Improved Depressive Symptoms in Adults with Schizophrenia During a Smoking Cessation Attempt with Varenicline and Behavioral Therapy

Abstract

Objective: Smoking prevalence rates are elevated in individuals with schizophrenia spectrum disorders (SSD) compared with the general population, with attendant disproportionate smoking-related morbidity and mortality. Pharmacotherapies that improve abstinence rates in this population are underutilized, partly due to concerns about neuropsychiatric safety, particularly for those with comorbid depression or prior suicide attempt. Prospective assessment of the psychiatric safety profile of varenicline in those with SSD is needed.

Methods: Adult smokers with SSD entered a 12-week trial of varenicline and behavioral therapy for smoking cessation. Depressive symptoms were assessed with the Calgary Depression Scale for Schizophrenia (CDSS) at baseline and weekly thereafter. Participants with baseline and one or more postbaseline CDSS assessments, n = 179, were included in a secondary analysis of change in depressive symptoms with varenicline treatment, adjusting for abstinence status and baseline depressive symptoms.

Results: Twenty-seven percent of participants had a CDSS score at baseline consistent with current major depressive disorder, and more than half had a prior suicide attempt. Forty-one percent (74/179) achieved two or more weeks of continuous abstinence at the end of treatment. CDSS scores declined 31% during the 12-week treatment period. Controlling for baseline CDSS scores, depressive symptoms declined over time in those who completed the trial, independent of abstinence status, and either declined or remained unchanged in those with major depressive disorder or prior suicide attempt or who were taking antidepressant medication. Those who did not complete the trial had no change in depressive symptoms.

Discussion: Depressive symptoms declined in adults with schizophrenia during 12 weeks of varenicline treatment and cognitive behavioral therapy, independent of tobacco abstinence. Smokers with SSD who have significant depressive symptoms may be successful in smoking cessation attempts with pharmacotherapeutic aids such as varenicline while maintaining stable psychiatric symptoms. This is a secondary analysis of data collected as part of a clinical trial registered as NCT00621777, at www.clinicaltrials.gov .

Keywords: Schizophrenia; abstinence; depressive symptoms; major depressive disorder; nicotine; smoking cessation; varenicline.

Figure 1.

Weekly depressive symptom severity ratings during 12-week smoking cessation attempt. Note. CDSS = Calgary Depression Scale for Schizophrenia (total score range: 0–27); M = mean; SD = standard deviation. Weekly depressive symptom ratings are presented by A: end of treatment abstinence status; B: severity of depressive symptoms at baseline; and C: lifetime suicide attempt.

Figure 2.

Severity of depressive symptoms at screening and one week following the quit date (study week 4) by abstinence status in the week following the quit date. Note. CDSS = Calgary Depression Scale for Schizophrenia (total score range: 0–27); SE = standard error.

Figure 3.

Weekly incidence of depressive symptom worsening compared to baseline. Note. CDSS = Calgary Depression Scale for Schizophrenia (total score range: 0–27).