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Chronic nicotine use dysregulates this system, increasing stress sensitivity and emotional instability over time. Additionally, Mendelian randomization studies have found causal evidence that smoking increases the risk of developing depression and even schizophrenia, rather than simply being a consequence of them. This supports the view that smoking may not only sustain but also exacerbate or even initiate mood disorders in vulnerable individuals

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There is also evidence that standardised packaging helps health warnings on packaging to be more prominent and effective (Moodie and others, 2021