E-Cigarettes Linked to Higher Odds of Depression

e cigarette sign
Approximately 3.7% of respondents to the BRFSS study were current e-cigarette users, whereas 11.2% said they were former e-cigarette users.

The use of e-cigarettes is associated with higher odds of self-reported depression, especially in people who are unemployed and use marijuana, as well as those who are widowed, divorced, or separated, according to a study published in the Journal of Addiction Medicine.

The cross-sectional study analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) in the United States (N=11,918). Participants who were ≥18 years of age and who answered questions about e-cigarette use and depression were included in the analysis. The primary outcome was the presence of self-reported depression, identified by asking respondents whether a physician, nurse, or other clinician told them they had any facet of depressive disorder. Self-reported covariates were assessed in their relationship between e-cigarette use and depression.

Approximately 3.7% of respondents to the BRFSS were current e-cigarette users, whereas 11.2% said they were former e-cigarette users. Compared with former users and nonusers, a significantly greater proportion of participants who currently used e-cigarettes reported having depression (27.3% and 16.0% vs 32.4%, respectively; P <.001). In the multivariable model, self-reported depression was higher among people who were unemployed and who currently used e-cigarettes vs people who did not use e-cigarettes (odds ratio [OR], 2.85; 95% CI, 1.63-4.97). In addition, greater odds of self-reported depression were found in former users of e-cigarettes who were unemployed (OR, 1.89; 95% CI, 1.26-2.84).

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People who used marijuana were more likely to report current use of e-cigarettes (OR, 1.68; 95% CI, 1.08-2.61) and former use of e-cigarettes (OR, 1.35; 95% CI, 1.07-1.71) compared with respondents who did not use marijuana. In addition, the odds of self-reported depression were higher in respondents who were widowed, divorced, or separated and who currently used e-cigarettes (OR, 3.42; 95% CI, 1.60-7.29) or who formerly used e-cigarettes (OR, 1.55; 95% CI, 1.03-2.34) compared with participants who did not use e-cigarettes.

The investigators noted that an explanation for the findings could be “the dysregulating effects of nicotine on mood.” They continued, “Excessive nicotine exposure can cause abnormal dopamine transmission, dysregulate neural pathways involved in emotional processing, amplify sensitivity to stress and disrupt adaptive coping strategies that work against depression.”

However, limitations of the study included its cross-sectional design, the self-reported nature of the data, the lack of data on nicotine content within participants’ e-cigarette of choice, and the lack of information as to the frequency of e-cigarette use per day. Findings from this study “support the need for standard assessment of depressive symptoms among e-cigarette users in the primary care setting.”


Saeed OB, Chavan B, Haile ZT. Association between e-cigarette use and depression in US adults [published online January 14, 2020]. J Addict Med. doi:10.1097/ADM.0000000000000604