Addressing Smoking: Is Varenicline the Answer?

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Author: David N. Osser
Date: Mar. 2021
From: Psychiatric Times(Vol. 38, Issue 3)
Publisher: Intellisphere, LLC
Document Type: Clinical report
Length: 776 words
Lexile Measure: 1450L

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Many patients with bipolar disorder (BD) have comorbid substance use disorders, including nicotine use. Some reports suggest 70% of patients with BD smoke. (1) Importantly, data show that continuing to smoke reduces the chances of successfully addressing other substance use. (2,3) The mechanisms of nicotine and other substances are similar, so it is necessary to stop all substances that are maintaining the pathological processes. Patients, and some clinicians, erroneously believe it is OK to wait to address cigarette and other nicotine use.

The most effective smoking cessation medication is varenicline. The EAGLES study, a randomized, double-blind, placebo-controlled trial (N=8144) compared varenicline, bupropion, and nicotine replacement therapy (NRT). The results confirmed many smaller studies that varenicline treatment had the best outcome (defined as abstinence at weeks 9-12). (4) The investigators also studied the effects among various diagnoses by dividing patients into 2 equal cohorts--one with and the other without psychiatric disorders (70% unipolar and bipolar mood disorders, 20% anxiety disorders, and 10% psychotic disorders). The study found varenicline performed the best of the 4 treatments in both groups. In the nonpsychiatric cohort, abstinence rates were 38% for varenicline vs 26% on other active treatments and...

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Gale Document Number: GALE|A676445543