Smoking behaviour during the course of paroxetine treatment: A case report

Selective serotonin reuptake inhibitors are used for the treatment of a wide range of psychiatric disorders, although nicotine craving attributed to the use of serotonin reuptake inhibitors especially paroxetine has not yet been reported in the literature. Here we present a case, who developed nicotine craving and started to smoke cigarettes after initiation of 20mg/day paroxetine, and discuss possible mechanisms of this side effect while reviewing current status of the literature. A 25 year-old female patient was evaluated at our outpatient clinic and diagnosed with generalized anxiety disorder. She was given paroxetine 20mg/day for four weeks. While her symptomatology improved by the second week of the treatment, she complained of nicotine craving at the fourth week. During psychiatric assessment there was not any history of smoking, alcohol or any other substance use disorder. She mentioned that she started smoking one package/day after starting the paroxetine treatment. The craving for nicotine decreased after the drug was discontinued and she quit smoking within two weeks. We did not find any report of smoking behaviour attributed to SSRIs in the literature, although there is a study about decreased smoking behaviour during paroxetine treatment. To the best of our knowledge this case is the first one in the literature. More research is needed to exlore nicotine craving and SSRIs.