We have previously discussed several risks associated with adolescent nicotine vaping and the use of nicotine pouches. These risks include acute and long-term pulmonary and cardiac complications, alteration of healthy neuro-cognitive development, and vulnerability to addiction. Nobody in their right mind would want these problems.
Yet
what if there is an upside to teenage vaping?
What
I am thinking about is that vaping (or other nicotine use) among teenagers
might at times be a primitive way to express feelings of distress. In the old
days, we might have called it “a cry for help.”
As
parents, we often find it challenging to understand what our kids are thinking
and feeling. We do not speak their language. Of course, teenagers are not
exactly celebrated for their direct and sincere communication. Perhaps vaping
might help to bridge the gap.
We
know that many mental health conditions are quite common in adolescence and can
impact healthy development. One of these conditions is depression, which is
sadly quite widespread and appears to be on the rise. Over 10% of our teenagers
will develop a depressive condition; many more will experience significant
symptoms of depression. It often goes unrecognized.
Depression
usually involves the expression of specific symptoms over a two-week period. This
is what distinguishes a diagnosis of depression from normal and expected
periods of sadness. The problem is that symptoms of adolescent depression do
not follow a precise pattern.
Some
kids become quite sad or irritable; others grow more fatigued. Depressed
teenagers might lose interest in school or other activities, spend more time
alone or on the phone, have trouble sleeping or concentrating, and gain weight
or lose weight.
The
only thing for certain is that teenagers will rarely tell us that they are
depressed. What they might do instead of discussing the issue is use substances
like nicotine. We know that there is a strong link between depression and
nicotine use. For example, teenagers who are depressed are much more likely
than non-depressed kids to use nicotine. We also know that teenagers who vape
over time find that their depressive symptoms get much worse.
Nicotine
is appealing as a drug because it is a stimulant. It wakes up the brain,
increases focus and memory, and offers a sense of relaxation. These effects are
very appealing to kids with depression. They are also fleeting. Over time,
nicotine users become more anxious and irritable and come to rely on nicotine
as a coping strategy. Once nicotine withdrawal kicks in, the nicotine user is
“self-medicating” unpleasant feelings each day.
The
point, I think, is that as parents, when we see or suspect that our child is
vaping, we should think about what the vaping hopes to accomplish. For some
teenagers, it may be easier to detect vaping than it is to detect depression or
other mental health concerns.
Another
factor to consider is gender. It turns out that young women are more likely to
experience depression than young men. Young women are also less successful in
stopping their vaping, and at least part of this problem may be due to
untreated depressive symptoms that reduce motivation to stop substance use.
The
good news is that we have wonderful treatments for depression. More and more
adolescents find help with individual therapy. Medications for depression, like
the SSRIs (Zoloft and Lexapro, for example), are very effective and come with
minimal side effects. At least outside the Jewish community, it is no longer
taboo to speak of mental health concerns and treatments. Within our community,
we have some work to do.
Of
course, not every teenager who vapes nicotine suffers from depression, and many
depressed adolescents choose not to engage in substance use. Vaping may signal
other conditions besides depression, like ADHD or anxiety, issues that are also
common in adolescence and if left untreated forecast future adjustment
difficulties.
I
will also note that treatment for depression is not treatment for vaping. These
are two different conditions. Even teenagers who have depression successfully
treated will likely continue vaping because addictions take on a life of their
own. I think it is fair to say, however, that addressing the depression will
make it easier for an adolescent to stop vaping.
If
your teenager vapes, please discuss what he or she is trying to accomplish. For
some, it is simply a matter of peer pressure and curiosity, a normal stage of
adolescence that they will hopefully outgrow and does not require treatment. For
others, vaping nicotine may offer a window into mental health concerns that are
often difficult for teenagers to discuss.
Pediatricians
are well-versed on the dangers of vaping and the rise in teenage depression and
can be helpful with referrals. Some pediatricians have experience prescribing
SSRIs or other medications to manage depression. There are also many highly
qualified psychiatrists and therapists in and out of our community who work
with adolescents and can help with both mental health and addiction issues. The
sooner these problems are addressed, the less impact they will have on school
achievement, social well-being, and healthy adolescent development.
