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Anxiety, suicidality, race predict psychiatric events during smoking cessation
Researchers found that existing anxiety, a history of suicidal ideation or behavior and being of white race predict clinically significant psychiatric adverse events in smokers taking medication for smoking cessation, according to study results.
"This is the first time that a large-scale multinational study has carefully examined psychiatric events among smokers with and without mental health issues, comparing risks across all three frontline medications," Robert Anthenelli, MD, professor of psychiatry at University of California, San Diego, said in a press release. "By identifying the baseline characteristics that predict moderate-to-severe adverse events, we can better treat all patients."
In this secondary analysis of the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES), the researchers aimed to determine the baseline characteristics that would predict which participants were more likely to experience moderate/severe neuropsychiatric adverse events — aside from history of mental illness.
The investigators examined the effects of bupropion (150 mg twice daily) or varenicline (1 mg twice daily) compared with active control (nicotine patch) and placebo for 12 weeks and 12-week nontreatment follow-up in smokers with (n = 4,050) and without (n = 3984) histories of mood (n = 2,882), anxiety (n = 782) and psychotic (n = 386) disorders.
Although the incidence of psychiatric adverse events was higher among smokers with histories of mental health disorders than those without (5.9% vs. 2.1%), three baseline characteristics predicted increased risk for experiencing clinically significant adverse events when trying to quit smoking regardless of whether they had a psychiatric diagnosis. These characteristics were current anxiety symptoms, history of suicidal ideation/behavior and being white.
Specifically, for every four-unit rise in Hospital Anxiety and Depression Scale anxiety score, the absolute risk for an adverse event increased by 1% in both people with and without psychiatric histories. Having a history of suicidal ideation/behavior was linked to a 4.4% (P = .001) increased risk for an adverse event among smokers with psychiatric histories, and a 4.1% (P = .02) increased risk among smokers without psychiatric histories after controlling for other factors. In addition, compared with black participants, white smokers with (P = .002) and without (P = .001) histories of mental health disorders were at greater risk for psychiatric adverse events.
In smokers with mental health problems, other predictors included younger age, being female, being a long-term smoker and having a history of co-occurring psychiatric and substance abuse disorders, according to the results.
"The good news is that the vast majority of people do not have adverse psychiatric events when taking the most prescribed smoking cessation drugs," Anthenelli said in the release. "These medicines are effective aids to quit smoking. However, like all drugs, these medications should be monitored, especially in patients who have a diagnosis of mental illness." – by Savannah Demko
Disclosure: The authors report numerous relevant financial disclosures; please see the full study for a complete list.