Mental health stability in veterans with posttraumatic stress disorder receiving varenicline

Campbell, Austin; Anderson, Keith D.

doi:10.2146/ajhp100196

Cited by 20 publications

(17 citation statements)

References 29 publications

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“…7 At the Veterans Affairs Medical Center (VAMC), varencline, a second-line medication with a reported 25% abstinence rate, is considered only after bupropion or nicotine replacement therapy or a combination of the two have failed, and then only after appropriate psychiatric and cardiovascular screening. [7][8][9][10][11][12] Alternatives to pharmacological therapies such as acupuncture, acupressure, and electrical stimulation have received minimal attention in the re-search but are used widely, and proponents of their use believe them to be effective and safe interventions for smoking. 13 However, a recent Cochrane review found little evidence from randomized controlled trials that any of these therapies work better than placebo.…”

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confidence: 99%

The Efficacy of Auriculotherapy for Smoking Cessation: A Randomized, Placebo-Controlled Trial

Fritz¹,

Carney²,

Steinmeyer³

et al. 2013

The Journal of the American Board of Family Medicine

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Background: Quitting smoking remains a challenge for almost one-third of the military veteran population. Alternatives to pharmacological therapies such as acupuncture, acupressure, and electrical stimulation have received minimal attention in research but have been widely reported to be popular and safe interventions for smoking cessation.Methods: This randomized, double-blind, placebo-controlled clinical trial of 125 veterans was conducted to determine whether aural electrical stimulation (auriculotherapy) once a week for 5 consecutive weeks is associated with a higher rate of smoking abstinence are than observed with sham stimulation.Results: Auriculotherapy was found to be safe and largely free from significant side effects. However, there was no difference in the rate of smoking cessation between those participants who received true auriculotherapy and those who received sham auriculotherapy. The auriculotherapy group achieved a rate of 20.9% abstinence versus 17.9% for the placebo arm after 6 weeks. Conclusion:The results of this randomized, controlled clinical trial do not support the use of auriculotherapy to assist with smoking cessation. It is possible that a longer treatment duration, more frequent sessions, or other modifications of the intervention protocol used in this study may result in a different outcome. However, based on the results of this study, there is no evidence that auriculotherapy is superior to placebo when offered once a week for 5 weeks, as described in previous uncontrolled studies. ( Smoking is a major health hazard. Although the risk of smoking-related diseases and death decline sharply when smokers quit, 19% of Americans currently smoke.1 Rates of smoking are even higher among US military veterans, with about 1 in 3 current smokers.2 In keeping with the 2008 clinical guidelines for smoking cessation, veterans are asked about their smoking status annually and are offered group or individual counseling and either bupropion or nicotine replacement therapy to help them achieve smoking abstinence. 3,4 Both bupropion and nicotine replacement therapy have been found to be more effective than placebo or no treatment, 5,6 but they are ineffective in many cases. In fact, a meta-analysis of clinical trials found that bupropion and a nicotine patch result in abstinence in only 20% and 13% of participants, respectively.7 At the Veterans Affairs Medical Center (VAMC), varencline, a second-line medication with a reported 25% abstinence rate, is considered only after bupropion or nicotine replacement therapy or a combination of the two have failed, and then only after appropriate psychiatric and cardiovascular screening. [7][8][9][10][11][12] Alternatives to pharmacological therapies such as acupuncture, acupressure, and electrical stimulation have received minimal attention in the re- search but are used widely, and proponents of their use believe them to be effective and safe interventions for smoking. 13 However, a recent Cochrane review found little evidence from randomized controlled tria...

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confidence: 99%

The Efficacy of Auriculotherapy for Smoking Cessation: A Randomized, Placebo-Controlled Trial

Fritz¹,

Carney²,

Steinmeyer³

et al. 2013

The Journal of the American Board of Family Medicine

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“…An open label trial of 112 smokers with stable schizophrenia also found no exacerbation of psychosis (Pachas et al, 2012). In a retrospective analysis of 78 veterans with posttraumatic stress disorder, two patients were found to have depressive episodes attributable to varenicline treatment, and four other patients had suicidal ideation or mental health-related hospitalizations not attributed to varenicline (Campbell, 2010). In another retrospective cohort of 50 veterans prescribed varenicline, four patients with underlying psychiatric illness discontinued therapy due to behavioral changes (Purvis et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Low incidence of adverse events following varenicline initiation among opioid dependent smokers with comorbid psychiatric illness

Nahvi

Richter

et al. 2013

Drug and Alcohol Dependence

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Background Most drug treatment patients smoke cigarettes, yet few data exist on the prevalence and outcomes of varenicline treatment among smokers with comorbid substance use and psychiatric disorders. Methods We reviewed all patient charts of opioid-dependent smokers prescribed varenicline between May 2006 and December 2009 in two urban methadone clinics that also provide on-site medical and psychiatric care. We assessed prevalence, adverse events, and effectiveness of varenicline treatment in this cohort. Results We identified 575 smokers among 690 patients (83.3%), and assessed 82 courses of varenicline treatment prescribed to 70 smokers. Both cardiovascular risk factors and psychiatric illness were highly prevalent among those prescribed varenicline: hypertension, 51%; hyperlipidemia, 23%; diabetes, 20%; depression, 53%; anxiety, 30%; psychotic disorders, 10%; bipolar disorder, 8.6%. Of 82 varenicline courses, nine (11%) were discontinued due to adverse events and two due to depressive symptoms. One patient initiated new psychiatric medications within six months of initiating varenicline, but did not discontinue varenicline. There were no reports of suicidal ideation, agitation prompting clinical intervention, or psychiatric hospitalization. There were no incident cardiac or vascular events within six months of varenicline prescription. Some (8.6%) varenicline-treated smokers quit smoking, and cessation was significantly associated with varenicline treatment duration. Conclusions Despite substantial comorbidity, opioid-dependent smokers receiving integrated substance abuse, medical and psychiatric care had few documented adverse events with varenicline treatment. Methadone patients will likely experience little harm and a great deal of benefit from treatment with varenicline for smoking cessation.

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“…This is of particular importance in a veteran population due to the increased prevalence of both nicotine dependence and comorbid psychiatric illness. Retrospective data indicate that the mental health of patients with PTSD may be destabilized while receiving varenicline (Campbell & Anderson, 2010). Perhaps most troubling are the substantially more reports of suicidal behavior in patients receiving varenicline as compared to other smoking cessation therapies (Moore, Furberg, Glenmullen, Maltsberger, & Singh, 2011).…”

Section: Discussionmentioning

confidence: 99%

Adverse Neuropsychiatric Events Associated with Varenicline Use in Veterans: A Case Series

Cantrell

Argo

Haak

et al. 2012

Issues in Mental Health Nursing

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Varenicline represents a major advance in the treatment of nicotine addiction and has been shown to be safe and effective to promote abstinence. However, in a small number of patients, neuropsychiatric adverse events and worsening of underlying psychiatric conditions have been reported. As the veteran population has higher rates of co-morbid psychiatric conditions and nicotine dependence this population may be at higher risk for serious adverse effects to varenicline warranting close monitoring. Herein we report seven cases of varenicline associated neuropsychiatric adverse events and describe an institutional response to adequately monitor patients to ensure safety and efficacy.

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Mental health stability in veterans with posttraumatic stress disorder receiving varenicline

Abstract: Varenicline appeared to have destabilizing effects on MH in veterans with PTSD.

Cited by 20 publications

References 29 publications

The Efficacy of Auriculotherapy for Smoking Cessation: A Randomized, Placebo-Controlled Trial

The Efficacy of Auriculotherapy for Smoking Cessation: A Randomized, Placebo-Controlled Trial

Low incidence of adverse events following varenicline initiation among opioid dependent smokers with comorbid psychiatric illness

Adverse Neuropsychiatric Events Associated with Varenicline Use in Veterans: A Case Series

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