Depression and anxiety symptoms associated with vaping nicotine and THC in teens and young adults

A study of more than 2,500 teens and young adults led by the American Heart Association found that vaporizing nicotine and THC, the psychoactive component in marijuana, was associated with self-reported symptoms of depression and anxiety.

The study’s preliminary findings will be presented at the Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023, to be held in Boston, February 28-March 3, 2023, providing the latest science on population-based health and wellness and implications for lifestyle and cardiometabolic health.

The use of pod-based e-cigarettes has exploded in recent years among youth and young adults. Previous studies have shown links between vaping and symptoms of both anxiety and depression in young adults.

“Younger people have long been vulnerable to tobacco use, may be more harmed by nicotine and other drugs, and may be targeted by tobacco advertisers and marketers,” said study author Joy Hart, Ph.D., a professor of communications at the University of Louisville. in Kentucky.

“E-cigarette devices are still relatively new compared to other tobacco products such as combustible cigarettes and pipes, so more research is needed to better understand the popularity of e-cigarettes, including reasons for vaping and associated health risks in young people .”

The researchers, several of whom work for the Association, conducted an online survey of 2,505 teens and young adults, ages 13-24, to measure differences in mental health between nicotine-only vapers, THC-only vapers, dual vapers of both nicotine and THC and people who had never vaped a product before.

The study focused on 1,921 people who had never vaped or were current vapers, defined as having vaped in the past 30 days. Of those participants, 562 individuals reported never vaping, 370 had only vaped nicotine, 159 had only vaped THC, and 830 were dual vapers of nicotine and THC.

Analysis of participants’ survey responses revealed:

• About 70% of THC-only vapers and 60% of nicotine-only and dual vapers reported experiencing anxiety symptoms, such as worry, flashbacks, panic attacks, and situational fears, in the past week, compared to about 40% of participants who never vaped before.
• More than half of nicotine-only vapers, THC-only vapers, and dual-vapers reported experiencing symptoms of depression, such as having difficulty or being interested in activities that are normally enjoyable, or feeling that depression is affecting their ability hindered them from doing the things they needed to do at work, school or home and whether depression interfered with their social lives and relationships – in the past week, compared to 25% of non-vapers.
• More than 50% of people in all vaping groups reported suicidal thoughts in the past 12 months, compared to just a third of non-users.
• About a quarter of dual-vapers and nicotine-only vapers started vaping nicotine to calm down or feel less stressed, and a third of participants in both groups reported that they currently vape nicotine to cope with anxiety. In contrast, about half of THC-only vapers started vaping THC and were currently vaping THC to relieve anxiety symptoms.
• About 20% of nicotine-only vapers and dual vapers started vaping to feel less depressed and are currently vaping for this reason. About a third of THC-only vapers started vaping THC and nearly half are currently vaping TCH to feel less depressed.

Dual-vapers were significantly more likely than nicotine-only vapers to report addiction to nicotine, which was defined in this study as behaviors such as waking up at night to vape. Nicotine and THC dual-vapers were also significantly more likely to report feeling less depressed after they started vaping, while nicotine-only vapers were more likely to report that vaping had no impact on their feelings of depression. This may be related to dual users’ stronger addiction to these products, rather than the products’ positive effects on their mental health, the researchers said.

“While we knew THC was commonly vaped, we were surprised to have so many dual-vapers – more than double the number of nicotine-only vapers. Dual use may exacerbate the addictive nature of vaping or attract people more prone to addiction “These findings suggest the importance of addressing THC use and the need to build resilience and coping skills for teens and young adults,” Hart said.

The study had limitations: Due to the use of cross-sectional data, researchers were unable to assess whether symptoms of anxiety and depression, as well as suicidal ideation, were caused or exacerbated by use of the THC and nicotine vapes, or whether the existence of those symptoms had an effect on the use of the vape products; online data collection through a web-based panel meant that participants may not be representative of all US teens and young adults; and the data were self-reported.

“When better coping skills are developed, there may be fewer temptations to try to manage anxiety symptoms and similar mental health issues through vaping, as well as better refusal skills if an electronic cigarette is offered. Increased prioritization for more positive behaviors to reduce tension and managing anxiety symptoms can reduce the likelihood of vaping, possible addiction and the increased risk of negative health outcomes,” said Rose Marie Robertson, MD, FAHA.

Robertson is deputy chief science and medical officer of the American Heart Association, co-director of the Association’s National Institutes of Health/US Food and Drug Administration-funded Tobacco Center of Regulatory Science, and senior author on the study. “There is also an urgent need for effective communication campaigns and educational programs to help youth and young adults better understand the risks of e-cigarette use,” she said.

Future research, Robertson said, is needed to explore the long-term connections between mental health and vaping, whether nicotine alone, THC alone, or both nicotine and THC.

“This study showed the striking significance of mental health issues in users of both nicotine and THC vapes, and as new products continue to come to market, I think this is something we will continue to see,” said Loren E. Wold, Ph.D., FAHA. Wold is assistant dean for biological health research in the College of Nursing, a professor in the Colleges of Nursing and Medicine (physiology and cell biology) at Ohio State University, and leader of the writing committee for the Association’s 2022 Statement on Cardiopulmonary Consequences of Vaping in Adolescents . “These products were developed as smoking cessation aids for those who use traditional cigarettes, so I am now very curious about the mental health implications of users using these products to help them quit smoking.”

Additional co-authors are Jeffrey Willett, Ph.D.; Allison Groom, M.D.; Robyn L. Landry; Engel Bassett, MA; Mary Dunn, Ph.D.; Kandi Walker, Ph.D.; Thomas Payne, Ph.D.; and Anshula Kesh, MPH, BDS