title: Effects of nicotine withdrawal on panic-like response to breath holding: a placebo-controlled, double-blind, crossover patch study.
abstract: BACKGROUND
  Cigarette smoking may increase the likelihood of developing panic disorder. Periods of nicotine withdrawal, in particular, may promote panic in individuals high in anxiety sensitivity. We examined the importance of nicotine withdrawal in the occurrence of smoking and panic.
  
  
  METHODS
  We utilized a placebo-controlled, double-blind, randomized, crossover design. Fifty smokers underwent a breath-holding (BH) challenge after the transdermal administration of nicotine on one test day and a placebo on another test day. Physiological and psychological variables were assessed at baseline as well as directly before and after the challenges.
  
  
  RESULTS
  Nicotine abstinence induced a decrease in heart rate and systolic blood pressure (BP) before the BH procedure (heart rate: 78.80 ± 11.43 under nicotine, 70.88 ± 10.83 under placebo; systolic BP: 124.90 ± 11.34 under nicotine, 121.18 ± 13.44 under placebo) and shorter BH duration relative to the nicotine patch condition. Nicotine abstinence did not, though, increase fear reactivity to the challenge.
  
  
  CONCLUSIONS
  The findings for heart rate and BP are consistent with the stimulant properties of nicotine. The reduced capacity to maintain apnea under placebo might be due to carbon dioxide (CO2 ) hypersensitivity during periods of nicotine abstinence. The negative findings regarding fear reactivity might be due to BH being a relatively weak anxiogen. Future researchers are encouraged to employ CO2 -inhalation procedures to study the relationship between nicotine withdrawal and panic.
authors.affiliation: Department of Health Sciences, University of Florence, Florence, Italy.
authors.forename: Fiammetta
authors.initials: F
authors.lastname: Cosci
authors.forename: Giuly
authors.initials: G
authors.lastname: Bertoli
authors.forename: Kenneth
authors.initials: K
authors.lastname: Abrams
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D062485:Breath Holding; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000009:adverse effects / Q000627:therapeutic use*; D018722:Nicotinic Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D010200:Panic; D016540:Smoking Cessation / Q000523:psychology*; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D061485:Tobacco Use Cessation Devices; D055815:Young Adult
chemical_list: D018722:Nicotinic Agonists; D009538:Nicotine
keywords: addiction; anxiety/anxiety disorders; panic attacks/agoraphobia; smoking; substance use disorders