Please Don't Panic, But If You Smoke You May

Add one more strike to the inflating list of miseries caused by smoking. It's beginning to look like there is no end to how long that list might grow to be. There is one major possible flaw inherent in the study providing evidence for the latest addition to the list - panic. The problem, readily admitted to by the authors Isensec and her colleagues, located in Germany and the United States, is that it's uncertain which comes first here, the chicken (nicotine dependence) or the egg (panic). Suppose we attempt to sort out the evidence as presented by their article published in the July 2003 Archives of General Psychiatry called "Smoking Increases the Risk of Panic: Findings From a Prospective Community Study."

A major factor in determining the reliability of the concept that dependence on nicotine comes first, followed by a tendency towards increased panicky behavior, is the choice of participants invited into the study. All were either adolescents or young adults. The choice was made based on a prior study by the group, which indicated that these youngsters, surrounded by peers exerting pressure, tend to have preexisting social fears. Once they start, the nicotine, according to some researchers, may exert a calming effect, which may relieve the symptoms of anxiety. However, the real reason for calming fears may not be a pharmacological effect, but rather due to alleviating some of these fears by joining in and starting to smoke. The next step is nicotine dependence, which the authors found previously will occur more readily in those afflicted with preexisting social fears. On the other hand, is it true that nicotine has only a calming effect? Apparently, it may well also "trigger and increase anxiety symptoms." The production of anxiety might actually be more important as a cause of some cases of panic disorder. In any event, there does not seem to be doubt, according to multiple studies, that there is a definite relationship between smoking and panic disorder. The question now arises; does the choice of preexisting social-fear-prone young individuals truly measure the relationship between smoking as a cause, and panic as a result? Would it not be more instructive to study smokers who were not influenced by peer pressure, but merely took up the habit as a pleasurable experience? If panic disorder were to be more prevalent in such a cohort, then smoking as a cause of increased panic would truly be a "smoking gun."

The research was done in Munich, Germany utilizing baseline and 4-year follow-up data based on a psychopathology study that investigated both regular and occasional smoking, nicotine dependence, panic attacks, panic disorder, other anxiety disorders, and other mental disorders. The title of the original study was called the Munich-Composite International Diagnostic Interview. There was little doubt that occasional and regular smoking, as well as nicotine dependence correlated well with panic attacks and panic disorder at baseline. The results foretold an increased risk for new onset of panic attacks with prior regular smoking and nicotine dependence, as well as an increased risk for onset of panic disorder when preceded by nicotine dependence. The reverse, where panic came first, did not appear to herald later smoking or nicotine dependence.

When the final results were subjected to statistical analysis using Cox regression, it was confirmed that nicotine dependence was related to later panic attacks, but this did not hold true for panic disorder. Instead, it appeared likely that prior panic attacks and/or disorder might also have an effect on later development of nicotine dependence.

So, it was concluded that young adults who smoke show a definite tendency to later develop panic attacks or panic disorder. However, although less common, it seemed likely that the reverse, prior panic and later nicotine dependence could occur.

For those of you who tend to pooh, pooh the growing evidence that smoking is dangerous to your health, I say, "Don't panic now. You'll have plenty of chance to do so in the future."

Puff with dignity, puff with grace, Puff then puke all over the place, Puff wearing leather, puff wearing lace, Puff until you're blue in the face. Puff on Monday, puff on Sunday, Puff if you're straight, puff if you're gay, Puff no matter what the doctors say, Puff until you're old and gray.