Panic Attacks More Common in Smokers

From the WebMD Archives

Dec. 14, 1999 (Atlanta) -- If you think smoking calms you down, think again. A study of thousands of smokers shows that they are three times more likely than nonsmokers to have panic attacks and panic disorder.

"We know already a whole lot about the effects of smoking on just physical health, and now we are also starting to see the adverse effects in new research on mental illness," study co-author Naomi Breslau, PhD, tells WebMD. "This is one example."

A panic attack can have all sorts of symptoms: shortness of breath, dizziness, heart palpitations, trembling, sweating, choking, nausea, numbness, flushes or chills, loss of one's sense of reality, chest pain, fear of dying, and/or fear of going crazy. People who have frequent panic attacks (more than four in a month) or have persistent fear of having another attack for a month after an attack suffer from panic disorder.

Breslau says, "It's not simply that the two things go together, but it's suggesting that smoking is playing a causal role." According to Breslau, smoking increases a person's lifetime risk of a panic attack by three to four times.

The risk of a first-time panic attack goes down in people who have quit smoking, although the studies do not show whether quitting will eliminate all risk in people who have smoked. But people who smoke should quit now, advises Breslau, who is director of research in the psychiatry department of the Henry Ford Health System. She and Donald F. Klein, MD, of the New York State Psychiatric Institute published their findings in the December issue of the journal Archives of General Psychiatry.

She suggested that tobacco smoke may induce panic attacks in susceptible individuals. "There can be other mechanisms by which smoking induces panic: the effect of nicotine for example," Breslau says. Nicotine has a stimulating effect on the brain. It does all sorts of things."

Panic attacks may be a false alarm in which a person's body mistakenly thinks it is suffocating, Klein previously has written. Based on this theory, Breslau and Klein suggest in their article that carbon monoxide in cigarette smoke may set off panic attacks in people predisposed to overreact.

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In an interview seeking objective comment, clinical psychologist Benjamin Fialkoff, PhD, tells WebMD that the study findings appear to be in line with his experience in treating patients with panic disorder.

"It doesn't surprise me in view of the findings that smoking increases stress," he said. "What we have in a panic response is the body's stress response going full out. ... In general, you don't feel a soothing, calming feeling after you have a cigarette."

Fialkoff says he prefers a combination treatment for patients with panic disorder. He refers those patients willing to take medications to a physician for a mild tranquilizer and an antidepressant. He then teaches patients ways to reduce their anxiety symptoms, usually with breathing or relaxation techniques but sometimes with self-hypnosis. When a specific irrational fear (phobia) is involved, Fialkoff helps patients confront these fears in small, incremental steps. Last but not least, he says he helps patients restructure their fearful thoughts so that they do not lead to full-blown panic.

  • Smokers are three times more likely to have panic attacks -- and panic disorder -- than nonsmokers.
  • In addition to harming a person's physical health, smoking can harm a person's mental health.
  • Risk of panic attack gets smaller in people who quit smoking, but it is not clear how long it takes for the risk to go down.
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