Over Eight in Ten Psychiatric Patients Who Vape Report Harmful Side Effects

A newly published study has found that most people with psychiatric illnesses who vape report harmful side effects within six hours. The findings appear in the March 2026 issue of Emerging Trends in Drugs, Addictions, and Health. They raise serious concerns about vaping risks for psychiatric patients and call for urgent action from clinicians and policymakers alike.

The research team at the University of California, San Diego, analysed survey data from 851 current and former e-cigarette users with pre-existing psychiatric conditions. The headline figure is hard to ignore. A total of 85.3% reported at least one adverse event within six hours of vaping. That is more than eight in every ten people.

What the Research Found About E-Cigarette Adverse Effects in Mental Health Patients

The most commonly reported side effects were coughing (33.7%), anxiety (33.3%), headache (31.4%), dry mouth (28.8%) and lightheadedness (25.9%). These are not minor inconveniences. For people already managing depression, bipolar disorder or anxiety disorders, such reactions worsen an already complex clinical picture.

The study examined three groups at elevated risk.

Dual vapers use both nicotine and cannabis e-cigarettes. They faced significantly higher odds of experiencing 12 adverse effects, even after researchers adjusted for age, sex, ethnicity, education and employment. Most strikingly, dual vapers had nearly five times the odds of vomiting (adjusted odds ratio: 4.94) compared with those who vaped only nicotine or only cannabis.

People with multiple medical comorbidities also fared considerably worse. Those with five or more pre-existing health conditions had more than double the odds of experiencing sixteen different adverse effects. These included heart palpitations, dizziness, lung discomfort and nausea.

Those with persistent psychiatric symptoms showed the most dramatic risk increases of all three groups. Persistent symptoms in this context include ongoing anxiety, depression, sleep disturbances and mood instability. Nineteen of the 26 adverse effects examined carried more than double the odds for people with five or more persistent psychiatric issues. Fatigue reached an adjusted odds ratio of 4.39 and mood swings reached 3.98.

Dual Vaping Compounds the Danger

One of the more troubling findings is just how common dual vaping is in this population. Of the 851 respondents, 51.9% used both nicotine and cannabis e-cigarettes. Only 16.8% vaped nicotine alone. The majority of people with psychiatric illnesses in this study already fell into the highest-risk category for e-cigarette adverse effects in mental health patients.

The simultaneous use of nicotine and cannabis through vaping is not simply two risks added together. Prior research suggests that using multiple tobacco and cannabis products together increases dependence risk and amplifies harmful side effects. The US Centers for Disease Control and Prevention also notes that flavoured tobacco products are more addictive than standard ones. Flavoured products attract disproportionately high uptake among younger and dual-use consumers, adding yet another layer of concern.

Anxiety was the most prevalent persistent psychiatric issue among respondents, affecting 72.5%. Depression followed at 57.8%, then sleep disturbance at 29%. Among those with five or more persistent psychiatric symptoms, the risk of experiencing anxiety as an immediate side effect after vaping was 41.7 percentage points higher than among those with no persistent issues. Vaping appears to actively worsen the very condition most of these individuals are trying to manage.

Why Psychiatric Patients Face Greater Vaping Risks

People with psychiatric illnesses use tobacco and nicotine products at substantially higher rates than the general population. E-cigarettes are often marketed as a cleaner alternative to combustible cigarettes. Many in this group have adopted them widely as a result. Yet evidence on vaping risks for psychiatric patients has, until recently, remained limited.

This study builds on earlier research linking e-cigarette use to worsening mental health outcomes. A 2021 systematic review concluded that vaping was associated with greater mental health problems across multiple domains, particularly among adolescents. National surveillance data have also revealed significant associations between e-cigarette use and depression. Separately, a study using the National College Health Assessment found that students with a mental health diagnosis in the past 12 months showed notably higher odds of e-cigarette use.

This new research goes further. It quantifies the acute physical and psychological risks that arise almost immediately after vaping. It also shows that risk escalates sharply with the number of comorbidities and the persistence of psychiatric symptoms.

The Comorbidity Effect

Pre-existing physical health conditions played a significant role in shaping outcomes. The most common comorbidities among respondents were allergy and immunological conditions (23.3%), respiratory conditions (23.3%), digestion and abdominal conditions (23.0%) and skin conditions (18.1%). Over a third of respondents (35.5%) reported three or more comorbidities. A further 14.3% reported five or more.

The data for those carrying multiple conditions is unambiguous. People with five or more comorbidities faced a 22.8 percentage point higher risk of dry mouth, an 18.3 percentage point higher risk of insomnia and a 20 percentage point higher risk of dizziness compared with those without any comorbidities. Physical vulnerabilities and vaping behaviour interact to produce a compounding effect. Clinicians need to take that seriously.

Calls for Targeted Action on Vaping Risks for Psychiatric Patients

The study authors are direct. Clinicians should routinely screen patients with psychiatric illnesses for nicotine and cannabis vaping. They should also counsel patients on the elevated risk of acute adverse effects. Integrated cessation and symptom monitoring strategies should be prioritised, especially for dual users, those with multiple comorbidities and those with persistent psychiatric symptoms.

For policymakers and public health agencies, the findings point toward targeted interventions. Standard public health messaging around vaping rarely distinguishes between healthy adults and those with complex mental health histories. The authors argue that a one-size-fits-all approach falls short. Specific guidance and resources must reach this vulnerable population.

E-cigarettes remain the most used tobacco product among young people in the United States. Vaping rates among adults with mental health conditions remain disproportionately high. These facts together make the need for action hard to argue against.Limitations and What Comes Next

The authors acknowledge several important limitations. The cross-sectional design means causation cannot be established. Survey responses carry recall bias and social desirability effects. The findings may not apply uniformly across all subpopulations. The questionnaire’s length and detail may also have introduced some respondent fatigue.

Future longitudinal studies will need to track how these risks develop over time. They should also examine social determinants of health, use patterns and the most effective interventions for people with pre-existing psychiatric conditions.

These limitations do not diminish the core message. For anyone working in mental health, addiction, public health or policy, e-cigarette adverse effects in mental health patients can no longer be a secondary concern. This population already carries a disproportionate burden of physical and psychological ill health. The evidence now makes clear that vaping adds substantially to that burden.

Reference

Purushothaman, V. & Cuomo, R.E. (2026). Adverse effects following E-cigarette use among users with psychiatric illnesses: Risks associated with dual vaping, multiple comorbidities and persistent psychiatric issues. Emerging Trends in Drugs, Addictions, and Health, 6, 100271.

Source: dbrecoveryresources