Nicotine Gum for Depression and Anxiety

(This article was reprinted in the online magazine of the Institute for Ethics & Emerging Technologies, May 5, 2016.)

(Disclaimer – I’m not a medical doctor. For more info on these topics consult an M.D.)

I was thinking about a friend who quit smoking about 10 years ago with the help of nicotine gum. She eventually kicked the nicotine gum habit too, although she claimed that it was about as difficult to quit the gum as it was the cigarettes. She did notice that her ability to deal with anxiety was reduced after quitting the gum, and she also became more depressed. As a result, she has considered starting to chew gum again.

Her main arguments against chewing the gum are: 1) the cost of the gum; 2) the worry that will come with always having to make sure she has enough gum; 3) possible dental issues caused by the gum; and 4) the sense of failure she feels in not being able to live without this crutch. Moreover, there is no guarantee that the gum will minimize her anxiety or depression, although there is some reason to think it will.

The main argument for chewing the gum is the reduction in anxiety and depression. (There are good reasons to think nicotine can help.) The thing to remember about this benefit, if it occurs, is that it is substantial and multi-faceted. Not only would she feel better—because her anxiety and depression would be minimized at all times—but she would be able to participate in, and better enjoy other, things that would make her life go better, like social relationships and productive work. Moreover, this reduction in anxiety and depressive symptoms would have good consequences for her physical health. (This assumes there are no negative health risks from chewing small doses of nicotine. As best as I can determine, there are no health risks.) So nicotine gum might both minimize her negative symptoms, and make it more likely that she participates in activities that help alleviate her symptoms. You don’t want to join a group or do productive work if you are anxious and depressed.

Now let’s consider her arguments against using the gum. If you can’t afford it, then you can’t buy the gum. In her case she can afford it, although the $60 or so a month is costly. The worry about having the gum readily available is a reasonable one, although it isn’t any different from worry about having any other kind of medicine with you. That is a small price to pay if a medicine is effective. As for oral health, the evidence suggest it has no ill effects, at least as far as I can tell.

The fourth argument is particularly interesting, but I think ultimately fallacious. There are many “crutches” people use to get by including, but not limited to: alcohol, tobacco, food, sex, religion, therapy and exercise. We also depend on things for our well-being like air, water, medicine, and more. If something helps you live better and doesn’t hurt anyone else, why not utilize the help? In fact, given that our behavior affects others, we may be morally obligated to do what’s necessary to help ourselves so as to be in a better position to help others. So if someone tells me they need to take some medicine or other drugs to physically or psychologically function, or they need to go the therapist or to church or for a long jog, I say … go for it. And those who say otherwise are probably motivated by things like guilt, perfectionism, or the desire to control others.

To place this issue in a philosophical context consider that we are all thrown into this world without our consent. We must live in a world about which ultimately we know very little. We don’t know for certain what to believe or what we should do. All we can do then, is our best. The philosopher and psychologist William James, who was himself tormented by depression, expressed these sentiments beautifully:

We stand on a mountain pass in the midst of whirling snow and blinding mist, through which we get glimpses now and then of paths which may be deceptive. If we stand still we shall be frozen to death. If we take the wrong road we may be dashed to pieces. We do not certainly know whether there is any right one. What must we do? ‘Be strong, and of good courage.’ Act for the best, hope for the best, and take what comes. If death ends all, we cannot meet death better.

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