Volume 9 Supplement 1

International Conference for Healthcare and Medical Students (ICHAMS) 2013

Poster presentation
Open Access

The psychiatric effects of varenicline on patients with depression

  • EYH Yeung1,
  • S Long1,
  • BL Bachi1,
  • J Lee1 and
  • Y Chao1
BMC Proceedings20159(Suppl 1):A31

https://doi.org/10.1186/1753-6561-9-S1-A31

©  Yeung et al; licensee BioMed Central Ltd. 2015

Published: 14 January 2015

Background

Varenicline is currently the most effective smoking cessation medication. Pre-marketing clinical trials excluded participants with psychiatric disorders, such as major depressive disorders. This study investigated the psychiatric effects of varenicline among patients with depression.

Methods

On 18 December 2012, a systematic search was performed using Medline with the following search terms: 1) varenicline and 2) depression. The search was limited to English articles, case reports, and original clinical studies. From the 58 retrieved documents, 15 articles were used in this review.

Results

The first case report on the effects of varenicline on patients with depression was published in June 2008. A man experienced an acute exacerbation of depressive symptoms, which resolved after he stopped his varenicline treatment. [1] Since then, there were 8 other case reports that described exacerbation of psychiatric symptoms in patients with depression taking varenicline [2–9]. Two of those case studies suggested the use of sertraline [7] and bupropion [8] to treat exacerbation of depressive symptoms associated with varenicline. In contrast, varenicline was shown to improve the affective symptoms of a smoker who developed depression and suicidal tendencies during previous cessation attempts [10]. There were 3 observational studies on patients with depression taking varenicline: 1) a one-year follow-up study on 112 smokers showed an association between increased Beck Depression Inventory score and continued smoking after 12 weeks of varenicline [11]; 2) an open-labelled study showed significant improvement in mood in 110 outpatient smokers with persistent depressive symptoms [12]; and 3) A smoking cessation trial on 217 varenicline users showed that depressive symptoms at the time of varenicline initiation (measured by Patient Health Questionnaire-2) were associated with suicidal ideation. [13] There were 2 clinical trials on patients with depression taking varenicline, with both of them showing worsening of psychiatric symptoms. [14, 15] Neither of the trials were placebo-controlled.

Conclusions

Despite some inconsistencies, the findings suggested that varenicline could worsen psychiatric symptoms in patients with depression. Clinicians should be advised to closely monitor patients with a history of depression on varenicline, although there were no studies on how to treat those patients. Bias and uncontrolled confounders potentially affected previous studies, and thus, a double-blinded placebo-controlled trial is needed to demonstrate the efficacy and side effects of varenicline on patients with depression.

Authors’ Affiliations

(1)
College of Medical and Dental Sciences, The University of Birmingham

References

  1. Popkin MK: Exacerbation of recurrent depression as a result of treatment with varenicline. Am J Psychiatry. 2008, 165: 774-View ArticlePubMedGoogle Scholar
  2. Pumariega AJ, Nelson R, Rotenberg L: Varenicline-induced mixed mood and psychotic episode in a patient with a past history of depression. CNS Spectr. 2008, 13: 511-514.PubMedGoogle Scholar
  3. Pirmoradi P, Roshan S, Nadeem SS: Neuropsychiatric disturbance after initiation of varenicline in a patient with a history of alcohol abuse and major depression. Am J Health Syst Pharm. 2008, 65: 1624-1626.View ArticlePubMedGoogle Scholar
  4. Lyon GJ: Possible varenicline-induced paranoia and irritability in a patient with major depressive disorder, borderline personality disorder, and methamphetamine abuse in remission. J Clin Psychopharmacol. 2008, 28: 720-721.View ArticlePubMedGoogle Scholar
  5. Raidoo BM, Kutscher EC: Visual hallucinations associated with varenicline: a case report. J Med Case Rep. 2009, 3: 7560-1947-3-7560Google Scholar
  6. Cantrell M, Argo T, Haak L, et al: Adverse neuropsychiatric events associated with varenicline use in veterans: a case series. Issues Ment Health Nurs. 2012, 33: 665-669.View ArticlePubMedGoogle Scholar
  7. Baran XY, Docherty JP: Rapid and sustained response to a single dose of sertraline in a patient with newly emergent depression during varenicline-assisted smoking cessation. CNS Spectr. 2010, 15: 148-151.PubMedGoogle Scholar
  8. Karam-Hage M, Shah KR, Cinciripini PM: Addition of bupropion SR to varenicline alleviated depression and suicidal ideation: a case report. Prim Care Companion J Clin Psychiatry. 2010, 12: 10.4088/PCC.09l00800bluGoogle Scholar
  9. Hussain S, Kayne E, Guwanardane N, et al: Varenicline induced mania in a 51 year old patient without history of bipolar illness. Prog Neuropsychopharmacol Biol Psychiatry. 2011, 35: 1162-1163.View ArticlePubMedGoogle Scholar
  10. Grosshans M, Mutschler J, Hermann D, et al: Reduced affective symptoms during tobacco dependence treatment with varenicline. Addiction. 2009, 104: 859-861.View ArticlePubMedGoogle Scholar
  11. Grassi MC, Enea D, Ferketich AK, et al: Effectiveness of varenicline for smoking cessation: a 1-year follow-up study. J Subst Abuse Treat. 2011, 41: 64-70.View ArticlePubMedGoogle Scholar
  12. Philip NS, Carpenter LL, Tyrka AR, et al: Varenicline augmentation in depressed smokers: an 8-week, open-label study. J Clin Psychiatry. 2009, 70: 1026-1031.View ArticlePubMedGoogle Scholar
  13. Cowan CM, Wink JS, DeZee KJ: Use of the Patient Health Questionnaire-2 to predict suicidal ideations in patients taking varenicline. Am J Addict. 2012, 21: 356-362.View ArticlePubMedGoogle Scholar
  14. McClure JB, Swan GE, Jack L, et al: Mood, side-effects and smoking outcomes among persons with and without probable lifetime depression taking varenicline. J Gen Intern Med. 2009, 24: 563-569.View ArticlePubMed CentralPubMedGoogle Scholar
  15. McClure JB, Swan GE, Catz SL, et al: Smoking outcome by psychiatric history after behavioral and varenicline treatment. J Subst Abuse Treat. 2010, 38: 394-402.View ArticlePubMed CentralPubMedGoogle Scholar

Copyright

© Yeung et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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