What happens to anxiety levels on giving up smoking?

Am J Psychiatry. 1997 Nov;154(11):1589-92. doi: 10.1176/ajp.154.11.1589.


Objective: DSM-IV lists increased anxiety as a nicotine withdrawal symptom. Increased anxiety has been reported to follow smoking cessation in most but not all studies. Indeed, there is some evidence for a reduction in anxiety, compared with precessation levels, after the first few weeks of abstinence. This study reports data from 101 smokers who attempted to stop smoking and who satisfied DSM-III-R criteria for nicotine dependence.

Method: Unlike most studies in this area, a strict criterion of lapse-free abstinence was adopted. It is argued that lapses during an attempt at cessation may underlie a transient increase in anxiety. Anxiety was measured both by a single rating typical in withdrawal studies and by the State-Trait Anxiety Inventory--State Form X. Patients were rated 2 weeks and 1 week before cessation, immediately before cessation, 24 hours after cessation, and 1, 2, 3, and 4 weeks after cessation.

Results: Seventy patients were abstinent for the 4-week follow-up period. There was no evidence of an increase in anxiety following smoking cessation. However, there was a significant decrease in anxiety from the first week of abstinence.

Conclusions: The results weaken the view that increased anxiety is a robust and central element of the nicotine withdrawal syndrome and suggest that giving up smoking is quite rapidly followed by a reduction in anxiety that may reflect removal of an anxiogenic agent, nicotine.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety / diagnosis
  • Anxiety / epidemiology
  • Anxiety / etiology*
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Smoking Cessation*
  • Smoking Prevention*
  • Substance Withdrawal Syndrome / diagnosis
  • Substance Withdrawal Syndrome / epidemiology
  • Substance Withdrawal Syndrome / etiology*
  • Tobacco Use Disorder / complications*
  • Tobacco Use Disorder / diagnosis