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One potential confounding factor is the massive drop in smoking rates, particularly among those in the prime age for schizophrenia onset. The evidence seems to

One potential confounding factor is the massive drop in smoking rates, particularly among those in the prime age for schizophrenia onset. The evidence seems to strongly indicate that nicotine is a powerful antipsychotic. When smoking was widespread it's possible that many schizophrenics were self-medicating in a basically effective way. The trend is probably particularly acute among cannabis users. 40 years, I'd expect that nearly all cannabis smokers were cigarette smokers. (Non-smoke consumption being essentially a rounding error back then.) Nowadays the sizable majority of cannabis users probably don't smoke cigarettes whatsoever.

meowface 5y ago
>The evidence seems to strongly indicate that nicotine is a powerful antipsychotic. Source? It's commonly known that there's a very high nicotine use rate among people with schizophrenia, but I haven't heard that it has antipsychotic properties. It likely temporarily helps with certain symptoms, but doesn't necessarily reduce psychosis. I think it may generally be used as self-medication for the negative rather than the positive symptoms of schizophrenia.
- dcolkitt 5y ago
  As is often the case on these type of topics, Slate Star Codex had a really good roundup of the evidence: https://slatestarcodex.com/2016/01/11/schizophrenia-no-smoking-gun/ https://slatestarcodex.com/2016/01/11/schizophrenia-no-smoki...
  - meowface 5y ago
    Interesting post. I think nicotine is probably a valuable nootropic for most people and for schizophrenics (though extremely unhealthy if it's consumed via smoking tobacco), but I don't think that post is at all trying to argue that "The evidence seems to strongly indicate that nicotine is a powerful antipsychotic." Rather, it says a single study found that, when controlling for confounders, smokers in their sample were less likely to get schizophrenia, and heavy smokers were much less likely to get schizophrenia. (When not controlling for confounders, they were more likely to get schizophrenia.) First, "antipsychotic" doesn't necessarily imply "reduces chance of developing schizophrenia". Modern-day antipsychotics generally seem to be blunt instruments designed to dampen acute states of psychosis at that moment, often by doing things like antagonizing dopamine receptors. Something that lowers the risk of developing schizophrenia won't necessarily be an antipsychotic in this sense, even if it could be considered anti-"psychotic disorder development". As far as I know, nicotine doesn't work as an antipsychotic in the sense of it helping to stop an ongoing psychotic episode. It may temporarily improve functioning for someone in such a state, but it may not make them feel less delusional or paranoid, for example. Or at least I'm not aware of evidence of that. And, conversely, I don't know if taking antipsychotics actually reduces the chance of developing schizophrenia if you aren't currently diagnosed with it. And this is just a single study, cited by the author of Beware the Man of One Study (https://slatestarcodex.com/2014/12/12/beware-the-man-of-one-study/ https://slatestarcodex.com/2014/12/12/beware-the-man-of-one-...). He definitely is not trying to claim that this is overall strong evidence for nicotine being a powerful antipsychotic. As he mentions in it, controlling for confounders is very complex and difficult. So, it seems plausible it could possibly help reduce the chance of developing schizophrenia, but there's definitely not strong evidence of it at this time. The only strongly supported phenomenon I know of is that schizophrenics very commonly use it, with some evidence that it may temporarily reduce negative symptoms and improve cognitive functioning.

meowface 5y ago

>The evidence seems to strongly indicate that nicotine is a powerful antipsychotic. Source? It's commonly known that there's a very high nicotine use rate among people with schizophrenia, but I haven't heard that it has antipsychotic properties. It likely temporarily helps with certain symptoms, but doesn't necessarily reduce psychosis. I think it may generally be used as self-medication for the negative rather than the positive symptoms of schizophrenia.

dcolkitt 5y ago
As is often the case on these type of topics, Slate Star Codex had a really good roundup of the evidence: https://slatestarcodex.com/2016/01/11/schizophrenia-no-smoking-gun/ https://slatestarcodex.com/2016/01/11/schizophrenia-no-smoki...
- meowface 5y ago
  Interesting post. I think nicotine is probably a valuable nootropic for most people and for schizophrenics (though extremely unhealthy if it's consumed via smoking tobacco), but I don't think that post is at all trying to argue that "The evidence seems to strongly indicate that nicotine is a powerful antipsychotic." Rather, it says a single study found that, when controlling for confounders, smokers in their sample were less likely to get schizophrenia, and heavy smokers were much less likely to get schizophrenia. (When not controlling for confounders, they were more likely to get schizophrenia.) First, "antipsychotic" doesn't necessarily imply "reduces chance of developing schizophrenia". Modern-day antipsychotics generally seem to be blunt instruments designed to dampen acute states of psychosis at that moment, often by doing things like antagonizing dopamine receptors. Something that lowers the risk of developing schizophrenia won't necessarily be an antipsychotic in this sense, even if it could be considered anti-"psychotic disorder development". As far as I know, nicotine doesn't work as an antipsychotic in the sense of it helping to stop an ongoing psychotic episode. It may temporarily improve functioning for someone in such a state, but it may not make them feel less delusional or paranoid, for example. Or at least I'm not aware of evidence of that. And, conversely, I don't know if taking antipsychotics actually reduces the chance of developing schizophrenia if you aren't currently diagnosed with it. And this is just a single study, cited by the author of Beware the Man of One Study (https://slatestarcodex.com/2014/12/12/beware-the-man-of-one-study/ https://slatestarcodex.com/2014/12/12/beware-the-man-of-one-...). He definitely is not trying to claim that this is overall strong evidence for nicotine being a powerful antipsychotic. As he mentions in it, controlling for confounders is very complex and difficult. So, it seems plausible it could possibly help reduce the chance of developing schizophrenia, but there's definitely not strong evidence of it at this time. The only strongly supported phenomenon I know of is that schizophrenics very commonly use it, with some evidence that it may temporarily reduce negative symptoms and improve cognitive functioning.