Does nicotine cause mental health issues?
Or do people with mental health issues have a higher rate of using nicotine?
How do we help people dealing with mental health challenges stop smoking?
Scientific Publications - Youth and Young Adults
- Conclusions: Mental health problems following social media use served as a risk factor for e-cigarette use among youth. Interventions aiming to improve youth's mental health could in turn temper e-cigarette use among youth social media users, and implementing tailored interventions in response to racial differences is warranted.
- Zheng X, Yang M, Li W, Lin HC. The mediating roles of mental health problems and racial differences in the linkage between social media use and E-cigarette use among American youth. Prev Med. 2023 Dec 31;179:107842. doi: 10.1016/j.ypmed.2023.107842. Epub ahead of print. PMID: 38169240.
- Factors with the greatest effect on students' likelihood to vape, smoke, or do both were parental attitude toward adolescent smoking and depressive symptoms.
- Students who reported depressive symptoms had 2.1 times higher adjusted odds of vaping, 2.7 times higher adjusted odds of smoking, and 3.0 times higher adjusted odds of vaping and smoking compared with students who did not report depressive symptoms.
- Tilton, G., Huston, S., & Albert, P. (2023). Risk and Protective Factors for Vaping and Smoking Among High School Students in Maine. Preventing chronic disease, 20, E28. https://doi.org/10.5888/pcd20.220307
2023: Symptoms of Depression and Anxiety and Subsequent Use of Nicotine and THC in Electronic Cigarettes
- Data were from an online survey of youth and young adults in urban areas of Texas
- Symptoms of depression and comorbid depression and anxiety at baseline were significantly associated with both nicotine and THC use in e-cigarettes 12 months later. Symptoms of anxiety were associated with nicotine use in e-cigarettes 12 months later.
- Citation: Clendennen, S. L., Smith, J., Sumbe, A., Chen, B., Wilkinson, A. V., & Harrell, M. B. (2023). Symptoms of Depression and Anxiety and Subsequent Use of Nicotine and THC in Electronic Cigarettes. Substance use & misuse, 58(5), 591–600. https://doi.org/10.1080/10826084.2023.2177110
- Depression symptoms predicted more rapid e-cigarette progression in adolescents.
- E-cigarette use was not associated with an escalation in depression symptoms.
- E-cigarette use was not related to the development of depression symptoms over time.
- Citation: Afaf F. Moustafa, Shannon Testa, Daniel Rodriguez, Stephen Pianin, Janet Audrain-McGovern, Adolescent depression symptoms and e-cigarette progression, Drug and Alcohol Dependence, Volume 228, 2021, 109072, ISSN 0376-8716, doi.org/10.1016/j.drugalcdep.2021.109072.
- Approximately 51.7% of the sample reported at least one ACE
We observed graded relationships between levels of ACE exposure and physical, mental, and behavioral health indicators including cigarette use, e-cigarette use, drinking and driving, obesity, lifetime depression, suicide ideation and attempt, non-suicidal self-injury, and lack of restful sleep. ACE-exposed females reported worse mental health status than ACE-exposed males while males reported more substance use than females. Most outcomes did not vary significantly by sex.
- Citation: Grigsby TJ, Rogers CJ, Albers LD, Benjamin SM, Lust K, Eisenberg ME, Forster M. Adverse Childhood Experiences and Health Indicators in a Young Adult, College Student Sample: Differences by Gender. Int J Behav Med. 2020 Dec;27(6):660-667. doi: 10.1007/s12529-020-09913-5. PMID: 32643038.
- The current study indicates that depressive symptoms predict subsequent e-cigarette use and not vice versa.
- Citation: Bandiera, F. C., Loukas, A., Li, X., Wilkinson, A. V., & Perry, C. L. (2017). Depressive Symptoms Predict Current E-Cigarette Use Among College Students in Texas. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 19(9), 1102–1106. https://doi.org/10.1093/ntr/ntx014
- Depressive symptoms in childhood may lead to altered developmental trajectories that either directly or indirectly contribute to adolescent outcomes, including cigarette use.
- Citation: Prinstein, M. J., & La Greca, A. M. (2009). Childhood depressive symptoms and adolescent cigarette use: A six-year longitudinal study controlling for peer relations correlates. Health Psychology, 28(3), 283–291. https://doi.org/10.1037/a0013949
- The present results suggest that, in childhood and early adolescence, disruptive disorder should be the focus of prevention and intervention efforts. Youths with disruptive disorder are at increased risk not only for developing mood disorder but also for other negative psychosocial outcomes, including smoking and the development of nicotine dependence with the health burdens that it entails.
- By contrast, nicotine dependence did not predict the onset of a psychiatric disorder.
- Citation: Griesler, P. C., Hu, M.-C., Schaffran, C., & Kandel, D. B. (2008). Comorbidity of Psychiatric Disorders and Nicotine Dependence Among Adolescents: Findings From a Prospective, Longitudinal Study. Journal of the American Academy of Child & Adolescent Psychiatry, 47(11), 1340–1350. doi:10.1097/chi.0b013e318185d2ad
- individuals with attentional and emotional dysfunctions are most at risk for smoking initiation and subsequent nicotine addiction.
- The findings on dispositional risk factors (i.e.,ADHD, hostility, depression, aggression), age, and gender in the human behavioral and brain imagingstudies along with animal models suggest thatattentional and emotional dysfunctions elevate the risk for smoking initiation and uptake in adolescents.
- Citation: Gehricke, J.-G., Loughlin, S., Whalen, C., Potkin, S., Fallon, J., Jamner, L., … Leslie, F. (2007). Smoking to self-medicate attentional and emotional dysfunctions. Nicotine Tobacco Research, 9, 523–536. https://doi.org/10.1080/14622200701685039
- Among baseline non-users with social fears and the superordinated group of nondependent respondents with social fears, we found significantly increased odds for subsequent occurrence of nicotine dependence during the four-year follow-up period.
- Citation: Sonntag, H., Wittchen, H. ., Höfler, M., Kessler, R. ., & Stein, M. . (2000). Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults? European Psychiatry, 15(1), 67–74. doi:10.1016/s09249338(00)00209-1
- Adolescents with depressive symptoms were more likely than other adolescents to start smoking.
- Initiation of smoking may occur rapidly among adolescents who feel depressed, anxious, or experience frequent stressful events.
- Citation: Escobedo, L. G., Reddy, M., & Giovino, G. A. (1998). T he relationship between and cigarette sm oking in depressive sym ptom s U S adolescents. Addiction, 93(3), 433–440. doi:10.1046/j.1360-0443.1998.93343311.x
- Depressive and anxiety symptoms are associated with higher risks for initiation through an increased susceptibility to peer smoking influences. Promoting the psychological well-being of adolescents and addressing perceived interpersonal benefits of smoking may play a role in the prevention of adolescent tobacco use.
- Citation: G C Patton, J B Carlin, C Coffey, R Wolfe, M Hibbert, and G Bowes, 1998: Depression, anxiety, and smoking initiation: a prospective study over 3 years. American Journal of Public Health 88, 1518_1522, https://doi.org/10.2105/AJPH.88.10.1518
Scientific Publications - Not Youth Specific
- Review includes human and animal studies.
- "Nicotine has been associated with positive effects on cognition and inflammation, which may benefit individuals with neurological and immune system disorders. As a stimulant, nicotine can bind to the acetylcholine receptors on neurons to promote the release of dopamine and alleviate various neurological diseases. Anti-inflammatory effects against some diseases are associated with the cholinergic anti-inflammatory pathway. Nicotine reduces the release of various inflammatory cytokines by binding to the macrophage surface receptors."
- "Nicotine can extensively improve cognition, which has long attracted the interest of researchers. This section introduces the therapeutic effects of nicotine on Alzheimer’s disease (AD), Parkinson’s disease (PD), schizophrenia, attention-deficit/hyperactivity disorder (ADHD), and major depressive disorder (MDD)."
- "Inflammation involves multiple genes and signaling pathways. In addition, it promotes the occurrence and development of various diseases to varying degrees. Nicotine plays an active role in various immune disorders because of its broad anti-inflammatory properties. This section describes the therapeutic effects of nicotine in rheumatoid arthritis (RA), OA, sepsis, endotoxemia, ulcerative colitis (UC), and myocarditis."
- Citation: Cao, Y., Sun, J., Wang, X., Zhang, X., Tian, H., Huang, L., Huang, Z., Zhang, Y., Zhang, J., Li, L., & Zhou, S. (2024). The double-edged nature of nicotine: Toxicities and therapeutic potentials. Frontiers in Pharmacology, 15, 1427314. https://doi.org/10.3389/fphar.2024.1427314
- Acknowledgement: This work was financially supported by the Technology Project of Anhui Zhongyan Industry Co., Ltd. (2022156), Science and Technology Projects of State Tobacco Monopoly Administration (110202201046XX-05), Startup Program of XMU and Fundamental Research Funds for the Central Universities. Authors YC, XW, XZ, HT, YZ, JZ, and SZ were employed China Tobacco Anhui Industrial Co., Ltd.
- Citation: Cao, Y., Sun, J., Wang, X., Zhang, X., Tian, H., Huang, L., Huang, Z., Zhang, Y., Zhang, J., Li, L., & Zhou, S. (2024). The double-edged nature of nicotine: Toxicities and therapeutic potentials. Frontiers in Pharmacology, 15, 1427314. https://doi.org/10.3389/fphar.2024.1427314
- Smoking, vaping and dual use were substantially higher among those with a history of MHC, especially multiple MHC, and experiencing past month distress than those not having a history of MHC or experiencing past month distress respectively. Analysis used descriptive epidemiology and causation cannot be determined.
- Citation: Taylor, E., Brose, L.S., McNeill, A. et al. Associations between smoking and vaping prevalence, product use characteristics, and mental health diagnoses in Great Britain: a population survey. BMC Med 21, 211 (2023). https://doi.org/10.1186/s12916-023-02890-y
- In Norway, current snus users differ from current smokers by having a higher socio-economic status and no detectable association with anxiety and depression. This suggests that the relationship between tobacco use and anxiety and depression is associated with the administration method.
- Citation: Yebo Yu, Fan Yang, Mingqi Fu, Farooq Ahmed, Muhammad Shahid, Jing Guo, Relationship Between Work-Family Conflict and Depressive Symptoms Among Male Firefighters in China, Journal of Occupational & Environmental Medicine, 10.1097/JOM.0000000000002759, 65, 4, (337-343), (2022).
- Nicotine administration normalized DMN hyperconnectivity in schizophrenia. We here provide direct evidence that the biological basis of nicotine dependence is different in schizophrenia and in non-schizophrenia populations. Our results suggest the high prevalence of nicotine use in schizophrenia may be an attempt to correct a network deficit known to interfere with cognition.
- Twitter thread about this study
- Citation: Ward HB, Beermann A, Nawaz U, Halko MA, Janes AC, Moran LV and Brady RO Jr (2022) Evidence for Schizophrenia-Specific Pathophysiology of Nicotine Dependence. Front. Psychiatry 13:804055. doi: 10.3389/fpsyt.2022.804055
- Acknowledgement: This work was supported by NIMH R01MH116170 (RB); NIMH R01MH111868 and NIMH R01MH117063 (MH); NIDA 1K02DA042987 and NIDA K01DA029645 (AJ); NIMH K23MH110564, NARSAD Young Investigator Award, Brain and Behavior Research Foundation, Pope-Hintz Fellowship Award, McLean Hospital, Dupont-Warren Fellowship Award, and Harvard Medical School (LM); and the Sidney R. Baer, Jr. Foundation, and the Norman E. Zinberg Fellowship in Addiction Psychiatry Research, Harvard Medical School (HW).
- Citation: Ward HB, Beermann A, Nawaz U, Halko MA, Janes AC, Moran LV and Brady RO Jr (2022) Evidence for Schizophrenia-Specific Pathophysiology of Nicotine Dependence. Front. Psychiatry 13:804055. doi: 10.3389/fpsyt.2022.804055
- Human and Animal Studies
- Clinical trials and case series report anti-aggressive effects of nicotine. Here we argue that the nAChR system, the molecular basis for the global public health problem of tobacco smoking, may also be a key target for modulation of aggressive behaviors. Future research should aim to clarify which forms of aggression are most strongly affected by nAChR modulation, identify the nAChR subtypes, circuits, and neurobiological mechanisms of nicotine action, and determine whether more selective nAChR-active agents can replicate or improve the serenic effects of nicotine, especially with chronic dosing. Given the prevalence of aggressive behaviors across neuropsychiatric disorders affecting the very young to the very old, these studies have the potential to have a significant impact on public health.
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- Citation: Alan S. Lewis, Marina R. Picciotto, Regulation of aggressive behaviors by nicotinic acetylcholine receptors: Animal models, human genetics, and clinical studies, Neuropharmacology, Volume 167, 2020, 107929, ISSN 0028-3908, doi: 10.1016/j.neuropharm.2019.107929.
- Acknowledgements: This work was supported by National Institutes of Health grants MH116339 (A.S.L.), MH077681 and DA14241 (M.R.P.).
- Nicotine may ameliorate OC symptoms in severe, treatment-refractory OCD patients. Although encouraging, these initial positive effects should be tested in large controlled studies.
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- Citation: Piacentino D, Maraone A, Roselli V, Berardelli I, Biondi M, Kotzalidis GD, Pasquini M. Efficacy of nicotine administration on obsessions and compulsions in OCD: a systematic review. Ann Gen Psychiatry. 2020 Sep 30;19:57. doi: 10.1186/s12991-020-00309-z. PMID: 33014119; PMCID: PMC7528475.
- Cognitive and early sensory alterations are core features of schizophrenia. A single dose of nicotine can improve those features in patients. Attention domain is the most responsive to nicotine in patients. Effects vary upon type of neuropsychological assessment and nicotine intake condition.
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- Citation: Clément Dondé, Jérôme Brunelin, Marine Mondino, Caroline Cellard, Benjamin Rolland, Frédéric Haesebaert, The effects of acute nicotine administration on cognitive and early sensory processes in schizophrenia: a systematic review, Neuroscience & Biobehavioral Reviews, Volume 118, 2020, Pages 121-133, ISSN 0149-7634, doi: 10.1016/j.neubiorev.2020.07.035.
- Nicotine improves cognitive performance in clinical and preclinical studies.
- Nicotine may also benefit depressive symptoms and depressive behavior.
- Cognitive and mood benefits may be mediated by nicotinic effect on neural networks.
- Nicotine’s effects on networks may reverse network changes seen in depression.
- Improvement to mood and cognition may particularly benefit older depressed adults.
- Both preclinical and clinical studies support that nicotine and other nAChR agonists can improve depressive behavior, mood, and cognitive performance. nAChR agonists also demonstrate neuropharmacologic effects that oppose the intrinsic network alterations reported in MDD. Through modulation of intrinsic functional networks, nAChR agonists may reduce depressive symptoms, enhance emotional regulation ability, and improve cognitive deficits common in LLD. For these reasons, we propose nAChR agonists as a potential novel treatment for the mood and cognitive symptoms of LLD.
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- Citation: Gandelman, J. A., Newhouse, P., & Taylor, W. D. (2018). Nicotine and networks: Potential for enhancement of mood and cognition in late-life depression. Neuroscience & Biobehavioral Reviews, 84, 289–298. doi:10.1016/j.neubiorev.2017.08.0
- In MDD, acute nicotine administration normalized both pathways to the level of healthy controls, while having no impact on healthy controls. These results indicate that nicotine normalizes dysfunctional cortico-striatal communication in unmedicated non-smokers with MDD.
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- Citation: Janes AC, Zegel M, Ohashi K, Betts J, Molokotos E, Olson D, Moran L, Pizzagalli DA. Nicotine normalizes cortico-striatal connectivity in non-smoking individuals with major depressive disorder. Neuropsychopharmacology. 2018 Nov;43(12):2445-2451. doi: 10.1038/s41386-018-0069-x. Epub 2018 Apr 19. PMID: 29795403; PMCID: PMC6180119.
- Late Life Depression (LLD) is characterized by poor antidepressant response and cognitive dysfunction. Late life depression has no currently approved treatment that improves both its mood and cognitive symptoms.
- We observed robust response (86.7%) and remission rates (53.3%). There was a significant decrease in MADRS (Montgomery-Asberg Depression Rating scale) over the study, with improvement seen as early as three weeks. We also observed improvement in apathy and rumination. We did not observe improvement on the CPT (Conners Continuous Performance Test), but did observe improvement in subjective cognitive performance and signals of potential drug effects on secondary cognitive measures of working memory, episodic memory, and self-referential emotional processing.
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- Citation: Gandelman JA, Kang H, Antal A, Albert K, Boyd BD, Conley AC, Newhouse P, Taylor WD. Transdermal Nicotine for the Treatment of Mood and Cognitive Symptoms in Nonsmokers With Late-Life Depression. J Clin Psychiatry. 2018 Aug 28;79(5):18m12137. doi: 10.4088/JCP.18m12137. PMID: 30192444; PMCID: PMC6129985.
- Taken together, our study provides evidence for the feasibility and tolerability of transdermal nicotine (TN/TNP) in a small sample of adults with severe Autism Spectrum Disorder (ASD) symptoms and pathological chronic aggression and irritability.
- Our results also suggest that TN may have a beneficial effect on aggression, irritability, and sleep in ASD, though the sample size of this study is too small to make definitive conclusions.
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- Citation: Lewis AS, van Schalkwyk GI, Lopez MO, Volkmar FR, Picciotto MR, Sukhodolsky DG. An Exploratory Trial of Transdermal Nicotine for Aggression and Irritability in Adults with Autism Spectrum Disorder. J Autism Dev Disord. 2018 Aug;48(8):2748-2757. doi: 10.1007/s10803-018-3536-7. PMID: 29536216; PMCID: PMC6394231.
- Acknowledgements: This work was supported by Autism Speaks grant #9699 (ASL), National Institutes of Health grants R01DA14241 and R01MH077681 (MRP), R25MH071584, T32MH019961, and T32MH14276 (ASL), and the Child Study Center Associates and the AACAP Pilot Award for General Psychiatry Residents (GIvS).
- Animal Study
- “Our study provides compelling biological evidence that a specific genetic variant contributes to risk for schizophrenia, defines the mechanism responsible for the effect and validates that nicotine improves that deficit,” said Jerry Stitzel, a researcher at the Institute for Behavioral Genetics (IBG) and one of four CU Boulder researchers on the study.
- Previous genome-wide association studies have suggested that people with a variation in a gene called CHRNA5 are more likely to have schizophrenia, but the mechanism for that association has remained unclear. People with that variant are also more likely to smoke.
- Citation: Fani Koukouli, Marie Rooy, Dimitrios Tziotis, Kurt A Sailor, Heidi C O'Neill, Josien Levenga, Mirko Witte, Michael Nilges, Jean-Pierre Changeux, Charles A Hoeffer, Jerry A Stitzel, Boris S Gutkin, David A DiGregorio Uwe Maskos Nature Medicine volume 23, pages347–354 (2017)
- This brief review discusses evidence from neurophysiological and neuroimaging studies in schizophrenia patients that nicotinic agonists may effectively target dysfunctional neuronal circuits in the illness. Evidence suggests that nicotine significantly modulates a number of these circuits, although relatively few studies have used modern neuroimaging techniques (e.g. functional magnetic resonance imaging (fMRI)) to examine the effects of nicotinic drugs on disease-related neurobiology. The neuronal effects of nicotine and other nicotinic agonists in schizophrenia remain a priority for psychiatry research.
- Citation: Smucny J, Tregellas JR. Targeting neuronal dysfunction in schizophrenia with nicotine: Evidence from neurophysiology to neuroimaging. J Psychopharmacol. 2017 Jul;31(7):801-811. doi: 10.1177/0269881117705071. Epub 2017 Apr 26. PMID: 28441884; PMCID: PMC5963521.
- Some nicotine users benefit from self-medication effects for alleviation of stress, anxiety, depression, and other mental health and medical conditions...
- Truth Initiative / Schroeder Institute: Raymond Niaura, PhD. - This paper was also reviewed by content area experts whose feedback was included: Drs. Neal Benowitz, Peter Shields, Dorothy Hatsukami, and Ken Warner
- Findings from Mendelian randomisation analyses do not support a causal role of smoking heaviness in the development of depression and anxiety.
- Citation: Taylor, A. E., Fluharty, M. E., Bjørngaard, J. H., Gabrielsen, M. E., Skorpen, F., Marioni, R. E., Campbell, A., Engmann, J., Mirza, S. S., Loukola, A., Laatikainen, T., Partonen, T., Kaakinen, M., Ducci, F., Cavadino, A., Husemoen, L. L. N., Ahluwalia, T. S., Jacobsen, R. K., Skaaby, T., Ebstrup, J. F., … Munafò, M. R. (2014). Investigating the possible causal association of smoking with depression and anxiety using Mendelian randomisation meta-analysis: the CARTA consortium. BMJ open, 4(10), e006141. https://doi.org/10.1136/bmjopen-2014-006141
- As there was no association of the smoking-related rs1051730 SNP with anxiety and depression among smokers, the results suggest that smoking is not a cause of anxiety and depression.
- Citation: Bjørngaard, J. H., Gunnell, D., Elvestad, M. B., Davey Smith, G., Skorpen, F., Krokan, H., Vatten, L., & Romundstad, P. (2013). The causal role of smoking in anxiety and depression: a Mendelian randomization analysis of the HUNT study. Psychological medicine, 43(4), 711–719. https://doi.org/10.1017/S0033291712001274
- Smokers with PTSD report greater NA (Negative Affects) immediately prior to smoking and greater decreases in NA following smoking, and these findings are consistent with the observed patterns of brain activation in the current study. Thus, our findings provide a neurobiological basis that helps explain why individuals with PTSD are at greater risk of smoking and also experience greater difficulty quitting. The present study is not without its limitations. Our sample size was small and was predominately represented by female smokers.
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- Citation: Froeliger, B., Crowell Beckham, J., Feldman Dennis, M., Victoria Kozink, R., & Joseph McClernon, F. (2012). Effects of Nicotine on Emotional Reactivity in PTSD and Non-PTSD Smokers: Results of a Pilot fMRI Study. Advances in Pharmacological Sciences, 2012, 1–6. doi:10.1155/2012/265724
- Acknowledgement: Department of Veterans Affairs or the National Institutes of Health.
- Our results do not support a causal role of smoking on depressed mood, but are consistent with a self-medication hypothesis, whereby smoking is used to alleviate symptoms of depression.
- Citation: Lewis SJ, Araya R, Smith GD, Freathy R, Gunnell D, Palmer T, Munafò M. Smoking is associated with, but does not cause, depressed mood in pregnancy--a mendelian randomization study. PLoS One. 2011;6(7):e21689. doi: 10.1371/journal.pone.0021689. Epub 2011 Jul 19. PMID: 21818261; PMCID: PMC3139580.
- The principal reason for the markedly increased rate of cigarette smoking in people with schizophrenia: tobacco cigarette smoking represents an attempt at self-medication in schizophrenia, because the additional nicotine so provided alleviates the hypofunctional sensory gating seen in this illness.
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- Citation: Conway JL. Exogenous nicotine normalises sensory gating in schizophrenia; therapeutic implications. Med Hypotheses. 2009 Aug;73(2):259-62. doi: 10.1016/j.mehy.2009.02.017. Epub 2009 Mar 27. PMID: 19328631.
- Human and Animal study
- Nicotinic receptor systems in the brain are important for a variety of aspects of cognitive function impaired in schizophrenia and aggravated by antipsychotic drugs. Nicotine and selective nicotinic α7 and α4β2 agonists can significantly improve learning, memory and attention. Nicotine and nicotine agonists can reduce some of the cognitive impairments caused by some antipsychotic drugs as well as reduce cognitive impairments seen in the NMDA glutamate blockade animal model of schizophrenia.
- Citation: Levin ED, Rezvani AH. Nicotinic interactions with antipsychotic drugs, models of schizophrenia and impacts on cognitive function. Biochem Pharmacol. 2007 Oct 15;74(8):1182-91. doi: 10.1016/j.bcp.2007.07.019. Epub 2007 Jul 20. PMID: 17714691; PMCID: PMC2702723.
- Acknowledgement: Research presented was supported by a grant from the National Institute of Mental Health grant MH64494.
- Citation: Levin ED, Rezvani AH. Nicotinic interactions with antipsychotic drugs, models of schizophrenia and impacts on cognitive function. Biochem Pharmacol. 2007 Oct 15;74(8):1182-91. doi: 10.1016/j.bcp.2007.07.019. Epub 2007 Jul 20. PMID: 17714691; PMCID: PMC2702723.
- These findings suggest a role for nicotinic receptor systems in the pathophysiology of depression and that nicotinic compounds should be evaluated for treating depression symptoms.
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- Citation: McClernon FJ, Hiott FB, Westman EC, Rose JE, Levin ED. Transdermal nicotine attenuates depression symptoms in nonsmokers: a double-blind, placebo-controlled trial. Psychopharmacology (Berl). 2006 Nov;189(1):125-33. doi: 10.1007/s00213-006-0516-y. Epub 2006 Sep 15. PMID: 16977477.
2004: Nicotine as Therapy
- Yet few of the horrendous health effects of smoking are traceable to nicotine itself—cigarettes contain nearly 4,000 other compounds that play a role. Until recently, nicotine research has been driven primarily by nicotine's unparalleled power to keep people smoking, rather than its potential therapeutic uses.
- There's a cheap, common, and mostly safe drug, in daily use for centuries by hundreds of millions of people, that only lately has been investigated for its therapeutic potential for a long list of common ills. The list includes Alzheimer disease, Parkinson disease, depression and anxiety, schizophrenia, attention deficit hyperactivity disorder (ADHD), and even pain and obesity.
- People with depressive-spectrum disorders, schizophrenia, and adult ADHD tend to smoke heavily, which suggested to researchers that nicotine may soothe their symptoms. Common to all these disorders is a failure of attention, an inability to concentrate on particular stimuli and screen out the rest. Nicotine helps.
- Researchers at the National Institute on Drug Abuse have shown via functional magnetic resonance imaging that nicotine activates specific brain areas during tasks that demand attention
- Citation: Powledge TM. Nicotine as therapy. PLoS Biol. 2004 Nov;2(11):e404. doi: 10.1371/journal.pbio.0020404. Epub 2004 Nov 16. PMID: 15547644; PMCID: PMC526783
- Acute administration of nicotine patches produced rapid eye movement sleep (REM) increases in non-smoking major depressed patients as well as clinical improvement in mood. Antidepressant effect was also observed after four continuous days of nicotine administration. (NOTE: Study consisted of 15 people)
- Citation: Salin-Pascual R. J. (2002). Relationship between mood improvement and sleep changes with acute nicotine administration in non-smoking major depressed patients. Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion, 54(1), 36–40.
- For development of nicotinic treatments we are fortunate to have a well characterized lead compound, nicotine. Transdermal nicotine patches offer a way to deliver measured doses of nicotine in a considerably safer fashion than the more traditional means of administration, tobacco smoking. We have found that transdermal nicotine significantly improves attentional function in people with Alzheimer's disease, schizophrenia or ADHD as well as normal nonsmoking adults.
- Citation: Levin ED, Rezvani AH. Nicotinic treatment for cognitive dysfunction. Curr Drug Targets CNS Neurol Disord. 2002 Aug;1(4):423-31. doi: 10.2174/1568007023339102. PMID: 12769614.
2000 The Effects of Nicotine on Neural Pathways Implicated in Depression: A Factor in Nicotine Addiction?
- . It is also possible that an underlying depressive disorder enhances the “rewarding” properties of addictive drugs in a way that does not depend upon alleviation of the symptoms per se. However, this review has outlined evidence that nicotine has antidepressant-like properties that could also account for the association
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- Citation: Balfour, D. J. ., & Ridley, D. L. (2000). The Effects of Nicotine on Neural Pathways Implicated in Depression. Pharmacology Biochemistry and Behavior, 66(1), 79–85. doi:10.1016/s0091-3057(00)00205-7
- Animal Study
- Epidemiological studies indicate a high incidence of cigarette smoking among depressed individuals. Moreover, individuals with a history of depression have a much harder time giving up smoking. It has been postulated that smoking may reflect an attempt at self-medication with nicotine by these individuals.
- The data strongly implicate the involvement of central nicotinic receptors in the depressive characteristics of the FSL rats, and suggest that nicotinic agonists may have therapeutic benefits in depressive disorders
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- Citation: Tizabi, Y., Overstreet, D., Rezvani, A. et al. Antidepressant effects of nicotine in an animal model of depression. Psychopharmacology 142, 193–199 (1999). https://doi.org/10.1007/s002130050879
- Acknowledgements This work was supported in part by the Department of Pharmacology, Howard University, VAMC and Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
- Keywords: Key words Nicotine · Nicotinic receptor · FSL and FRL rats · Animal model of depression
- Transdermal nicotine patches increased REM sleep in normal volunteers and depressed patients during 4 days of continuous administration. In addition, a significant improvement of mood was observed in depressed patients. Nicotinic mechanisms may be involved in depression. These findings suggest that nicotine receptor activation may be important in major depression and shows for the first time that nicotine patches may be useful in the treatment of depression.
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- Salín-Pascual RJ, Drucker-Colín R. A novel effect of nicotine on mood and sleep in major depression. Neuroreport. 1998 Jan 5;9(1):57-60. doi: 10.1097/00001756-199801050-00012. PMID: 9592048.
- ACKNOWLEDGEMENT: This work has been supported by the following grants: DGAPA-UNAM IN -200895 to R.J.S-P.
1996: Antidepressant effect of transdermal nicotine patches in nonsmoking patients with major depression
- Nicotine patches produced short-term improvement of depression with minor side effects.
- Citation: Salín-Pascual, R. J., Rosas, M., Jimenez-Genchi, A., Rivera-Meza, B. L., & Delgado-Parra, V. (1996). Antidepressant effect of transdermal nicotine patches in nonsmoking patients with major depression. The Journal of clinical psychiatry, 57(9), 387–389.
- There is, then, no evidence in these data that the occurrence of MDD in persons with a prior history of nicotine dependence might have been caused directly by recent persistent smoking.
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- Citation: Breslau N, Kilbey MM, Andreski P. Nicotine Dependence and Major Depression: New Evidence From a Prospective Investigation. Arch Gen Psychiatry. 1993;50(1):31–35. doi:10.1001/archpsyc.1993.01820130033006
- When chronically taken, nicotine may result in: (1) positive reinforcement, (2) negative reinforcement (mood normalization) (other issues and diseases mentioned in study)
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- Citation: Jarvik ME. Beneficial effects of nicotine. Br J Addict. 1991 May;86(5):571-5. doi: 10.1111/j.1360-0443.1991.tb01810.x. PMID: 1859921.
- Acknowledgement: Supported by U. C. Tobacco-related Disease program, grant # RT87 and a grant from the John D. and Catherine T. MacArthur Foundation.
Conference Presentations
2021: E-Cigarette Summit UK: Depression causes vaping!
- In this talk Professor Notley will discuss the latest evidence exploring associations between nicotine use and common mental health conditions, including depression.
- Interpretive assumptions will be drawn out, including inappropriate claims of causal relationships between vaping and depression.
- Presented by Helen Redmond at GFN 2017 in Warsaw Poland.
Articles / Blogs
2023: Article and Video: Watch: A Documentary About Schizophrenia and Vaping
- “People with schizophrenia die not from schizophrenia, but from smoking. People with schizophrenia can improve their quality of life and there is a solution,” Dr. Pasquale Caponetto, a clinical psychologist at the University of Catania in Italy, told us in our new documentary.
- Helen Redmond, Filter Magazine
- "On average, people with a mental illness die up to 25 years younger than the general population, and many die from smoking-related chronic diseases. Tobacco-related diseases contribute to approximately 53 percent of deaths among people living with schizophrenia, 50 percent among people with depression, and 48 percent among people with bipolar disorder. It’s estimated that somewhere over 20 percent of people in the US live with a mental illness. But this population smokes almost half of all the cigarettes sold around the country each year."
- Kim "Skip" Murray, Filter Magazine
- Activist-group rhetoric aside, no evidence implicates vaping in teenage depression. There is an established link between the disease and nicotine consumption, though it's a complicated relationship that doesn't lend itself to political causes.
- The Truth Initiative seems to be aware that mental illness often leads to nicotine use as patients seek symptom relief, pointing out that its “surveys reveal that many young people cite feelings of stress, anxiety, or depression as reasons they start and continue vaping.”
- Citation: Cameron English, American Council on Science and Health
- "Ross’s work often focuses on vulnerable groups of smokers, including people from low-income communities, people who are homeless and people with mental health issues. She is a pioneer in bringing vaping products into a mental health hospital in her community."
- Helen Redmond, Filter Magazine
- "Professional organizations like RANZCP coming out in favor of tobacco harm reduction really matters, because people with psychiatric diagnoses suffer disproportionately from the harms of tobacco smoking. In Australia 70 percent of people with schizophrenia and 61 percent of people with bipolar disorder smoke. But incredibly, Australia has completely banned vaping products."
- Helen Redmond, Filter Magazine
Smoking Cessation
- Use of vaping products, varenicline, or heated tobacco products in a quit attempt was associated with significantly greater odds of successful cessation, after adjustment for use of other cessation aids and potential confounders.
- Article: Smoking-Cessation Hope for People With Mental Health Conditions
- We used a nationally representative survey of ~70,000 adults in the general population in Great Britain (the Smoking Toolkit Study) to describe trends in disposable e-cigarette use since 2021, establish the number who would currently be affected by a ban on disposables, and assess their sociodemographic and smoking profile.
- Our data show that while disposable vapes are particularly popular among young adults, they are also used by a large number of current smokers and ex-smokers and by people from disadvantaged groups – including those with a history of mental health conditions and working in lower paid jobs.
- These findings suggest banning disposable vapes isn’t a straightforward solution to stop young people from vaping. It could also have unintended consequences for smokers, including discouraging people from using e-cigarettes to try to quit smoking or triggering relapse among those who have already used disposables to quit. It may also worsen health inequalities. We suggest these trade-offs should be carefully considered when making decisions around banning disposables.
- Citation: Jackson SE, Tattan-Birch H, Shahab L, Oldham M, Kale D, Brose L, Brown J. Who would be affected by a ban on disposable vapes? A population study in Great Britain. Public Health. 2024 Feb;227:291-298. doi: 10.1016/j.puhe.2023.12.024. Epub 2024 Jan 24. PMID: 38267284.
- Acknowledgement: This work was supported by CRUK (PRCRPG-Nov21∖100002) and UK Prevention Research Partnership (MR/S037519/1). For the purpose of Open Access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. JB has received unrestricted research funding from Pfizer and J&J, who manufacture smoking cessation medications. LS has received honoraria for talks, unrestricted research grants and travel expenses to attend meetings and workshops from manufactures of smoking cessation medications (Pfizer; J&J), and has acted as paid reviewer for grant awarding bodies and as a paid consultant for health care companies. All authors declare no financial links with tobacco companies, e-cigarette manufacturers, or their representatives.
- Citation: Jackson SE, Tattan-Birch H, Shahab L, Oldham M, Kale D, Brose L, Brown J. Who would be affected by a ban on disposable vapes? A population study in Great Britain. Public Health. 2024 Feb;227:291-298. doi: 10.1016/j.puhe.2023.12.024. Epub 2024 Jan 24. PMID: 38267284.
- Although not a panacea, electronic cigarettes may represent a powerful harm reduction tool amongst subpopulations traditionally left behind in conventional smoking cessation movements. The argument in favor of studies of electronic cigarettes as a smoking cessation, harm reduction intervention in people with BHC [Behavioral Health Conditions] is multi-faceted. People with BHC have higher levels of smoking burdens and nicotine addiction compared to the general population, and they quit at lower rates. Unlike NRT, the nicotine delivery from an electronic cigarette mimics the nicotine pharmacokinetics of tobacco cigarettes unaccompanied by high levels of toxicants and carcinogens.
- This was the first prospective study to compare e-cigarette provision with assessments only to evaluate the appeal and impact of e-cigarettes on smoking behavior, carbon monoxide exposure, and nicotine dependence among smokers with Severe Mental Illness (SMI) who had tried but were unable to quit and were not currently interested in cessation treatment. The finding that e-cigarette provision led to significant reductions in smoking and carbon monoxide without increasing nicotine dependence has implications for reducing harm not only among the millions of smokers with SMI who struggle to quit, but also for other vulnerable smokers who cannot achieve cessation.
- Nicotine replacement therapy (NRT), anti-depressants and other medication have all been shown to help smokers without mental health problems stop smoking. They may also be helpful for people with depression or schizophrenia. NRT appears to be more effective when combined with talking therapy.
- You could also consider e-cigarettes. They’re much safer than cigarettes and can help people stop smoking.
- Smoking remains the leading cause of health and financial disparities for people living with mental illness and new and effective strategies are urgently needed. Growing evidence suggests that tobacco harm reduction with nicotine vaping could benefit this population.
- Citation: Mendelsohn CP. The role of vaping nicotine in psychiatry practice. Australas Psychiatry. 2021 Feb;29(1):5-6. doi: 10.1177/1039856221989096. PMID: 33530755.
- Acknowledgement: The author received no financial support for the research, authorship, and/or publication of this article. The author is the founding chairman of the Australian Tobacco Harm Reduction Association (ATHRA), a health promotion charity. ATHRA received some funding from the retail vaping industry to establish the charity. Since March 2020, ATHRA no longer accepts funding from the vaping industry.
- Citation: Mendelsohn CP. The role of vaping nicotine in psychiatry practice. Australas Psychiatry. 2021 Feb;29(1):5-6. doi: 10.1177/1039856221989096. PMID: 33530755.
- An estimated 60%–90% of people with schizophrenia smoke, compared with 15%–24% of the general population, exacerbating the already high morbidity and mortality rates observed in this population.
- Pilot Study - only 40 participants
- Sixteen (40%) participants quit by the end of 12 weeks. For the whole sample, we observed an overall, sustained 50% reduction in smoking or smoking abstinence in 37/40 (92.5%) of participants and an overall 75% reduction in median cigarettes per day from 25 to six was observed by the end of the 12 weeks.
- A high strength nicotine e-cigarette has the potential to help people with schizophrenia spectrum disorders to quit or reduce smoking.
- PDF Version
2021: The Taxation of Nicotine in Canada: A Harm-Reduction Approach to the Profusion of New Products
- A critical feature of tobacco use is that morbidity and mortality spring primarily from the combustion process associated with traditional cigarettes. Nicotine, a chemical found in tobacco, is addictive and may not be safe in extreme doses but it, by itself, is not the source of harm from tobacco/smoking. As a result, policymakers must take this into account when considering tax rates for nicotine/tobacco-based products. The harm-reduction approach taken in this Commentary recognizes that cigarettes kill and that if alternative nicotine systems are known with certainty to contain a small fraction of the toxins in cigarettes, this is sufficient to attempt to divert users away from the killer products toward the lower-risk ones, even with uncertainty surrounding the lifecycle health impacts of the latter.
- Several identifiable social groups experience high rates of tobacco use: individuals with poor mental health, First Nations and Indigenous Communities (FNICs), the homeless and individuals who identify as LGBTQ+. For many in these communities, tobacco is both a comfort and a burden: nicotine provides the comfort while the toxins debilitate the body and the mind. The objective of reducing smoking must become more keenly focused upon who is still smoking and why. If nicotine alone provides minimal health damage and at the same time provides satisfaction to users, then the “war on tobacco” needs to separate out combustion-related tobacco toxins from nicotine. These high nicotine-use social groups also have lower average incomes than the population at large and, therefore, should not be denied access to less-expensive nicotine by limiting access to lowerpriced ANDS (Alternative Nicotine Delivery Systems).
- “Funded by Health Canada’s Substance Use and Addictions Program, the LRNUG has developed several resources to help guide people who use, or are thinking about using nicotine, on how to lower the risk associated with these products. ...E-cigarettes with nicotine may be an effective cessation aid for people who use combustible tobacco. People who switch from combustible tobacco to e-cigarettes will reduce their exposure to numerous toxicants and carcinogens.”
- Quick Tips: “Using tobacco in forms that don’t burn, like smokeless tobacco or heat-not-burn products, will reduce your exposure to harmful combusted chemicals including carbon monoxide. [You can] further reduce your risk by switching to products that don’t have tobacco like NRT [e.g., nicotine patches or nicotine gum] or e-cigarettes.”
- Statement by: CAMH - Centre for Addiction and Mental Health, Pharmacists for a Smoke-free Canada, The Ontario Tobacco Research Unit, Centre for Effective Practice.
2021 American Psychiatric Nurses Association: POSITION STATEMENT: Psychiatric-Mental Health Nursing’s Role in Tobacco Treatment
- "Smoking and tobacco use are widely recognized as an addiction, not merely a personal choice, and health care clinicians increasingly address this chronic, relapsing disease using recovery-oriented language. Terms such as “cessation” are being replaced with “treatment” and “smoker” replaced with person-first language such as “person who smokes.”
- Studies specifically on people with mental health problems have also shown that e-cigarettes can help reduce smoking with few side effects, particularly when combined with behavioural support, although more research is needed.
- Citation: Mental Health and Smoking Partnership. Use of electronic cigarettes by people with mental health problems: A guide for health professionals. March 2020.
- Among participants, mean age was 46 years, the majority (70.3%) had tried an e-cigarette. Among those who had ever tried an e-cigarette, over half (54.6%) reported the reason was to quit smoking, while 13.9% reported that the reason was to reduce smoking.
- There is a need to find ways of making traditional cigarettes less appealing and alternative less harmful nicotine products (licensed and unlicensed) more appealing and accessible to this group of high risk smokers.
- Spontaneous e-cigarette use during cessation treatment was common among smokers with mental illness and was not associated with positive or negative treatment outcomes. The high rate of naturalistic e-cigarette use in this group suggests that e-cigarettes are an appealing strategy to obtain nicotine during cessation treatment that could be harnessed as a smoking cessation tool or for harm reduction.
- Presented by Helen Redmond at GFN 2017 in Warsaw Poland.
- Evidence based information should be available to all those with a mental health condition about a range of alternative nicotine containing products including electronic cigarettes.
- Individuals with mental health conditions (MHC) have disproportionately high tobacco-related morbidity and mortality due to high smoking prevalence rates. As high consumers of cigarettes, smokers with MHC may consider using e-cigarettes as an alternative form of nicotine delivery.
Individuals with MHC were more likely to have tried e-cigarettes (14.8%) and to be current users of e-cigarettes (3.1%) than those without MHC (6.6% and 1.1%, respectively; p<0.01). Ever smokers with MHC were also more likely to have tried approved pharmacotherapy (52.2% vs 31.1%, p<0.01) and to be currently using these products (9.9% vs 3.5%, p<0.01) than those without MHC. Additionally, current smokers with MHC were more susceptible to future use of e-cigarettes than smokers without MHC (60.5% vs 45.3%, respectively, p<0.01). Smokers with MHC are differentially affected by the rise in popularity of e-cigarettes. Clinical interventions and policies for tobacco control on e-cigarettes should take into account the possible outcomes and their implications for this priority population.
E*ven with intensive smoking cessation management programs specifically designed for patients with schizophrenia, quit rates are low. Although not formally regulated as a pharmaceutical product, the e-cigarette can help smokers with schizophrenia to reduce their cigarette consumption or remain abstinent and reduce the burden of smoking-related morbidity and mortality, particularly in schizophrenic patients who smoke
The most important message from this case series is that these individuals were able to quit and to remain abstinent for at least 6 months after taking up an electronic cigarette. This is the first time that objective measures of smoking cessation are reported in smokers, suffering from depression, who quit after experimenting with the e-cigarette. This is quite outstanding in consideration of the fact that this result was accomplished by highly addicted smokers who repeatedly failed professional smoking cessation assistance without the support of recommended nicotine dependence treatments and smoking cessation counselling.
- Depressed smokers relapsed significantly earlier than the nondepressed. Nicotine gum was significantly more effective than placebo gum among all smokers. The benefits of nicotine gum were particularly apparent among the depressed. Only 12.5% of depressed smokers quit successfully with placebo gum for 3 months, whereas 29.5% quit with nicotine gum. Depressed smokers reported more stress, less coping resources, more physical and psychological symptoms, and more frequent smoking in the presence of negative affect than did the nondepressed.
- PDF Version
- Citation: Kinnunen, T., Doherty, K., Militello, F. S., & Garvey, A. J. (1996). Depression and smoking cessation: Characteristics of depressed smokers and effects of nicotine replacement. Journal of Consulting and Clinical Psychology, 64(4), 791–798. https://doi.org/10.1037/0022-006X.64.4.791
Stigma
2024: Breathe Easy Maine Webinar Addressing the Harmful Effects of Tobacco-Related Stigma
- Presenter: Derek Bowen, MaineHealth Center for Tobacco Independence
- Stigma is the public’s effect of marking disgrace of a certain quality within a targeted community. People who use tobacco are faced with stigma and the challenges it brings day by day, and it leaves a great impact on the individual’s quality of life, mental health, and likeliness to stop using tobacco further down the road. Within the webinar, we will discuss different types of stigmas, the effects of stigma, and ways to reduce and prevent stigma when it comes to individuals who use tobacco.
2021: Truth Initiative's Depression Sticks Campaign
- 2021: Video: Depression causes vaping!
- In this talk Professor Notley will discuss the latest evidence exploring associations between nicotine use and common mental health conditions, including depression.
- Interpretive assumptions will be drawn out, including inappropriate claims of causal relationships between vaping and depression.
- 2021: Video (Consumer) The Truth about #DepressionSticks
- Depression is nothing to laugh about or stigmatize. @TruthInitiative has created a multi-million dollar ad campaign that does both. @imaracingmom opens up about her struggle with depression and her pain magnified by the #DepressionStick misinformation campaign. They make light of youth depression and shame people for trying to minimize their suffering by any means necessary. It's time we told them you will not shame me. You will not reduce my suffering to a hashtag and you will not lie to me any more.
- De-normalization of smoking as a public health strategy may create shame and isolation in vulnerable groups unable to quit. To examine the nature and impact of smoking stigma, we developed the Internalized Stigma of Smoking Inventory (ISSI), tested its validity and reliability, and explored factors that may contribute to smoking stigma.
- In addition to the health disparities experienced by smokers, psychosocial factors such as smoking stigma can cause additional strain on health, and may thwart positive behavior change. Smoking stigma can be defined as a social process by which exclusion, rejection, blame or devaluation occurs,7 in this case related to smoking or being identified as a smoker. Stigma can be categorized as: 1) internally-focused self-stigma resulting from the internalization of public stigma and characterized by statements about the individual's worth, e.g., “I am worth less because I smoke”; 2) perceived or felt stigma, which is an awareness of devaluation or stereotype in work, social, and everyday situations, and includes fear of being stigmatized, experiencing external blame, and social isolation; or 3) enacted stigma, which refers to acts of discrimination perpetrated on stigmatized individuals.
- We would consider, however, efforts to induce stigma as abjectly wrong and avoidable. Instead, treatment engagement strategies could emphasize stigma-reduction as an ancillary benefit – i.e., messaging that quitting smoking can reduce stigma, rather than messaging aimed at increasing stigma to induce quitting.
- Citation: Brown-Johnson CG, Cataldo JK, Orozco N, Lisha NE, Hickman NJ 3rd, Prochaska JJ. Validity and reliability of the Internalized Stigma of Smoking Inventory: An exploration of shame, isolation, and discrimination in smokers with mental health diagnoses. Am J Addict. 2015 Aug;24(5):410-8. doi: 10.1111/ajad.12215. Epub 2015 May 1. PMID: 25930661; PMCID: PMC4675843.
- Acknowledgement: This work was supported by the National Institute of Mental Health, Bethesda, Maryland, grant number #R01 MH083684 (PI Judith J. Prochaska); National Cancer Institute, Bethesda, Maryland, grants number CA-113710 and CA-87472 (PI Judith J. Prochaska); National Institute on Drug Abuse, Bethesda, Maryland, grants number #K23 DA018691 and #P50 DA09253 (PI Judith J. Prochaska);NIH National Heart, Lung and Blood Institute, Bethesda, Maryland, grant #5T32 HL007034-39 (PI Christopher Gardner); and the State of California Tobacco-Related Disease Research Program, University of California Office of the President, Oakland, California grant number #21BT-0018 (PI Judith J. Prochaska).
- Citation: Brown-Johnson CG, Cataldo JK, Orozco N, Lisha NE, Hickman NJ 3rd, Prochaska JJ. Validity and reliability of the Internalized Stigma of Smoking Inventory: An exploration of shame, isolation, and discrimination in smokers with mental health diagnoses. Am J Addict. 2015 Aug;24(5):410-8. doi: 10.1111/ajad.12215. Epub 2015 May 1. PMID: 25930661; PMCID: PMC4675843.
Misperceptions
- The perception of harm associated with ENDS was fair in the current study, with 27.3% of the ever smokers perceiving it as more harmful than regular cigarettes...
- Citation: Asharani, PV PhD; Seet, Vanessa BA; Devi, Fiona BSc; Wang, Peizhi MPH; Roystonn, Kumarasan MSc; Subramaniam, Mythily PhD. Electronic nicotine delivery systems: prevalence and perception of risk/harm in individuals with mental illness. Singapore Medical Journal 65(1):p 51-56, January 2024. | DOI: 10.11622/smedj.2022091
- Acknowledgement: This work was supported by the National Medical Research Council Centre Grant Seed Funding (NMRC/CG/M002/2017_IMH).
- Citation: Asharani, PV PhD; Seet, Vanessa BA; Devi, Fiona BSc; Wang, Peizhi MPH; Roystonn, Kumarasan MSc; Subramaniam, Mythily PhD. Electronic nicotine delivery systems: prevalence and perception of risk/harm in individuals with mental illness. Singapore Medical Journal 65(1):p 51-56, January 2024. | DOI: 10.11622/smedj.2022091
- 36% of study participants falsely believed vaping was as harmful as smoking.
- Citation: Devika Dixit, Ellen Herbst, Smita Das, E-Cigarette Use and Perceptions Among Veterans Receiving Outpatient Treatment in Veterans Affairs Substance Use and Mental Health Clinics, Military Medicine, Volume 186, Issue 1-2, January-February 2021, Pages 24–29, https://doi.org/10.1093/milmed/usaa292
- Acknowledgement: This was funded by 2016 APA SAMHSA Substance Abuse Fellowship, Smita Das, MD, PhD, MPH (no number associated).
- Citation: Devika Dixit, Ellen Herbst, Smita Das, E-Cigarette Use and Perceptions Among Veterans Receiving Outpatient Treatment in Veterans Affairs Substance Use and Mental Health Clinics, Military Medicine, Volume 186, Issue 1-2, January-February 2021, Pages 24–29, https://doi.org/10.1093/milmed/usaa292
Never say "Never"
A Note from the Safer Nicotine Wiki team
We've provided examples of studies showing that nicotine doesn't cause depression for everyone who uses nicotine. We've also linked to studies showing that people living with depression smoke at a higher rate than people who aren't dealing with depression. The purpose of this Safer Nicotine Wiki page is to show that people living with depression are at a higher risk of smoking. And some people living with things like depression and anxiety are self-medicating with nicotine.
How can evidence show both? Let's throw out the possibilities of bias and poorly conducted studies for either theory, and what we have left is thousands of individuals who have participated in studies. What do those individuals have in common? They are each unique in their own way.
Why doesn't everyone who goes to a baseball game end up loving baseball? How can some people drink alcohol and not become addicted to it? Why do some people like Brussels Sprouts while other people hate them? Because we are all different! It is logical that the relationship between depression and nicotine can have different outcomes for different people. It's also worth noting that some people who use nicotine don't deal with any depression.
Depression greatly reduces someone's quality of life and can even lead to death. If we suspect that someone (or ourselves) is living with depression, that should be taken seriously.
The most important thing here is that if you live with depression, please don't struggle alone. Reach out to family and friends. Connect with other people dealing with depression on social media or in local face-to-face groups. Talk to your healthcare provider. Find things that help you, and practice self-care and self-love. You are not alone, so please don't go on this journey alone.
There are wonderful organizations that can help you learn about depression and how to manage your depression. There are also good resources for those of you who love someone living with depression.
May is Mental Health Awareness Month. Many of us dealing with depression are left feeling inadequate, like we are not good enough, we don't do enough, and we are failures. Sometimes it feels like the joy of living is sucked right out of us. We're pleased to see that the 2023 theme for Mental Health Awareness Month is #MoreThanEnough. Reminding all of us that we have value just the way we are.
- ...smoking leads to depression while in others, depression leads to smoking--a hypothesis that is consistent with the results of the present study."
- Citation: Chaiton MO, Cohen JE, O'Loughlin J, Rehm J. A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Public Health. 2009 Sep 22;9:356. doi: 10.1186/1471-2458-9-356. PMID: 19772635; PMCID: PMC2758872.
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