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Abstract

Acute post-quit mood and early relapse to smoking or vaping: A systematic review

Aims: Early relapse after smoking or vaping cessation is common, and the first four weeks strongly predict longer-term abstinence. Acute post-quit mood disturbance may be a modifiable relapse mechanism, but evidence has not been systematically synthesised during this critical period. We aimed to review and meta-analyse associations between mood within four weeks post-quit and relapse within 12 weeks, including variation by intervention type and psychiatric history.

Methods: We searched MEDLINE, Embase, PsycINFO, CENTRAL, CINAHL, and Web of Science in March 2026 for prospective adult smoking/vaping cessation studies. Eligible studies assessed mood within four weeks post-quit and reported relapse or abstinence within 12 weeks. Screening is complete; extraction follows a partially duplicate process. Risk of bias will be assessed with the Newcastle–Ottawa Scale. Random-effects meta-analyses will pool absolute post-quit mood and mood-change estimates.

Results: We identified 18,149 records and removed 8,971 duplicates. Of 9,178 records screened, 20 studies currently contribute eligible data, and authors of a further 20 studies have been contacted for additional estimates. Evidence to date implicates post-quit anhedonia, depressive symptoms, anxiety sensitivity, and related affective processes in early relapse. Final meta-analytic and narrative synthesis results will be presented.

Conclusions: Early post-quit mood disturbance appears to be a clinically relevant, time-sensitive relapse mechanism after smoking and vaping cessation. By quantifying associations during the first four weeks and linking them to relapse within 12 weeks, this review will clarify when mood matters most and inform the development and optimisation of interventions targeting affect during the period of greatest relapse vulnerability.