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How Smoking and Vaping Can Affect Mental Health

Almost 70% of the 28.3 million U.S. adults who smoke say they want to quit.1 Smoking poses significant health risks. Cigarette smoking causes over 480,000 deaths in the United States annually, making it the leading preventable cause of death worldwide.2

Vaping and smoking are two alternative methods to deliver nicotine. Concerns about the health risks of smoking have led many people to choose vaping as an alternative. About 1 in every 20 Americans (10.8 million) uses vaping devices, and one in three uses them daily.3 According to the 2022 Gallup poll, 8% of U.S. adults regularly or occasionally vape. One in every four high school students uses vaping products. 

Nicotine is a compound that is rapidly delivered to the brain. It is a highly addictive substance that alters brain chemistry, prompting researchers to look into its potential effects on mental health.

Does Nicotine Cause Anxiety?

Generalized anxiety disorder is characterized by a persistent feeling of worry and anxiety.4 This chronic mental health condition affects all aspects of life, leading many to seek relief by smoking or vaping. Compared to the general population, smoking rates are higher in people with anxiety disorders, and anxiety disorders are more common in people dependent on nicotine.5

Research has shown inconsistent results when exploring the relationship between nicotine use and anxiety. Some studies show that nicotine can ease anxiety, though the effect may be temporary.6 Other studies indicate that, ultimately, nicotine use increases anxiety.7

A study of 2,500 adults and teens found that those who smoke or vape reported more anxiety (60%), depression, and suicidal thoughts than those who did not (40%).  

A person smoking

Can Nicotine Help With Anxiety?

People living with depression or anxiety have a much higher rate of smoking than the general population, leading some researchers to theorize that people who smoke use nicotine to relieve their mental health symptoms,7 but does nicotine use really help with anxiety?

No, nicotine use does not help treat anxiety. Nicotine withdrawal causes uncomfortable symptoms, including anxiety, irritability, and depression. People who stop smoking may mistakenly believe that nicotine is easing their anxiety, but in reality, it relieves symptoms from quitting smoking.7

A sad woman with a cigarette

The Relationship Between Nicotine and Mental Health

Addiction, stress, anxiety, depression, and schizophrenia are mental health conditions linked to nicotine use. Researchers continue to investigate the complex relationships between mental health conditions and nicotine’s effects on the brain.

Compared with the general population, people with schizophrenia, depression, and other mental health conditions are three times more likely to smoke. They also smoke more intensely, drawing more nicotine out with each breath, and are more nicotine-dependent. 8  

The high prevalence of smoking in people with mental health conditions may be because nicotine temporarily reduces symptoms such as poor concentration, low mood, and stress. Ultimately, smoking cessation is linked to reduced depression, anxiety, and stress, as well as better mood and quality of life.9,10

Addiction

Nicotine is a highly addictive substance that changes brain chemistry and leads to cravings and withdrawal symptoms with decreased use. Changes in brain chemistry from nicotine exposure cause tolerance or a need to use higher and higher nicotine doses to get the same effect.

Withdrawal symptoms can cause insomnia, mood changes, cravings, anxiety, restlessness, and depression. 

Stress and Anxiety

Changes in brain chemistry from nicotine exposure are associated with a depressed mood, agitation, and anxiety shortly after smoking. A person who smokes has fluctuations in their psychological state as they go through repeated withdrawal cycles throughout the day. This can worsen mental health. However, according to researchers, a causal relationship between smoking and mental health conditions cannot be supported. In a review of 29 studies, researchers found that quitting smoking and vaping was associated with a decrease in anxiety and stress symptoms.10

Depression

In one study, over half of the 108 participants who were moderately or heavily dependent on nicotine reported moderate-to-severe depression, and 44% reported moderate-to-severe anxiety, as well. Interestingly, the degree of nicotine addiction was inversely related to the severity of anxiety and depression. This illustrates the complex relationship between mental health conditions and nicotine use.11

In a review of 29 studies, the improvement researchers saw in mood disorders when people stopped smoking was similar to using antidepressant treatments.10

Schizophrenia

A strong link between schizophrenia and smoking exists. Some reports suggest that cigarette smoking increases the risk of schizophrenia. However, more research is needed.

Theories on the association between schizophrenia and smoking include:12

  • Self-medication theory: Smoking increases dopamine levels and may improve symptoms.
  • Causal: Smoking may play a role in developing schizophrenia.
  • Genetic: There may be a shared genetic predisposition for both schizophrenia and smoking.

People with schizophrenia inhale more deeply, have higher nicotine exposure, consume more cigarettes, and have higher levels of nicotine dependence than smokers who do not live with schizophrenia. People living with schizophrenia have a shorter lifespan (by 28 years) than people who do not, and the health effects of cigarette smoking contribute to this.12

Varenicline and other smoking cessation medications can be effective for smoking cessation and can increase the odds of quitting by a factor of 4 to 5 times in people with schizophrenia. Without medication, the smoking cessation success rate is very low.13 More research is needed to develop effective smoking cessation programs for people with mental health conditions.12

A therapist talking to a client

How Quitting Can Benefit Mental Health

Nicotine increases dopamine levels in the brain and changes the metabolism of other brain chemicals. When people quit smoking, they are more likely to experience irritability, anxiety, depression, and memory and concentration problems.

To successfully quit smoking, it is essential to prepare yourself mentally and physically for your first smoke-free day. After quitting smoking, you will experience many long-term mental and physical health benefits. Smoking has a significant impact on heart health, and reducing stress also improves heart health.

What About Depression After Quitting Smoking?

Not only are people who smoke more likely to experience depression than those who do not, but low mood is more common when trying to quit smoking due to nicotine withdrawal.

People who experience depression after quitting smoking are more likely to relapse. However, the first two to three days after quitting smoking will be the worst. According to timelines for quitting smoking, nicotine cravings, irritability, sleep problems, anxiety, and restlessness peak within three to seven days after stopping smoking and using nicotine replacement therapies can make these symptoms much more manageable. The symptoms are expected to resolve within a month.

If you can successfully quit smoking, researchers have found that depressive symptoms significantly improve.14

How To Get Help With Addiction or Mental Health

Nicotine is very addictive, maybe even more so than cocaine and heroin.15 Its addictive quality makes it difficult for people to stop smoking. Behavior, psychological, and medical support can make it easier to successfully quit. Smoking cessation help is available, even online, through the TelegraMD platform.

Talk With a Therapist

Smoking cessation and withdrawal from nicotine can temporarily increase anxiety, stress, and depression. Talk to a good online therapist to develop a plan for managing your addiction and other mental health symptoms. An analysis of over 52 clinical studies and nearly 20,000 patients found that using a combination of behavioral therapy and medication compared to minimal support alone led to more effective smoking cessation success.16

Consult With a Doctor

Online doctors can provide an individualized smoking cessation program and prescribe nicotine replacement therapy as an online prescription and transmit it to your local pharmacy. These prescription and over-the-counter medications ease withdrawal symptoms. The TelegraMD platform provides 24-hour doctor care access so you can get help whenever you need it.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Cornelius ME, Loretan CG, Jamal A, et al. Tobacco Product Use Among Adults — United States, 2021. MMWR Morb Mortal Wkly Rep 2023;72:475–483.

2. Rigotti NA. Strategies to Help a Smoker Who Is Struggling to Quit. JAMA. 2012;308(15):1573–1580. doi:10.1001/jama.2012.13043

3. Mohammadhassan Mirbolouk, Paniz Charkhchi, Sina Kianoush, et al. Prevalence and Distribution of E-Cigarette Use Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016. Ann Intern Med.2018;169:429-438. [Epub 28 August 2018]. doi:10.7326/M17-3440

4. National Institute of Mental Health. Generalized anxiety disorder: When worry gets out of control. Updated 2022. Accessed September 11, 2023. https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml

5. Kutlu MG, Parikh V, Gould TJ. Nicotine addiction and psychiatric disordersInt Rev Neurobiol. 2015;124:171-208. doi:10.1016/bs.irn.2015.08.004

6. Xiao X, Shang X, Zhai B, Zhang H, Zhang T. Nicotine alleviates chronic stress-induced anxiety and depressive-like behavior and hippocampal neuropathology via regulating autophagy signaling. Neurochemistry International. 2018;114:58-70. doi:10.1016/j.neuint.2018.01.004

7. Fluharty M, Taylor AE, Grabski M, Munafò MR. The association of cigarette smoking with depression and anxiety: a systematic review. NICTOB. 2017;19(1):3-13. doi:10.1093/ntr/ntw140

8. Gilbody S, Peckham E, Bailey D, Arundel C, Heron P, Crosland S, Fairhurst C, Hewitt C, Li J, Parrott S, Bradshaw T, Horspool M, Hughes E, Hughes T, Ker S, Leahy M, McCloud T, Osborn D, Reilly J, Steare T, Ballantyne E, Bidwell P, Bonner S, Brennan D, Callen T, Carey A, Colbeck C, Coton D, Donaldson E, Evans K, Herlihy H, Khan W, Nyathi L, Nyamadzawo E, Oldknow H, Phiri P, Rathod S, Rea J, Romain-Hooper CB, Smith K, Stribling A, Vickers C. Smoking cessation for people with severe mental illness (SCIMITAR+): a pragmatic randomised controlled trial. Lancet Psychiatry. 2019 May;6(5):379-390. doi: 10.1016/S2215-0366(19)30047-1. Epub 2019 Apr 8. PMID: 30975539; PMCID: PMC6546931.

9. National Institute on Drug Abuse. Do people with mental illness and substance use disorders use tobacco more often? February 24, 2023. Accessed September 11, 2023. Retrieved from https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/do-people-mental-illness-substance-use-disorders-use-tobacco-more-often

10. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P et al. Change in mental health after smoking cessation: systematic review and meta-analysis BMJ 2014; 348 :g1151 doi:10.1136/bmj.g1151

11. Papazisis A, Koreli A, Misouridou E. Heavy Smoking is Associated with Low Depression and Stress: a Smokers’ Paradox in Cardiovascular Disease? Mater Sociomed. 2019 Dec;31(4):268-272. doi: 10.5455/msm.2019.31.268-272. PMID: 32082091; PMCID: PMC7007605.

12. Ding JB, Hu K. Cigarette Smoking and Schizophrenia: Etiology, Clinical, Pharmacological, and Treatment Implications. Schizophr Res Treatment. 2021 Dec 13;2021:7698030. doi: 10.1155/2021/7698030. PMID: 34938579; PMCID: PMC8687814.

13. Cather C, Pachas GN, Cieslak KM, Evins AE. Achieving Smoking Cessation in Individuals with Schizophrenia: Special Considerations. CNS Drugs. 2017 Jun;31(6):471-481. doi: 10.1007/s40263-017-0438-8. PMID: 28550660; PMCID: PMC5646360.

14. Stepankova L, Kralikova E, Zvolska K, et al. Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up, Annals of Behavioral Medicine, Volume 51, Issue 3, June 2017, Pages 454–463, https://doi.org/10.1007/s12160-016-9869-6

15. Brunette P, Harris S et al. UCSF Medical Center Fontana Tobacco Treatment Center Stop Smoking Workbook. Accessed July 6, 2023. extension://oemmndcbldboiebfnladdacbdfmadadm/https://www.ucsfhealth.org/-/media/project/ucsf/ucsf-health/pdf/fttc-tobacco-workbook-011912.pdf

16. Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev. 2016 Mar 24;3(3):CD008286. doi: 10.1002/14651858.CD008286.pub3. PMID: 27009521; PMCID: PMC10042551.