Smoking and mental health - NCSCT

Smoking cessation interventions for individuals with mental disorders 5
5.4.1 Adverse events relating to smoking cessation interventions
Evidence on adverse events occurring in the context of stopping smoking aided
by different pharmacological regimens suggests that, overall, smoking cessation
interventions in people with mental disorders are well tolerated and safe. Of
four studies in people with schizophrenia exploring adverse events with
bupropion alone or in combination with NRT in people with schizophrenia,
two used the Systematic Assessment For Treatment Emergent Effects
(SAFTEE), 35,36 and two recorded events descriptively. 38,39 In placebo-controlled
studies of bupropion, no adverse events were reported in the smallest, involving
18 participants, 35 whereas a study involving 53 participants reported three
adverse events requiring trial withdrawal: one a probable medication allergy,
and two cases of suicidal ideation (trial group not clear). 36 A study of 51
patients with schizophrenia using bupropion or placebo in addition to NRT 38
reported four trial withdrawals due to medication side effects, two in the
intervention group, whereas a similar study by George et al 39 reported three
serious adverse events described as psychotic decompensation, two of which
occurred in the placebo group.
Adverse events relating to the concurrent use of NRT while smoking were
assessed in a study of smoking reduction; 54 none were reported. For varenicline,
the available evidence 27,41,45 suggests that the medication is well tolerated in
participants with schizophrenia, schizoaffective disorders and major depression,
with no differences in the occurrence of adverse events detected between the
respective intervention and placebo groups; however, side effects in the form of
nausea and insomnia are common, as is the case with this drug in the general
population. A study conducted in the military health service in the USA showed
that there does not appear to be an increase in neuropsychiatric hospitalisations
with varenicline compared with NRT patch over 30 or 60 days after drug
initiation. 57
5.4.2 Effects of smoking cessation on mental health symptoms
Studies using validated symptom scales to ascertain whether psychiatric
symptoms change during cessation interventions generally suggest that smoking
cessation has no negative impact on psychiatric symptoms in people with
schizophrenia, and that there may in fact be benefits in relation to depression
and anxiety, eg in patients with schizophrenia receiving cessation interventions
significantly lower scores have been reported on the Beck Depression Index II
(BDI-II), Short Form 12 (SF-12) and State Trait Anxiety Inventory (STAI), 30
reduced Brief Psychiatric Rating Scale (BPRS) general score, 35 improved Positive
and Negative Symptoms Scale (PANSS) scores, 36 and lower Barnes Akathisia
Scale and Simpson Angus Scale (SAS) scores for extrapyramidal side effects, 38
and a greater decrease in PANSS score (negative symptoms). 39 A recent study of
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