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Facts and fiction on stopping smoking

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One of the reasons I decided to write this blog was that over the years I’ve seen a lot of nonsense written by so-called experts on smoking, and I felt that the public could do with some accurate information for a change.
So just now I’m sitting at an ice-hockey rink watching my daughter play and thought I’d check out the accuracy of information that pops up when I do a search on ”smoking” on the healthline website. The first hit listed was an article on “nicotine withdrawal” that had been reviewed by the “A.D.A.M Editorial team”. Unfortunately it has the usual smattering of inaccuracies, so I thought it might be worth correcting a few:
1. It lists “headache” and “drowsiness” as nicotine withdrawal symptoms. In fact neither of these symptoms are reliably caused by withdrawal from nicotine
Nicotine withdrawal symptoms are: irritability, depressed mood, anxiety, poor concentration, sleep disturbance, restlessness, hunger/increased appetite. Reduced heart rate also occurs on nicotine withdrawal, but smokers don’t notice or complain of it.
2. It mentions buspirone (Buspar) and fluoxetine (Prozac) as medicines that have been shown to help smokers quit. In fact the best evidence suggests that these medicines are not effective in helping smokers quit. The medicines that are approved by the U.S. Food and Drug Administration as safe and effective for smoking cessation are the nicotine replacement therapies (patch, gum, nasal spray, lozenge and inhaler), bupropion (Zyban) and varenicline (Chantix). In addition, nortriptyline and clonidine have good evidence supporting their efficacy for smoking cessation but are less often used, partly because no company has applied for FDA approval for that indication, and partly because they tend to have more side effects.
3. It states that nicotine itself has antidepressant effects. I am not aware of any solid evidence showing that nicotine has antidepressant effects, other than perhaps in individuals suffering acute nicotine withdrawal. I would not recommend that non-smokers who are depressed should try chewing nicotine gum (or using tobacco) to treat their depression, as there is not sufficient (or indeed barely any) evidence to suggest it might be helpful.

The problem with some of these inaccuracies is that they will tend to lead readers to the wrong conclusions in trying to understand their symptoms and seek remedies for them. When you are seeking advice on how to quit smoking, it is always a good idea to ask the person what training and experience they have had on the topic. Unfortunately most medical doctors and other health professionals have had as little as an hour total training on it as part of their primary degree, and may not have had any more training on it for decades.

You can find a thorough summary of the best evidence on what works for treating tobacco dependence at: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.section.28164
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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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