medication. This page is that service: prescription help to stop smoking or vaping nicotine, run inside your psychiatric care instead of as a separate program that never sees your medication list.
PsychMed Care is the medication management practice of Solutions Psychiatry. If you are looking for therapy, or therapy and medication together, the full practice is at psych.us.
Why this is a medication problem
The smoking is part of the condition, not separate from it
Most quit attempts are made on willpower alone. When one fails, the usual conclusion is that the person did not want it enough. The more accurate conclusion is that a drug dependence was asked to yield to resolve, while the condition underneath it went untreated. Dependence is pharmacology, and pharmacology answers to medication.
Not a willpower problem
Nicotine dependence is a drug dependence. Cravings, irritability, poor sleep, and the rest of withdrawal are what the drug does when it leaves, not evidence about your character. Treating the dependence directly, with medication, is what gives effort something to stand on.
Prescribed together, not separately
Varenicline, bupropion, and nicotine replacement are the standard options, and each one meets psychiatric treatment differently. Bupropion is also an antidepressant, which can help or complicate depending on what you already take. Varenicline runs as a set course with a quit date inside it. Nicotine replacement steadies the drop while the habits change. Which fits you is decided against your current medication list and your history, not from a shelf.
Your other doses get reviewed
Tobacco smoke speeds up the breakdown of some psychiatric medicines, so people who smoke often need higher doses to get the same effect. When you quit, that speed falls, blood levels climb, and a dose that was right can become too much. Reviewing your psychiatric doses as you quit is built into this plan. It is the same careful work described on the deprescribing page, applied to a planned change instead of a problem found later.
Safety, studied in people with mental health conditions
These medicines were once shadowed by warnings about psychiatric side effects, and people with mental health conditions were told to avoid them or to be especially careful. Large safety studies run since then, in people with psychiatric conditions specifically, found that varenicline, bupropion, and nicotine replacement did not increase psychiatric side effects. They are prescribed here as part of psychiatric care, monitored at every follow-up like any other medication change.
If things reach the point of thoughts of harming yourself, help is available now: call or text 988, text HOME to 741741 for Crisis Text Line, or call the NAMI Helpline at 1-800-950-6264. If someone is in immediate danger, call 911. This practice is not an emergency service. The crisis page lists more options.
Who this is for
For people who smoke or vape, and take psychiatric medication
This service is for people who smoke cigarettes or vape nicotine and who also live with a mental health condition or take psychiatric medication for one. If you have tried to quit before and the attempt fell apart when your mood dropped or your anxiety climbed, that history is information, not a verdict: it usually means the psychiatric side of the attempt was never treated while the nicotine was removed. It is also for people who are not sure they are ready. The first appointment can be a planning conversation about what quitting would involve on your current medication, and no quit date is required before it.
The process
Assessment, a quit plan, then adjustments
The work is measured the way the rest of the medication care here is measured: symptoms and sleep are tracked at the Comprehensive Initial Appointment and at every Follow-up Appointment, so the effect of quitting on your condition is seen early rather than guessed at. When labs are part of a decision, they are drawn at any lab near you; nothing requires a trip to a particular facility.
The assessment
A full psychiatric evaluation that includes the smoking itself: how much, since when, past attempts, what helped, and what happened to your symptoms each time. Your complete medication list is reviewed for interactions and for the dose changes quitting is likely to cause.
The quit plan
You leave with a chosen medicine and a start date, a quit date set inside the course of that medicine, and a plan for the first two weeks, when withdrawal, habit change, and shifting medication levels all arrive at once.
Follow-up and adjustment
Follow-up visits check cravings, mood, anxiety, and sleep together. If a psychiatric dose has become too strong or too weak since you quit, it moves. If the cessation medicine is not carrying its share, it is changed rather than endured.
Cost and coverage
What it costs, and what your plan covers
The first appointment is a 60-minute Comprehensive Initial Appointment at $350. Follow-up Appointments run 30 minutes at $250 each. Most patients here use insurance: copays are typically $0 to $40, and your coverage and your exact cost are verified before your first visit, so the number is known before you commit to anything. In network: Aetna, Cigna and Evernorth, UnitedHealthcare and Optum, the Blue Cross Blue Shield family, Oscar, Oxford, Carelon, and Providence, plus Medicare in Arizona, California, Colorado, Texas, and Utah, and Medicaid in Oregon and Wyoming. Care is by secure telehealth in 34 states plus DC, for ages 17 and up. You can book here, or call (800) 303-3221.
“You do not have to choose between your mental health and quitting smoking.”
Start with a 60-minute evaluation that plans the quit around the medication you already take