Nicotine withdrawal

Definition

Nicotine withdrawal involves irritability, headache, and craving. These symptoms happen with the sudden stopping or reduction of smoking (or other tobacco use) by a nicotine-dependent individual. See smoking - tips on how to quit and smoking hazards.

Alternative Names

Causes

Almost all people who try to quit have some form of nicotine withdrawal. Generally, people who smoked longer or higher higher number of cigarettes are more likely to have withdrawal symptoms. The severity of the symptoms is also dependent on the duration of smoking and number of cigarettes smoked.

People who are regular smokers tend to have particularly strong cravings and worsening of withdrawal symptoms at certain times, places, or situations associated with smoking.

Symptoms

Common symptoms include:

• An intense craving for nicotine
• Tension
• Irritability
• Headaches
• Difficulty in concentrating
• Drowsiness and trouble sleeping
• Increased appetite and weight gain.

A milder form of nicotine withdrawal, involving some or all of these symptoms, can occur when a smoker switches from regular to low-nicotine cigarettes or significantly cuts down on the number of cigarettes smoked.

Symptoms of nicotine withdrawal can mimic, disguise, or aggravate the symptoms of other psychiatric problems, according to the American Psychiatric Association.

Treatment

There are several strategies for treating nicotine withdrawal. Nicotine supplementation in the form of gum or patch can be helpful. A variety of other agents have also been used with some success in maintaining abstinence and reducing withdrawal symptoms.

These agents include clonidine, antidepressants such as fluoxetine (Prozac), and buspirone (Buspar). Bupropion (Zyban) was approved in 1996 by the Food and Drug Administration (FDA) as a treatment for nicotine dependence.

Using bupropion or nicotine replacement therapies alone doubles the odds of successful quitting. Using a combination of these methods increases success rates even more.

The FDA has also approved a new medication for smoking cessation, Chantix. It acts to block the effects of nicotine and eases withdrawal symptoms. There is some evidence that it may be more helpful in quitting smoking than buspirone.

Buproprion and other antidepressants are not habit-forming, and may help reduce the possibility that nicotine withdrawal may lead to depression.

Since nicotine itself has antidepressant effects -- and many smokers unknowingly smoke to self-medicate depression -- use of antidepressants to relieve withdrawal may be particularly helpful.

A screening for depression may also be helpful to ensure proper treatment and increase the odds of maintaining abstinence.

People trying to quit smoking often become discouraged when they don't succeed at first. Research shows that the more times you try, the more likely you are to succeed -- so don't give up!

Outlook (Prognosis)

Nicotine withdrawal is short-lived and should pass in time. While withdrawal is the most uncomfortable part of quitting, the real challenge is beating long-term cravings and staying abstinent.

Possible Complications

The most likely complication will be a return to smoking. Weight gain due to increased eating also may occur. This is much less unhealthy than continuing to smoke, and those with concerns about weight should address them while quitting so that they do not undermine their attempts to stay away from cigarettes.

Withdrawal may also sometimes bring on a relapse of major depression, bipolar disorder, or substance abuse problems.

When to Contact a Medical Professional

See your health care provider if you wish to stop smoking, or have already done so and are experiencing withdrawal symptoms. Your provider can help provide treatments, some of which are only available by prescription.

Anderson JE, Jorenby DE, Scott WJ, et al. Treating tobacco use and dependence: An evidence-based clinical practice guideline for tobacco cessation. Chest. 2002;121(3:932-941.

Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service. June 2000.