Think Smoking Calms Your Nerves? Think Again

From the WebMD Archives

Nov. 7, 2000 -- Each day in the U.S., some 3,000 kids and teens take up smoking, and it's a safe bet that just about all of them know the practice is a threat to their physical health. But research from New York's Columbia University suggests smoking may impact their mental health as well, by increasing the risk of certain anxiety disorders.

Teens who smoked at least one pack of cigarettes a day were 15 times as likely to develop panic disorders, or repetitive episodes of panic, during early adulthood as those who did not smoke. Generalized anxiety disorder, characterized by feelings of apprehension or worry resulting in physical symptoms, developed in early adulthood five times more often, and agoraphobia, defined as an incapacitating fear of open spaces, occurred seven times more often in people who smoked heavily as teens. The findings are reported in the Nov. 8 issue of The Journal of the American Medical Association.

"This study breaks new ground, and it is important for two reasons," Campaign for Tobacco-Free Kids president Matthew Myers tells WebMD. "First, it demonstrates that smoking causes serious problems almost immediately. You need not wait 20 years to face serious health problems related to smoking. Second, there has long been a myth among teens that smoking is a way to calm your nerves and focus your attention. This demonstrates that the opposite is true."

While previous research has linked cigarette smoking with psychiatric disorders, it has not been clear whether anxiety causes people to smoke or smoking causes anxiety. "Our findings provide unequivocal support for the hypothesis that smoking contributes to the increased risk for the onset of three kinds of anxiety disorder, but we obtained no evidence in support of the hypothesis that anxiety disorders increase the risk for the initiation of cigarette smoking," study author Jeffrey G. Johnson, PhD, of Columbia University and the New York State Psychiatric Institute tells WebMD.

"This finding is not particularly surprising because a recent study indicated that nicotine appears to have [anxiety-producing] properties. [And in fact], anxious youths may [actually] avoid cigarette smoking because they tend to feel a bit more anxious when they smoke," he says. "Although regular smokers may find that cigarettes have a temporary calming effect, because smoking relieves their nicotine withdrawal symptoms, [that study] found that regular smokers who quit smoking for more than two weeks had lower anxiety levels than when they were smoking regularly."

Johnson and colleagues based their research on the Children in the Community Study, an ongoing research project involving approximately 1,000 randomly sampled families living in upstate New York. Participants included nearly 700 smoking and nonsmoking teenagers interviewed between 1985 and 1986, at an average age of 16, and again between 1991 and 1993, at an average age of 22.

A total of 10% of the participants who reported heavy cigarette smoking during their teen years also reported being agoraphobic during the second interview approximately six years later, compared to 2% of those who were not heavy smokers as teenagers. Likewise, 20% of the heavy-smoking teens later reported generalized anxiety disorders, compared to 4% of those who did not smoke heavily. And panic disorders were seen in almost 8% of young adults who smoked heavily as teens, compared to less than 1% of those who did not.

The researchers found no association between teen smoking and the later development of obsessive-compulsive disorder or social anxiety disorder. Prior studies have suggested that impaired breathing may be associated with agoraphobia, generalized anxiety disorder, and panic disorder, but not with social anxiety disorder or obsessive-compulsive disorder.

Future studies may shed light on the role that impaired breathing and the anxiety-producing effects of nicotine play on the three anxiety disorders found to be higher in this group of young adults, Johnson says. In the meantime, both Johnson and Myers stress that education efforts need to include both the physical and mental health consequences of smoking.

"Study after study shows that teens believe that they will have no trouble quitting smoking and that it doesn't hurt them to smoke during their teen years," he says. "But this study tells a different story. Even if you smoke for only a few years, you can suffer substantial and serious ill consequences. That is an important message to get across."