Up in Smoke

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I recently began reading Brain on Fire by Susannah Cahalan, which describes the author’s experience battling a mysterious mental illness. One of the early symptoms was long stretches of general anxiety with emotional peaks that resembled panic attacks. Cahalan describes an evening with her boyfriend when anxiety begins to set in, and her boyfriend notices that she’s been smoking nearly non-stop for quite a period of time. I was vividly able to picture this scene, because it’s such a cliché picture: the stressed protagonist fumbles for a cigarette to ease her anxiety, or the camera fading into the ash tray filled with cigarette butts as the novelist desperately grapples with his writers’ block. If Hollywood has taught me anything, it’s that cigarettes are a surefire means of dealing with nerves.

This got me wondering how accurate this depiction is. The ingredients in cigarettes (nicotine in particular) do a lot of crazy, usually harmful, things to the body, so can they really be that helpful for the mind? A bit of time reading articles on PubMed brought me to a frustrating conclusion: it depends. Research by the Instituto de Investigaciones Farmacológicas in Argentina concluded that small amounts of nicotine in mice did reduce anxiety, but higher doses actually increased anxiety. The problem is further complicated when other chemicals are added to the equation, as sometimes the effects are negated, while other times they are amplified.

So where does this put Susannah Cahalan as she reflexively smokes to deal with this stress. Given that she was smoking a large amount in this particular instance, I would hazard a guess that she was not doing anything biologically to relieve any of her stress. However the very act of smoking could have become so linked to relaxation for her that it still would have had a calming effect. Whatever the case, in this circumstance it was ineffective as her symptoms continued to progress until, less than 24 hours later, she found herself in the hospital.

References:

Varani, A.P., et al., Involvement of GABAB receptors in biochemical alterations induced by anxiety-related
responses to nicotine in mice: Genetic and pharmacological approaches, Neuropharmacology (2014), http://dx.doi.org/10.1016/j.neuropharm.2014.01.030

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