Varenicline Improves Smoking Abstinence in Individuals With MDD

In smokers with major depressive disorder (MDD), varenicline improved 27-week smoking cessation compared with placebo, according to recent study results from Northwestern University and the University of Pennsylvania, Philadelphia.

“Additionally, varenicline did not increase risk of adverse or serious adverse events, even among the large proportion of individuals in the sample with current, severe, untreated MDD,” wrote corresponding author Brian Hitsman PhD, of Northwestern University Feinberg School of Medicine in Chicago, Illinois, and study coauthors. “These data further increase confidence in the safety of varenicline for smokers with MDD.”

The randomized, 2 × 2 factorial trial compared behavioral activation for smoking cessation (BASC) with standard behavioral treatment and varenicline with placebo.

Some 300 adult smokers with current or past MDD received 12 weeks of either BASC or standard behavioral treatment, and either varenicline or placebo. Standard behavioral treatment was based on the 2008 US Public Health Service practice guideline, while BASC combined behavioral activation therapy with standard treatment in an aim to increase engagement in rewarding activities by reducing avoidance, withdrawal, and inactivity associated with depression. Both BASC and standard treatment were delivered in eight 45-minute sessions between weeks 1 and 12. Varenicline and placebo were administered between weeks 2 and 14.

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Follow-up took place 13 weeks after treatment was discontinued, at week 27.

Intent-to-treat abstinence rates at 27 weeks were 16.2% with varenicline compared with 7.5% with placebo, according to the study. Adverse event rates were higher for placebo than varenicline.

“However, we found no evidence that BASC was more effective than standard behavioral treatment in increasing cessation. Indeed, our findings indicate that, at least in the context of intensive treatment delivered primarily by telephone, standard behavioral treatment may even be superior to BASC when provided alone, but this potential advantage was not present when added to varenicline,” researchers reported.

Reference

Hitsman B, Papandonatos GD, Gollan JK, et al. Efficacy and safety of combination behavioral activation for smoking cessation and varenicline for treating tobacco dependence among individuals with current or past major depressive disorder: a 2 × 2 factorial, randomized, placebo-controlled trial. Published online April 17, 2023. doi:10.1111/add.16209