The co‐occurrence of cigarette smoking and bipolar disorder: phenomenology and treatment considerations

Abstract

Objectives Despite recent advances in understanding the causes and treatment of nicotine dependence among individuals with psychiatric disorders, smoking among individuals with bipolar disorder (BD) has received little attention. The goal of this review is to synthesize the literature on the epidemiology, consequences, and treatment of smoking and nicotine dependence among individuals with BD and to delineate a future research agenda. Methods We conducted a PubMed search of English-language articles using the search terms “bipolar disorder,” “mania,” “tobacco,” “nicotine,” “and “smoking,” followed by a manual search of the literature cited in the identified articles. Articles were chosen by the authors on the basis of their relevance to the topic areas covered in this selective review. Results Adults with BD are 2 to 3 times more likely to have started smoking and, on the basis of epidemiological data, may be less likely to initiate and/or maintain smoking abstinence than individuals without psychiatric disorders. Smoking cessation is achievable for individuals with BD, but challenges such as chronic mood dysregulation, high prevalence of alcohol and drug use, more severe nicotine dependence, and limited social support can make quitting more difficult. Effective treatments for tobacco cessation are available, but no controlled trials in smokers with BD have been conducted. Conclusions Cigarette smoking is a prevalent and devastating addiction among individuals with BD and should be addressed by mental health providers. Additional research on the mechanisms of, and optimal treatment for, smoking and nicotine dependence in this population is desperately needed.

Long-Term Lithium Use and Risk of Renal and Upper Urinary Tract Cancers

“…We had only indirect information on heavy smoking, which is an established risk factor for both renal cancer and cancers of the pelvis or ureter. 28 Individuals suffering from bipolar disorder and severe depression, including lithium users, smoke on average more than the general population, 29,30 and thus smoking might have confounded the risk estimates in our study. However, any confounding by smoking would result in an overestimation of the association between lithium use and UUTC risk, and thus our finding of mainly neutral associations between lithium use and UUTC risk provides further reassurance of our null results.…”

Efficacy of Varenicline for Smoking Cessation in Bipolar Disorder

“…Do psychiatrists even recognize counseling about smoking cessation (alongside other lifestyle factors that jeopardize physical health and longevity) as falling within their purview and scope of practice? An extensive review 8 of cigarette smoking and bipolar disorder observed that, while most surveyed psychiatrists were aware of smoking status among their patients, counseling or intervention was provided during no more than 12% of visits. This marked disparity is especially troubling given the relevance of smoking to mental health management, including known links between smoking and depression, smoking and other substance misuse, the need to gauge metabolic risk factors when prescribing medications that can adversely affect weight or glycemic and lipid levels, and, not least of all, anticipating pharmacokinetic interactions between tobacco smoke and certain antipsychotics or serotonin reuptake inhibitors.…”

“…This marked disparity is especially troubling given the relevance of smoking to mental health management, including known links between smoking and depression, smoking and other substance misuse, the need to gauge metabolic risk factors when prescribing medications that can adversely affect weight or glycemic and lipid levels, and, not least of all, anticipating pharmacokinetic interactions between tobacco smoke and certain antipsychotics or serotonin reuptake inhibitors. 8 Second, psychiatrists must feel knowledgeably equipped to guide their patients as well as other physicians and health care providers about the psychiatric safety of varenicline as a treatment option for smokers with psychiatric illnesses. How do we place into proper context the handful of case reports linking varenicline with iatrogenic psychosis or adverse mood effects alongside the US Food and Drug Administration's 2009 black box warning of an 8-fold increased risk for suicidal or self-injurious behavior?…”

“…Two-thirds or more of adults with bipolar disorder are smokers, 8 many of whom neglect physical health concerns and may seldom see a primary care doctor 11 -and, when they do, the presence of bipolar disorder often may be overlooked or misidentified. 12 For these reasons, psychiatrists are perhaps ideally poised to recognize and address smoking cessation as part of comprehensive mental health treatment.…”

Magnesium and Zinc Involvement in Tobacco Addiction

“…The nicotine addiction and the tobacco smoking have an high prevalence in schizophrenia and bipolar disorders [47,48]. In the bipolar disorder peoples, tobacco smoking is prevalent [49].…”