February 25, 2020
Patching Up the Blues with Nicotine
Patching up the blues with nicotineSource: The Burgundy Zine
Whether it’s a bandaid over a bullet wound or a patch over an underlying mental health condition, researchers have been studying the effectiveness of treating depression and attention-deficit disorder with nicotine patches.
Which leaves one to wonder which is the lesser of two evils – a dependence on nicotine, a highly addictive substance, or grappling with depression and ADHD?
Research on Nicotine and Mental Health
Nicotine and Depression
In a 2018 Journal of Clinical Psychiatry study, 15 non-smoking adults with late-life depression were given up to 21 mg of nicotine a day through a nicotine patch.
For reference, the average cigarette contains 10 to 12 mg of nicotine but most of it is burned off, so the user inhales about 1.1 to 1.8 mg of nicotine per cigarette, according to a Healthline article.
The researchers observed a “robust response” of 86.7 percent and a remission of 53.3 percent among patients, and results began to show as early as three weeks into the study.
“We did not observe improvement on the Conners Continuous Performance Test, but did observe improvement in subjective cognitive performance and signals of potential drug effects on secondary cognitive measures of working memory, episodic memory, and self-referential emotional processing,” the study says. “Overall transdermal nicotine was well tolerated, although six participants could not reach the maximum targeted dose.”
In the same vein, a 2018 Neuroscience & Behavior review concluded that nicotine can improve depressive behavior, mood, and boost cognitive performance.
Nicotine and ADHD
Prior to the 2000s – when ADHD diagnoses skyrocketed – researchers had tested the effectiveness of treating ADHD with nicotine.
“Several lines of evidence suggest that nicotine may be useful in treating the symptoms of Attention-Deficit/Hyperactivity Disorder,” says a 1996 Psychopharmacology study. “This effect was significant when only the nonsmokers were considered, which indicated that it was not due merely to withdrawal relief.”
Their conclusion prompted the idea that perhaps ADHD could be treated with nicotine patches, as they had used in their study.
However, it’s hard to truly investigate whether nicotine is a viable treatment option for ADHD, as the diagnosis tends to coincide with nicotine dependence.
“ADHD and tobacco smoking are among the most common and costly psychiatric and behavioral problems,” says a 2009 Annals of the New York Academy of Sciences review. “The rates of co-occurrence of these two common problems are larger than expected by chance… Moreover, recent evidence suggests that ADHD symptoms, even at levels below the threshold required to make a clinical diagnosis, are significantly associated with risk for smoking.”
11-years ago, the rate of smoking among patients with ADHD (or symptoms of it) in clinical samples was 40 to 41 percent, whereas the rate of smoking among those without ADHD was 26 percent.
More recently, a 2016 Boston Medical Psychiatry Center study estimated ADHD and nicotine dependence ran together hand-in-hand at rates of 35 to 55 percent.
When patients with ADHD in their study attempted to quit smoking, they experienced intense nicotine withdrawal symptoms and perceived heightened ADHD symptoms. They also relapsed earlier and more often.
“Most participants favored a smoking cessation program specifically designed for individuals with ADHD because they thought ADHD complicated their nicotine withdrawal and that an ADHD-specific smoking cessation program should address specific symptoms of this disorder,” the study concluded.
Empirically, you could suggest the nicotine dependence is a way for patients to experiment with self-medicating. On the flip side, it could suggest a vulnerability to a nicotine addiction due to the dopaminergic effects of the substance.
A Bit About Nicotine
Nicotine is a stimulant class of drugs most commonly found in tobacco products, says the National Institute on Drug Abuse.
Within eight seconds of inhaling nicotine, the substance reaches the body. Then, nicotine increases heart rate, blood pressure, and alertness while reducing appetite.
“Nicotine affects the neurotransmitter acetylcholine and its receptor,” the NIH says. “This receptor is located in many brain structures and body organs. It carries messages related to respiration, heart rate, memory, alertness, and muscle movement.”
In addition to being an acetylcholine-agonist, nicotine triggers a surge of dopamine to rush circuits within the brain’s reward system, inducing a feeling of pleasure. Nicotine also decreases an enzyme responsible for breaking down dopamine in the brain, causing the increased dopamine levels to linger longer.
A Bit About Dopamine
Dopamine is pretty dope – I mean, it’s the “feel-good hormone” that regulates coordinated movements, hormones, and the brain’s reward system.
“Dopamine is a critical modulator of both learning and motivation,” says a 2018 Natural Neuroscience review. “The behavioral impact of dopamine varies by subregion, but in each case dopamine provides a dynamic estimate of whether it is worth expending a limited internal resource, such as energy, attention, or time.”
Dopamine and Depression
“Serotonin has traditionally been the transmitter linked with depression, based on pharmacological studies of antidepressant drugs that target the serotonin system, or depletion of serotonin in the CNS,” says a 2016 Nature Reviews Neuroscience article. “However, many of the symptoms seen in depression — such as anhedonia and amotivation — have been more consistently associated with dysfunctions in the DA [dopamine] system.”
The amygdala becomes hypersensitive to negative emotional stimuli in patients with depression, and over time, the constant stressor’s associated with the condition lead to a reduction of dopamine neurons firing, the study explains.
Even after the stressors have been reduced, the brain has adapted to a system of reduced dopamine levels, and thus the feeling of despair lingers.
A 2013 Nature study goes into the connection between dopamine and depression behavior even further, explaining how targeting dopamine in the midbrain is a crucial part of eliminating depression symptoms.
Decreased dopamine levels lead to an absence of both emotional and physical motivation, as dopamine affects locomotion. It’s not simply feeling depressed that makes the patient want to stay in bed, but their brain chemistry isn’t motivating them to move, either.
Dopamine and ADHD
Although there’s still much to be studied about the root of ADHD symptoms, research shows that dopamine dysfunction and neuroanatomical defects in the prefrontal cortex, temporal lobe, and corticostriatal pathways have a role in the condition, says a 2009 Integrative Medicine for Children article.
“Many ADHD experts posit that the central disability is impaired motor and behavioral inhibition, which leads to inability to manifest self-control, acquire appropriate social skills, and organize time, all of which in turn lead to hyperactivity, learning disability, aggression, anxiety, and other primary and comorbid characteristics,” the article says.
The dopamine and serotonin dysfunctions associated with ADHD also puts patients at a higher risk of substance abuse and nicotine dependence, a 2015 Addiction Biology study explains.
“Several neurobiological pathways have been implicated in both ADHD and SUDs [substance use disorder]s, including dopamine and serotonin pathway,” the study says. “While the focus of the literature so far has been mostly on dopamine, our study suggests that serotonin may also play a role in the relationship between these disorders.”
It’s also worth mentioning the medications currently used to treat ADHD symptoms are stimulants, like nicotine. Thus, further supporting the idea that nicotine use may be a form of self-medication for individuals with ADHD.
The Darkside of Nicotine
If nicotine has the potential to treat conditions like depression, ADHD, and additional forms of cognitive impairment, what’s stopping us from slapping an over the counter nicotine patch on everyone?
For one, nicotine is highly-addictive – as addictive as heroin and cocaine, according to the NIH.
While the carcinogenic properties of tobacco are responsible for the fatal side effects of smoking, nicotine causes long-term changes in brain functioning that creates a dependence on the substance.
When the user attempts to ween themselves off of nicotine, it causes highly uncomfortable withdrawal symptoms for days or even weeks, including:
- Inability to focus
- Increased appetite
If you or a loved one are currently in the process of quitting smoking and would like to speak to an expert for assistance, please call the Substance Abuse and Mental Health Services Administration hotline: 800-662-4357.
Additionally, we don’t know the long-term effects of nicotine patches. So far, six months is the longest the effects of nicotine patches have been observed in a study.
Nicotine may show potential promise for clinical applications, but at what cost? If nicotine therapy were implemented, is it truly benefiting the patient or is it simply covering up the underlying mental health condition by making them dependent on nicotine?
Furthermore, researchers need to investigate whether the long-term risks of nicotine therapy outweigh those of conventional depression and ADHD treatment options, such as selective serotonin reuptake inhibitors and prescription stimulants, which carry their own potential side effects.
However, there are currently treatment options available for both depression and ADHD that don’t rely on medication (or can be used with medication), like cognitive behavioral therapy – which has shown effectiveness among patients.
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