When most people hear nicotine, they picture stained lungs, cigarette ads, or sweet-flavored vapes. But nicotine isn’t tar, benzene, or formaldehyde. It’s a potent nicotinic acetylcholine receptor agonist with real neurochemical effects, and in carefully selected patients, it can help. I’ve been using nicotine gum and lozenges for years in patients with fatigue, mild depression, and ADHD, not as a miracle cure but as a targeted cognitive and mood-enhancing tool. It’s a stimulant, just not the kind that comes in a white powder or a pharmacy bottle.
The science was there long before the vape pens.
Nicotine stimulates nicotinic acetylcholine receptors, modulating dopamine, norepinephrine, and serotonin release. That’s not marketing hype; it’s basic neuropharmacology.
- Attention and vigilance: Multiple lab studies show improved reaction times, working memory, and sustained attention in both smokers and non-smokers given low-dose nicotine.
- Mood: Nicotine acts as a mild dopaminergic stimulant, increasing dopamine in the mesolimbic reward system, which can help patients with low mood or fatigue.
- ADHD and cognition: Several controlled trials have demonstrated short-term improvement in attention and executive function with transdermal nicotine or gum in adults with ADHD.
Depression: We’ve actually been here before
Before SSRIs took over, nicotine was quietly studied as an augmentation strategy in depression. In the 1990s, small clinical trials using transdermal nicotine patches in patients with refractory depression showed significant mood improvements within days, not weeks. A 1995 Biological Psychiatry study by Salin-Pascual and colleagues found that nicotine patch use led to rapid and measurable antidepressant effects in treatment-resistant patients. Subsequent work in Psychopharmacology confirmed transient mood elevation, improved psychomotor speed, and increased alertness. These studies were small but compelling. Then SSRIs flooded the market, nicotine was culturally exiled, and the research door quietly closed.
The real problem isn’t nicotine, it’s the delivery system
Cigarettes and vapes are chemical clown cars: hundreds of toxins hitching a ride with a molecule that, on its own, has therapeutic potential. If caffeine only came through a dirty pipe, we’d demonize it too. Nicotine can be delivered cleanly and safely: gum, lozenges, and patches. Controlled dose. No tar, no benzene, no combustion.
It’s not for everyone.
Nicotine is habit-forming and should never be prescribed casually. But to ignore its clinical potential because it got stuck in the wrong delivery system is bad medicine. We’ve seen this story before with cannabis, psychedelics, and beta blockers for performance anxiety. It’s time to separate the molecule from the Marlboro and bring science, not stigma, to the conversation.
Larry Kaskel is an internist and “lipidologist in recovery” who has been practicing medicine for more than thirty-five years. He operates a concierge practice in the Chicago area and serves on the teaching faculty at the Northwestern University Feinberg School of Medicine. In addition, he is affiliated with Northwestern Lake Forest Hospital.
Before podcasts entered mainstream culture, Dr. Kaskel hosted Lipid Luminations on ReachMD, where he produced a library of more than four hundred programs featuring leading voices in cardiology, lipidology, and preventive medicine.
He is the author of Dr. Kaskel’s Living in Wellness, Volume One: Let Food Be Thy Medicine, works that combine evidence-based medical practice with accessible strategies for improving healthspan. His current projects focus on reevaluating the cholesterol hypothesis and investigating the infectious origins of atherosclerosis. More information is available at larrykaskel.com.
