How much Nicotine? What is it doing to my Mental Health?

By,

Meghan Dow DNP-PMHNP, CARN-AP

              For years the negative health effects and risks of nicotine use have been well documented. Including the implications to the cardiovascular system, respiratory system, GI and oral track, brain chemistry, and cancers. Yet, Nicotine remains one of the most addictive substances to exist. And now use/consumption is exponentially higher with introduction of vapes and higher dose pouches. Lets look at the milligram comparisons.

Nicotine Comparisons

Cigarettes (standard packs) is 22-36 mg of nicotine, some estimates as high as 10-15 mg per cigarette (brand dependent).

Chewing Tobacco is about 144 mg a can

Vapes (large variation in strengths) at 5% which is higher concentration, though lower concentrations are available. Here are some common vapes and the amounts:

JUUL- pods of 3 and 5%. In 5% pod 59 mg/mL (each pod 2.8 mL). Total amount for the pod 165.2 mg=    4.5-7.5 packs of cigarettes

Geek Bar- 5% and 50 mg/ml (each vape device 16 mL) Total amount for the device 800 mg= 22-36 packs of cigarettes

Lost Mary- 2 or 5% and respectfully 20 mg/mL and 50 mg/mL (13 mL in device). Total amount per device 260mg to 650 mg= 7-12 packs of cigarettes and 18-29 packs of cigarettes

Elf Bar- Same as Lost Mary in strength and mL as above, available with 2% and 5%

Funky Republic- this is 5% and similar to Geek Bar above 13-17 mL per vape device

Flum- 5% or 50 mg/mL and devices 8 mL, 14 mL, and 15 mL. In comparison to cigarette amounts= 11-18 packs of cigarettes, 19-31 packs of cigarettes and 22-36 packs of cigarettes

Raz- same as Geek Bar above

Fifty Bar- same as Geek Bar above

Pouches Each pouch labelled with mg amount per pouch

Addiction Qualities

              Nicotine reaches the brain in seconds, binding with nicotinic acetylcholine receptors and releasing dopamine, norepinephrine, acetylcholine, glutamate, serotonin, GABA, and endorphins. This in turn has rewarding results on cognition and mood, but the effects are short lived and withdrawals include symptoms of anxiety, depression, irritability and agitation following.

              The speed to reach max concentration in the blood and inversely, how quickly the max concentration is achieved and substance begins metabolization (leaving the blood stream) is indicative of how addictive the delivery of nicotine is. The following graph outlines this for the various modes of consumption.

              You can see cigarettes, e-cigarettes, and chewing tobacco are the most addictive, where replacement methods (tobacco replacement/cessation options) are the least. This is why nicotine cessation treatment options remain the best way to reduce and ultimately stop the use of nicotine.

Too Much

Lethal amounts of nicotine are about 50-60 mg without metabolism or elimination. Various levels of intoxication of nicotine exist and symptom occurrence is dose dependent. Outlined below are the symptoms associated with the levels of intoxication:

              Mild intoxication- increased heart rate, increased blood pressure, increased respiratory rate, slight tremor, cutaneous vasoconstriction, nausea, increased GI motility, increased alertness and euphoria

              Moderate intoxication- headache, dizziness, confusion, agitation, anxiety, restlessness, sweating, and tremors

              Severe intoxication- depression of the organ functions, lethargy, convulsions, coma, weakness, fasciculations, hypotonia, hyporeflexia, paralysis, respiratory paralysis, increased salivation, nausea, vomiting and diarrhea

Addiction and dependence occurs at very low amounts of nicotine consumption and is often independent of the individual and risk factors.

Effects on Anxiety and Depression

              What does all of this mean? At the receptor site level- activation of the nicotinic acetylcholine receptors produces short term anxiolytic (anxiety reducing) and antidepressant effects. But the catch is, the effects are short term (less than 2-3 hours) and then in withdrawals from nicotine, anxiety and depressive symptoms are produced.

Many animal studies are being conducted to look at the exact dosing that results in these effects and then time to withdrawal/secondary effects. One study looked at dosing to reduce anxiety in animals and found very low doses (0.05mg/kg) helped anxiety, but slightly higher doses (0.5 mg/kg) caused anxiety symptoms. Your kg to lbs calculation is 1 to 2.2, so you yourself can calculate the comparison for you. Chronic use increases risk for generalized anxiety disorder and panic disorder.

In comparison to those not using nicotine there is a 43% prevalence in nicotine users of depressive symptoms. Similarly, anxiety symptoms are more prevalent in those who use nicotine to those who do not. Depression rates are higher in those who use nicotine or have used nicotine to those who have never used nicotine. Depression rates decrease with quitting nicotine use and the longer abstinent the less depressive symptoms. Additionally, there is also a known negative change to the stress response with nicotine use.

Good news is that quitting nicotine use has demonstrated improved symptoms to mood (depression and anxiety) in thousands studied, for those who did not get improvement there was no worsening of mood state.

Quitting Nicotine (Cessation) IS the best way out!

              Much of the research in smoking cessation is focused on cigarettes, but nicotine is the active addictive substance and focus. Majority of users intend to quit and 7% remain abstinent with quitting the first time. On average 30 attempts are made before success. So if you are considering or previously tried- STICK WITH IT! The most vulnerable time for relapse is in early cessation. Withdrawal starts within four hours and peak symptoms are often present at 2-3 days. It’s very often the negative reinforcers of nicotine withdrawal that lead to relapse. The most common negative reinforcers experienced are anxiety, irritability, and difficulty concentrating, and the least common being depression and insomnia. Long term benefit to cessation is recovery from the negative reinforcers.

References

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Hahad, O., Beutal, M., Gilan, D. A., Michal, M., … Munzel, T. (2022). The association of smoking and smoking cessation with prevalent and incident symptoms of depression, anxiety, and sleep disturbance in the general population. Journal of Affective Disorders, 313, 100-109. doi: 10.1016/j.jad.2022.06.083

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