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35th AM (2025) - Poster Session
Persistent Bradycardia following Nicotine Withdraw ...
Persistent Bradycardia following Nicotine Withdrawal in Adolescents A Literature Review and Psychiatric Case Perspe
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Pdf Summary
This literature review and case report by Hauck and Lee examine persistent bradycardia following nicotine withdrawal in adolescents, a phenomenon poorly documented in psychiatric literature. Nicotine, widely used globally, has seen increased exposure among youth due to e-cigarette and vaping trends. Nicotine withdrawal commonly presents with symptoms such as anxiety, depression, irritability, and tremors; bradycardia (slow heart rate) has been noted but remains poorly understood, especially regarding duration and resolution in adolescents.<br /><br />A targeted review of 731 articles from the past decade identified only 17 relevant studies, highlighting a significant research gap on persistent bradycardia as a symptom of nicotine withdrawal in adolescents. Most existing studies focus on cardiovascular or pediatric perspectives rather than psychiatric aspects. No studies systematically address bradycardia as a withdrawal symptom in youth.<br /><br />The authors present a case of a 17-year-old male admitted for a spontaneous pneumothorax who developed severe bradycardia (heart rate drop to 32 bpm) and irritability following abrupt high-dose nicotine vaping cessation. Workups ruled out other causes; cardiology suspected nicotine withdrawal-induced bradycardia. Introduction of nicotine patches improved heart rate and mood. Psychiatric consultation noted underlying depression and anxiety; the patient was started on Lexapro and nicotine replacement, leading to stabilization and discharge with outpatient follow-up.<br /><br />Key findings from the literature include nicotine’s effects on adolescent autonomic function, such as increased heart rate variability disruption and sympathetic nervous system involvement—consistent with withdrawal bradycardia. However, direct study of persistent bradycardia after nicotine cessation in adolescents is scarce.<br /><br />The authors conclude that recognizing persistent bradycardia as a nicotine withdrawal symptom is critical to avoid misdiagnosis and unnecessary interventions in adolescents. Early involvement of addiction psychiatrists is recommended to improve care for youth exposed to nicotine products. This review calls for more psychiatric research focused on somatic withdrawal symptoms in adolescent nicotine users.
Keywords
nicotine withdrawal
persistent bradycardia
adolescents
nicotine vaping cessation
nicotine replacement therapy
autonomic function
psychiatric literature
e-cigarettes
withdrawal symptoms
addiction psychiatry
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