Photo Credit: pixinoo

The following is a summary of “Effects of Varenicline, Bupropion, Nicotine Patch, and Placebo on Treating Smoking Among Persons With Current or Past Major Depressive Disorder: Secondary Analysis of a Double-Blind, Randomized, Placebo-Controlled Trial,” published in the December 2024 issue of Psychiatry by Kypriotakis et al. 

Researchers conducted a retrospective study to compare the safety and efficacy of smoking cessation medications in individuals with current vs past major depressive disorder (MDD). 

They conducted a secondary analysis of a 12-week randomized, double-blind trial with 2,174 participants with past MDD, 451 with current MDD, and 4,028 without psychiatric disorders. Participants received 12 weeks of pharmacotherapy (placebo, nicotine replacement therapy (NRT), bupropion, or varenicline) and brief counseling. The primary safety outcome was the occurrence of moderate to severe neuropsychiatric adverse events (AEs), while efficacy was assessed through biochemically verified continuous abstinence during weeks 9–12. 

The results showed no difference in neuropsychiatric AEs by medication across past-MDD, current-MDD, or nonpsychiatric cohorts among 6,653 participants. MDD cohorts had a higher risk difference for AEs vs nonpsychiatric cohort (past-MDD: risk difference=−0.03, 95% CI=−0.05, −0.02; current-MDD: risk difference=−0.02, 95% CI=−0.05, 0.00). In the past MDD cohort, odds ratios (OR) compared with placebo were 3.0 (95% CI=2.0, 4.5) for varenicline, 2.1 (95% CI=1.6, 2.7) for bupropion, and 2.1 (95% CI=1.4, 3.2) for NRT. In the current MDD cohort, varenicline had an OR of 2.67 (95% CI=1.2, 6.15) vs placebo, and NRT had an OR of 2.93 (95% CI=1.2, 7.2). 

Investigators found that all medications were generally safe in MDD cohorts. Varenicline plus counseling showed greater efficacy and similar safety, making it the preferred treatment for individuals with past or current MDD. 

Source: psychiatryonline.org/doi/10.1176/appi.ajp.20230855