Adolescent Nicotine Use Linked to Anxiety, Depression and Sleep Problems, Studies Find

Three new studies from researchers at the University of Gothenburg suggest that adolescents who use nicotine—including e-cigarettes, nicotine pouches and traditional tobacco products—report more symptoms of anxiety, depression, sleep problems and suicidal thoughts than their peers who do not use nicotine. The associations were strongest among girls, while an animal study found that nicotine changed activity in the amygdala, a brain region involved in emotion and stress regulation.

“Cigarette smoking is a well-established risk factor for premature physical disease and mortality,” said University of Gothenburg Ph.D. student Johanna Andersson and her colleagues.

“Smoking is also disproportionately common among people living with psychiatric conditions, including anxiety, depression, bipolar disorder and schizophrenia.”

“Nicotine use often begins during adolescence, a critical period when the brain is still developing and maturing.”

“The adolescent brain appears to be particularly vulnerable to nicotine exposure. Regular nicotine use may cause lasting changes in brain regions involved in cognitive function and emotional processing.”

In the first study, published in Tobacco Use Insights, the researchers investigated whether tobacco-free nicotine products were associated with anxiety and depression symptoms in adolescents. They also compared these associations with those linked to traditional tobacco products and examined whether gender influenced the results.

The study included 3,730 adolescents, of whom 30% reported using nicotine.

Nearly 80% of the girls who used nicotine reported clinically relevant symptoms of anxiety.

The associations were observed among users of both traditional tobacco products and tobacco-free nicotine products, including nicotine pouches and e-cigarettes.

In the second study, published in Nicotine & Tobacco Research, the researchers followed 1,592 adolescents in southern Sweden from lower secondary school through high school.

Depressive symptoms and suicidal thoughts were more common among adolescents who smoked.

Girls who increased their tobacco use over time were also more likely to experience worsening sleep problems, anxiety, low mood and difficulty concentrating.

“We see clear differences between girls and boys, with girls who smoke appearing to be particularly vulnerable,” Andersson said.

“At the same time, we need a better understanding of how nicotine pouches affect adolescent mental health, particularly among girls, whose use of these products has increased rapidly.”

In the third study, conducted in animals and published in Neuropharmacology, the researchers found that nicotine affected the amygdala, a brain region that plays an important role in emotional regulation and the stress response. These effects were strongest in female rats.

Nicotine changed communication between neurons and caused long-lasting alterations in brain activity that remained after the substance had left the body.

“One of the key findings is that we see similar patterns across several studies using different types of data,” said University of Gothenburg Professor Louise Adermark.

“However, we still cannot determine cause and effect.”

“The animal studies demonstrate biological changes in the brain that could contribute to greater vulnerability to anxiety and stress-related symptoms.”

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Johanna Andersson et al. Gender-Specific Associations between Tobacco and Tobacco-Free Nicotine Use and Symptoms of Anxiety and Depression in Swedish Adolescents. Tobacco Use Insights, published online May 22, 2026; doi: 10.1177/1179173X261455075

Johanna Andersson et al. Sex-specific associations between tobacco use and youth mental health: prospective and cross-sectional findings from Swedish adolescents. Nicotine & Tobacco Research, published online June 30, 2026; doi: 10.1093/ntr/ntag148

Erika Lucente et al. 2026. Nicotine produces a sex- and subregion-specific hypoglutamatergic state in rodent amygdala which can be reversed by motor-skill training. Neuropharmacology 290, 110879; doi: 10.1016/j.neuropharm.2026.110879