The psychiatric effects of varenicline on patients with depression

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.