When the average person thinks of nicotine, they often envision discolored lungs, cigarette marketing, or sugary vapes. However, nicotine is not tar, benzene, or formaldehyde. It is a powerful nicotinic acetylcholine receptor agonist with genuine neurochemical impacts, and in carefully chosen individuals, it can be beneficial. I have been utilizing nicotine gum and lozenges for years with patients experiencing fatigue, mild depression, and ADHD—not as an extraordinary remedy but as a precise cognitive and mood-enhancing resource. It functions as a stimulant, though not the type found in a white powder or pharmaceutical container.
The research was established long before vaping devices emerged.
Nicotine activates nicotinic acetylcholine receptors, influencing the release of dopamine, norepinephrine, and serotonin. This is not mere advertising exaggeration; it’s fundamental neuropharmacology.
Focus and alertness: Various laboratory investigations indicate enhanced reaction times, working memory, and sustained focus in both smokers and non-smokers administered low doses of nicotine.
Emotional state: Nicotine serves as a mild dopaminergic stimulant, elevating dopamine levels in the mesolimbic reward circuit, which can aid individuals with low mood or fatigue.
ADHD and cognition: Numerous controlled studies have shown short-term enhancements in attention and executive functioning with transdermal nicotine or gum among adults diagnosed with ADHD.
Depression: We have previously explored this territory.
Prior to the dominance of SSRIs, nicotine was discreetly examined as an augmentation approach in treating depression. During the 1990s, small-scale clinical studies using transdermal nicotine patches in patients with resistant depression exhibited notable mood enhancements within days rather than weeks. A 1995 study published in Biological Psychiatry by Salin-Pascual and associates found that using nicotine patches resulted in swift and measurable antidepressant benefits in treatment-resistant individuals. Subsequent research in Psychopharmacology validated temporary mood improvement, better psychomotor speed, and heightened alertness. Although these studies were small, they were persuasive. Eventually, SSRIs saturated the market, nicotine became culturally marginalized, and research efforts waned.
The fundamental issue lies not with nicotine itself, but with how it is delivered.
Cigarettes and vapes are akin to chemical transport vehicles: numerous toxins accompany a molecule that has intrinsic therapeutic potential. If caffeine were only available through a contaminated source, we would likely vilify it as well. Nicotine can be administered cleanly and securely via gum, lozenges, and patches. Controlled dosage. No tar, no benzene, no combustion.
It’s not suitable for everyone.
Nicotine is addictive and should never be prescribed indiscriminately. Nonetheless, disregarding its clinical promise simply because it is trapped in the wrong delivery method is poor medical practice. We have encountered similar scenarios before with cannabis, psychedelics, and beta blockers for performance anxiety. It is essential to distinguish the molecule from the Marlboro brand and inject science, not stigma, into the discussion.
Larry Kaskel is an internist and “lipidologist in recovery” who has practiced medicine for over thirty-five years. He runs a concierge practice in the Chicago area and is part of the teaching staff at the Northwestern University Feinberg School of Medicine. Additionally, he has affiliations with Northwestern Lake Forest Hospital.
Before podcasts became commonplace, Dr. Kaskel hosted Lipid Luminations on ReachMD, where he created a compilation of more than four hundred episodes featuring prominent figures in cardiology, lipidology, and preventive medicine.
He authored Dr. Kaskel’s Living in Wellness, Volume One: Let Food Be Thy Medicine, works that merge evidence-based medical practices with approachable solutions for enhancing healthspan. His ongoing projects concentrate on reassessing the cholesterol theory and exploring the infectious origins of atherosclerosis. For further details, visit larrykaskel.com.