Smoking Cessation and Anxiety

To the Editor: In their article, Robert West, Ph.D., and Peter Hajek, Ph.D. (1), concluded that their results weaken the view that increased anxiety is a central element of the nicotine withdrawal syndrome and suggested that giving up smoking is quite rapidly followed by a reduction in anxiety. Unfortunately, the frequency of assessments chosen by the authors may have confounded their results. Their data included measurements of anxiety 2 weeks and 1 week before smoking cessation, immediately before cessation, 24 hours after cessation, and 1, 2, 3, and 4 weeks after cessation.

According to DSM-IV, nicotine withdrawal symptoms typically peak in 1 to 4 days and last for 3 to 4 weeks. Since this study had only one assessment during the first 4 days after cessation, the true peak of anxiety symptoms from nicotine withdrawal may have been missed. Daily assessments would seem indicated, at least for the first 4 days after cessation, to clarify the role of anxiety symptoms in nicotine withdrawal.

Regarding the finding that levels of anxiety were lower after smoking cessation than at baseline, it would be interesting to know the reasons for smoking perceived by these subjects. Russell (2) speculated that stimulation and sedation were separate reasons for smoking. Perhaps the subjects in this study smoked for stimulation and, therefore, experienced reduced anxiety after smoking cessation. Different results might be obtained among those who smoke for the perceived sedating effects of cigarettes.