Antidepressants and Nicotine Withdrawal Symptoms. Stop Smoking

Part of the difficulty of quitting stems from their chemical addiction to nicotine, a substance with potent neurochemical effects.

“I just don’t get it,” your colleague says. “Every November we have The Great American Smoke-out. Lung cancer, heart disease, emphysema — who would ever start smoking these days? Why don’t all smokers just quit?”

Why don’t smokers just quit?

Many people who smoke decide one day that now is the time to quit. They throw away their cigarettes, endure a few days, weeks or months of discomfort, and maintain their abstinence from cigarettes. Others may quit several times before becoming successful, learning more about how to quit from each previous attempt.

Some smokers do not yet want to quit. They may be unconcerned about the long-term health effects of smoking. They may think that they will quit later, when they are in a better position to do so. Over the years, however, they may become convinced by public health campaigns that quitting would be worth the effort, so health educators and fitness professionals should keep spreading the word.

Many smokers say that they wish they had never started, and that they would like to quit. Many smokers don’t “just quit” because they find quitting very difficult. Part of the difficulty stems from their chemical addiction to nicotine, a substance with potent neuro-chemical effects.

Nicotine and withdrawal

The degree to which people are addicted to nicotine is a strong predictor of quitting success. An addiction to smoking has both behavioral and chemical components. Behaviorally, smoking is used to take a break, spend time with smoking friends and deal with stress. Over the years, the act of smoking becomes associated with positive feelings, and people wish to continue smoking because of these pleasant associations.

The primary strength of cigarette addiction, however, lies in the chemical addiction to nicotine. The physical and psychological effects of nicotine are not totally understood, but scientists do know that it has powerful effects on many physiological systems, including the cardiovascular and respiratory systems. Nicotine also affects brain chemicals, called neurotransmitters, that are involved in a number of psychological functions, including regulation of mood.3

Like other strongly addictive drugs, nicotine causes changes in these neuro-chemical pathways that lead to powerful cravings and other symptoms when the drug is withdrawn. Withdrawal symptoms vary widely, but include feelings of irritability, anger, anxiety, tension, difficulty concentrating, restlessness, insomnia, excess hunger and drowsiness. People with especially strong negative withdrawal symptoms often have a great deal of difficulty kicking the habit.

Smoking and depression

Some research suggests an association between depression and smoking. Researchers continue to explore this association. Are depressed people more likely to smoke because they are looking for a way to relieve negative feelings? Depression may prompt young people to begin smoking. Most smokers begin smoking in adolescence, however, and peer group smoking is the strongest predictor of smoking for that age group — much stronger than depression.4 Smoking may also increase risk of depression in some people, although the mechanisms for this are not yet clear.

Does quitting smoking cause depression? Yes, but in a minority of people. Most people who are at-risk for depression are smokers with a prior history of at least one episode of major depression, and people addicted to alcohol or other drugs.3 But depression can also develop in ex-smokers who have never experienced depression or have never been addicted to other substances.

Antidepressants to help quit smoking

The smoking-depression link prompted researchers to investigate the use of antidepressants in smoking cessation programs.5 Various studies have found that when compared to receiving a placebo, people receiving antidepressants have significantly higher success rates for quitting smoking. This holds true even for people who are not depressed, which means that antidepressants work not only by relieving depression in depressed people, but by other mechanisms as well. In fact, in one study, recent ex-smokers receiving an antidepressant reported fewer withdrawal symptoms than did subjects receiving the placebo. Symptoms less prevalent in the antidepressant group included anger, anxiety, irritability, tension, difficulty concentrating, restlessness and insomnia.5

Exercise vs. antidepressants

Antidepressants work by helping ex-smokers feel better, which reduces their need to “light up.” Studies on cessation programs have found that smoking relapse occurs primarily because ex-smokers feel a need to smoke to relieve negative feelings, a phenomenon researchers call “negative affect reduction smoking.”

Many physicians now prescribe antidepressants for people who need help quitting. It is important to note that antidepressants have drawbacks, including their expense and side-effects. Some people who use antidepressants remain on them for years and have difficulty withdrawing from them. Of course, antidepressant dependency and side-effects probably outweigh the negative health consequences of cigarette smoking. Nevertheless, it makes sense to explore other options, such as exercise.

Regular physical activity can also help people quit.2 This is not surprising considering the antidepressant/smoking research. After all, exercise has effects similar to those of antidepressants. It reduces feelings of depression and also lessens feelings of anxiety, irritability, anger and tension. It improves sleep quality and mood. Regular physical activity may also help prevent or reduce the weight gain that commonly occurs with smoking cessation.

While exercise requires much more time and energy than taking pills, physical activity has enormous health benefits without unwanted side-effects. Encourage your clients and friends who smoke to give exercise a try.

1. Breslau, N., and E.O. Johnson. Predicting smoking cessation and major depression in nicotine-dependent smokers. American Journal of Public Health 90 (7): 1122-1127, 2000.

2. Marcus, B.H., et al. The efficacy of exercise as an aid for smoking cessation in women: A randomized controlled trial. Archives of Internal Medicine 159 (11): 1229-1234, 1999.

3. Patten, C.A., J.E. Martin, M.G. Myers, et al. Effectiveness of cognitive-behavioral therapy for smokers with histories of alcohol dependence and depression. Journal of Studies on Alcohol 59 (3): 327-335, 1998.

4. Patton, G.C., J.B. Carlin, C. Coffey, et al. Depression, anxiety, and smoking initiation: A prospective study over 3 years. American Journal of Public Health 88 (10): 1518-1522, 1998.

5. Prochazka, A.V., M.J. Weaver, R.T. Keller, et al. A randomized trial of nortriptyline for smoking cessation. Archives of Internal Medicine 158 (18): 2035-2039, 1998.

Barbara A. Brehm, Ed.D., is professor of exercise and sport studies at Smith College, Northampton, Mass.

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