The addictive hold that nicotine has on a smoker cannot be minimized.  Nicotine dependence is the most immediate cause for patients to have difficulty with smoking cessation.  A patient who is nicotine dependent and wants to stop smoking must expect some withdrawal symptoms no matter what pharmacotherapy help is being used.

Nicotine can be metabolized at a variety of speeds. The brain of a smoker has developed a tolerance to nicotine and expects to receive a dose usually about every hour.  When the dose of nicotine is not provided, the nicotine receptors in the brain begin to call for more.  This brain reaction reaches its height usually at about 72 hours, or three days.  If you talk with many patients who have tried to quit “cold turkey”, they most often will fail in that first 3 day period because of the intensity of the signals from the brain calling for more nicotine. After the 72 hour peak, the brain’s demand for nicotine gradually reduces over several weeks. It is during the early phase of nicotine cessation that withdrawal symptoms may occur.

Withdrawal symptoms may include changes in mood, irritability, anxiety, insomnia, difficulty in concentrating, and restlessness. To help with these symptoms, various pharmacotherapies can be used and they include nicotine replacement, bupropion, and varenicline.  The pros and cons of these methods should be discussed with your doctor.  My observation has been that, although pharmacotherapy is very helpful, a smoker needs to accept that he or she will experience some withdrawal.