Study shows association between e-cigarettes and depressive disorders

New data from the French epidemiological cohort Constances confirm the association already observed between e-cigarette use and depressive disorders.

Recently, several studies, particularly American ones, have suggested a link between vaping and depressive symptoms. Recent data provided by the epidemiological cohort[1] French Constances[2] confirm this observation and provide details on the causes and extent of this association.

Two American studies had already suggested this link at the end of 2019 and the beginning of 2020

Among the recent studies that found a link between e-cigarette use and depression is one whose results were published on December 4, 2019 in the medical journal JAMA Network Open[3].

One of the study's authors, Dr. Olufunmilayo Obisesan of Johns Hopkins University in Baltimore, explained the genesis of the project: "The link between smoking and an increased risk of developing major depressive disorder has already been established [...] In light of the similarities between some of the components of cigarettes and e-cigarettes, we decided to see if there was a similar association between e-cigarettes and depression."4].

The researchers surveyed nearly 900,000 randomly selected Americans aged 18 and older by telephone. Of those surveyed, 34% of current e-cigarette users and 27% of former users reported having suffered from clinical depression, a rate that rose to just 15% among those who had never vaped.5].

However, the researchers noted that their study did not allow them to determine whether it was vaping that promoted depression, or conversely whether it was depressive disorders that led to e-cigarette use, or whether the two phenomena were interdependent.6].

Another study, conducted by researchers at the University of Kansas Wichita School of Medicine and whose preliminary results were released in early March 2020, found that the rate of people suffering from depressive disorders was 55% higher among e-cigarette users compared to non-vapers.7To obtain this data, they used questionnaire responses from nearly 100,000 individuals collected from the Centers for Disease Control and Prevention.8], in 2014, 2016 and 2017.

However, this other study was also “purely observational,” and did not establish “a cause-and-effect relationship.”[9] between e-cigarette use and depressive symptoms.

The new French study provides more information on this association

Emmanuel Wiernik, a researcher at Inserm, explains that the study conducted on 35,337 volunteer subjects - aged 18 to 69 - from the Constances epidemiological cohort, “had the objectives of examining the associations […] between depressive symptoms and the use of electronic cigarettes in a large population sample, while taking into account smoking and sociodemographic confounding factors”[10].

It further states that “Participants were included from February 2012 to December 2016,” and that “Age, gender, and education level were reported at study entry as well as smoking status (never smokers, former smokers, current smokers), e-cigarette use (never, former, current), and nicotine concentration in mg/ml”[11].

The results of this study confirmed that depressive disorders were indeed associated with “current use” of e-cigarettes, which previous studies had already observed. However, the French study also demonstrates that depressive symptoms in e-cigarette users are positively associated with nicotine concentration[12].

The study published in December 2019 in JAMA Network Open already suggested that nicotine could be responsible for this association between e-cigarettes and depression, since “Exposure to nicotine over a long period of time can disrupt the brain's dopamine pathway, increase sensitivity to stress, and disrupt coping mechanisms that normally help protect against depression”[13].

Emmanuel Wiernik concludes from this now demonstrated association between the use of electronic cigarettes and depressive disorders that, “in patients who are depressed, it is appropriate to pay attention to their consumption of e-cigarettes (and/or tobacco); conversely, in those who consume e-cigarettes (and/or tobacco), it is necessary to look for depressive symptoms”[14].

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[1] “Consisting of a group of people followed individually over time, cohorts aim to identify the occurrence of health events of interest and the risk or protective factors relating to them. Cohorts constitute one of the reference instruments for epidemiological and public health research.” The cohorts, inserm.fr (accessed December 1, 2020).

[2] “Constances is a “generalist” epidemiological cohort made up of a representative sample of 200,000 adults aged 18 to 69 at inclusion, consulting the Social Security Health Examination Centers (CES).”

Presentation of Constances, constances.fr (accessed December 1, 2020). [3] Nancy Schimelpfening, Study Finds Depression Risk Greater for E-cigarette Users, healthline.com (December 9, 2019, accessed December 1, 2020). [4] Lisa Templeton, Study finds 'strong link' between vaping and depression, medicalnewstoday.com (December 14, 2019, accessed December 1, 2020). [5] Ibid. [6] Nancy Schimelpfening, Study Finds Depression Risk Greater for E-cigarette Users, healthline.com (December 9, 2019, accessed December 1, 2020). [7] Vaping linked to heart disease and depression, study finds, FranceInfo (March 8, 2020, consulted December 1, 2020).

[8] “The Centers for Disease Control and Prevention (Centers for Disease Control and Prevention, CDC), is the primary U.S. government agency for protecting public health and public safety.”

Activity and exercise management for patients with CFS, asso-sfc.org (accessed 1er December 2020). [9] Ibid. [10] Christine Fallet, Vape: beware of depressive disorders, The Doctor's Daily (published November 27, 2020, consulted December 1, 2020). [11] Ibid. [12] Ibid. [13] Nancy Schimelpfening, Study Finds Depression Risk Greater for E-cigarette Users, healthline.com (December 9, 2019, accessed December 1, 2020). [14] Christine Fallet, Vape: beware of depressive disorders, The Doctor's Daily (published November 27, 2020, consulted December 1, 2020). DNF - For a Zero Tobacco World |