Smoking and Panic Attacks: Can Smoking Cause Panic Attacks?

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A Strong Relationship

We have all witnessed it.. the anxious individual getting ready for a speech, to walk down the aisle, to take an important test, or to go into their job interview.. their desire for “one more cigarette”. I’ve known many smokers who need their cigarette to deal with life’s stressors. Indeed, smoking has been called a “social lubricant”, like alcohol, making introverted individuals able to make small talk with complete strangers over a smoke. These individuals believe that smoking actually makes them feel better.

Scientists argue that it is actually the opposite – that in the long run, smoking may make your anxiety worse, or may even cause panic attacks. It is apparent that a strong relationship between smoking and panic disorder exists. Smoking and panic attacks have been shown to be intricately linked; indeed, many studies have revealed that smoking increases the chance of developing panic disorder, as well as the severity of panic disorder that is already present in an individual.

For example, researchers from Maastricht University in the Netherlands induced panic attacks in both smokers and non-smokers. Smokers reported a significantly higher experience of panic than non-smokers, even when baseline levels of anxiety were controlled for. The two groups did not differ in their baseline anxiety levels but did in their severity of panic attack. The study was published in the Journal of Affective Disorders.

You may be thinking that it is the panic that causes the individual to smoke in the first place, and this has also been shown to be true. Since studies have historically tried to determine whether smoking causes panic or whether panic causes smoking, one group of researchers from the Netherlands aggregated data from over 20 studies, revealing that both may cause the other!

Panic Increases Smoking

One thing is certain; once a person has panic attacks and panic disorder, they are more likely to smoke. More specifically, having a history of panic attacks significantly increases an individual’s amount of smoking, nicotine dependence, and inability to quit smoking. In general, data indicates that the more severe the mental illness, the greater their prevalence of smoking and smoking related issues (i.e. problems quitting).

How Can Smoking Cause Panic?

No single causal reason for how smoking may cause panic disorder has been decided upon by researchers, although multiple theories have been introduced. It makes sense that the mechanism by which smoking causes panic may differ across individuals and their subjective experience of panic (for example, if their panic is based on misinterpreted bodily sensations or not). The main ways in which smoking may cause panic disorder are:

  1. Cigarette smoking increases bodily sensations that create fearful responses in the individual, or they create respiratory abnormalities

  2. Nicotine leads to a release of norepinephrine in the brain which causes panic

  3. Cigarette smoking is utilized as a means to self-medicate the already present panic disorder, thereby causing nicotinic dependence

  4. The gene/s or behavior which cause one (smoking or panic attacks) also causes the other, or in other words, there is a third causal mechanism which creates both in the individual.

Smoking and Panic Attacks: Conclusion

These theories supporting how smoking and panic attacks are linked have been scientifically supported . At the end of the day though, the main point is that there are many ways in which smoking can cause a person to develop panic disorder, or increase the severity of pre-existing symptoms.

If you are currently experiencing panic attacks and also are a smoker, smoking cessation would be very beneficial for you. The research data support that it is much more difficult to quit smoking if you have an anxiety disorder as well. I encourage you to let others help you through the process and try smoking cessation aids, such as prescription medicines (i.e. Bupropion), over the counter gums and patches, as well as behavioral aids.

NB: The content of this article is for information purposes and is not intended to replace sound medical advice and opinion.


Cosci F, Knuts IJ, Abrams K, Griez EJ, Schruers KR. “Cigarette smoking and panic: a critical review of the literature.” Journal of Clinical Psychiatry, May 2010.

JR, Zvolensky MJ, Fitch KE, Sachs-Ericsson N. “The role of comorbidity in explaining the associations between anxiety disorders and smoking” Nicotine and Tobacco Research, April 2010.

Knuts IJ, Cosci F, Esquivel G, Goossens L, van Duinen M, Bareman M, Overbeek T, Griez EJ, Schruers KR. “Cigarette smoking and 35% CO(2) induced panic in panic disorder patients.” Journal of Affective Disorders, July 2010.