Three Factors Predict Psych Events With Drugs for Smoking Cessation

Anxiety, history of suicidal ideation/behavior, being white associated with higher risk for events

THURSDAY, March 21, 2019 (HealthDay News) -- Three factors predict clinically significant neuropsychiatric adverse events (NPSAEs) in smokers with or without mental health conditions who use cessation pharmacotherapy, according to a study published online March 7 in the Journal of General Internal Medicine.

Robert M. Anthenelli, M.D., from the University of California San Diego in La Jolla, and colleagues evaluated data from 3,984 smokers without a history of psychiatric disorders and 4,050 with histories of or current clinically stable psychiatric disorders, including mood (71 percent), anxiety (19 percent), and psychotic (10 percent) disorders. Patients had been randomly assigned to bupropion (150 mg twice daily) or varenicline (1 mg twice daily) versus active control (nicotine patch; 21 mg/day with taper) and placebo for 12 weeks with 12-week nontreatment follow-up.

The researchers found that the incidence of moderate-to-severe NPSAEs was higher among smokers in the psychiatric cohort versus the nonpsychiatric cohort (5.9 versus 2.1 percent). Regardless of carrying a psychiatric diagnosis, increased risk for experiencing clinically significant NPSAEs when quitting was predicted by current symptoms of anxiety, previous history of suicidal ideation and/or behavior, and being of white race versus black race. Younger age, female sex, history of substance use disorders, and proxy measures of nicotine dependence or psychiatric illness severity predicted a greater risk for NPSAEs among smokers with psychiatric disorders.

"[People with mental illness] have a harder time quitting smoking and are disproportionately affected by tobacco-related diseases and premature death," Anthenelli said in a statement. "Just because they have mental illness, however, does not mean they should not consider a smoking cessation drug as the risk of disease from long-term smoking is much greater."

Several authors disclosed financial ties to pharmaceutical companies, including Pfizer and GlaxoSmithKline, which funded the trial, and one author has served as a paid expert witness in litigation against tobacco companies.

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