Emergency Psychiatric Effects of Nicotine Vaping Cessation: A Narrative Review
Abstract
Nicotine vaping represents a common form of nicotine use among adolescents and adults. Nicotine dependence associated with vaping can develop rapidly. Emergency departments (EDs) are increasingly encountering patients with acute anxiety, mood instability, agitation, and other psychiatric symptoms. Abrupt cessation of nicotine vaping may be an under-recognized contributor in these cases due to withdrawal. This narrative aims to synthesize evidence on acute psychiatric effects following nicotine vaping cessation and nicotine withdrawal, with a focus on emergency and other acute-care settings. This objective builds on the growing recognition of nicotine withdrawal as a contributor to acute psychiatric presentations. This descriptive review summarizes PubMed-indexed English-language literature published from January 2010 to December 2025, including systematic reviews, observational studies, and clinical trials relevant to nicotine withdrawal treatment. It also covers ED and intensive care unit (ICU) studies where nicotine withdrawal presents as agitation or delirium, as well as case reports describing severe psychiatric presentations connected to e-cigarette use or withdrawal. Across study types, nicotine withdrawal is consistently associated with anxiety, irritability or agitation, depressed mood or anhedonia, sleep disturbance, and difficulty concentrating. In acute care environments, nicotine withdrawal has also been associated with agitation or delirium phenotypes in…
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