Emergency Psychiatric Effects of Nicotine Vaping Cessation: A Narrative Review

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 hospitalized and ICU populations. Furthermore, e-cigarette use has been linked to increased odds of suicidality and psychotic-like symptoms in some observational studies. Finally, case literature documents severe psychotic presentations that are temporally associated with e-cigarette use or nicotine withdrawal, although causality is difficult to establish. Nicotine vaping cessation can plausibly precipitate acute psychiatric symptoms that mimic primary psychiatric illness and complicate ED triage and disposition. As a result, consistent nicotine-use history-taking, withdrawal-aware differential diagnosis, and judicious use of nicotine replacement therapy (NRT) may increase diagnostic reliability and patient safety.