Does nicotine cause mental health issues?

Or do people with mental health issues have a higher rate of using nicotine?

Scientific Publications - Youth and Young Adults

2023: Risk and Protective Factors for Vaping and Smoking Among High School Students in Maine

• 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

2021: Adolescent depression symptoms and e-cigarette progression

• 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.

2017: Depressive Symptoms Predict Current E-Cigarette Use Among College Students in Texas

• 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

2009: Childhood depressive symptoms and adolescent cigarette use: A six-year longitudinal study controlling for peer relations correlates.

• 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

2008: The relationship between and cigarette smoking in depressive symptoms U S adolescents

• 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

2007 Smoking to self-medicate attentional and emotional dysfunctions

• 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

2000: Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults?

• 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

1998: The relationship between depressive symptoms and cigarette smoking in US adolescents

• 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

1998: Depression, anxiety, and smoking initiation: a prospective study over 3 years.

• 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

2018 Nicotine and networks: Potential for enhancement of mood and cognition in late-life depression

• 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.
• PDF Version
• 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

2018 Nicotine normalizes cortico-striatal connectivity in non-smoking individuals with major depressive disorder (MDD)

• 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.
• PDF Version
• 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.

2018 Transdermal Nicotine for the Treatment of Mood and Cognitive Symptoms in Non-Smokers with Late-Life Depression

• 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.
• PDF Version
• 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.

2016: Re-thinking nicotine and its effects

• 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

2014: Investigating the possible causal association of smoking with depression and anxiety using Mendelian randomisation meta-analysis: the CARTA consortium

• 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

2013: The causal role of smoking in anxiety and depression: a Mendelian randomization analysis of the HUNT study

• 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

2011: Smoking Is Associated with, but Does Not Cause, Depressed Mood in Pregnancy – A Mendelian Randomization Study

• 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.

2006 Transdermal nicotine attenuates depression symptoms in nonsmokers: a double-blind, placebo-controlled trial

• 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.
• PDF Version
• 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.

2002: Relationship between mood improvement and sleep changes with acute nicotine administration in non-smoking major depressed patients

• 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.

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
• PDF Version
• 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

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.

1993 Nicotine Dependence and Major Depression

• 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.
• PDF Version
• 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

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.

Articles / Blogs

2021: Vaping And Mental Health: Does Nicotine Use Cause Teen Depression?

• 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

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.

Did we prove that nicotine doesn't cause depression? NO! There are studies showing that it is possible that nicotine might lead to depression. We shouldn't dismiss this.

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.

2009: A systematic review of longitudinal studies on the association between depression and smoking in adolescents

• ...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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