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Cited by 72Bipolar Disorder and TreatmentSmoking Behavior and CessationSchizophrenia research and treatment

Going up in smoke: tobacco smoking is associated with worse treatment outcomes in mania

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Berk, Michael, Ng, Felicity, Wang, Wei V., Tohen, Mauricio, Lubman, Dan I., Vieta, Eduard, Dodd, Seetal·2008·Journal of Affective Disorders
DOI 10.1016/j.jad.2008.01.018
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Abstract

Background This study aimed to compare the treatment responses between smokers and non-smokers in bipolar mania clinical trials.Methods Post-hoc analysis was conducted on data collected from three double-blind, randomised controlled trials in bipolar mania that had similar inclusion criteria. Patients were randomised to olanzapine (N=70) or placebo (N=69) for 3 weeks in Trial 1, olanzapine (N=234) or haloperidol (N=216) for 12 weeks in Trial 2, and olanzapine (N=125) or divalproex (N=126) for 47 weeks in Trial 3. This study analysed the Young Mania Rating Scale (YMRS) total scores and Clinical Global Impressions scale for bipolar disorder (CGI-BP) mania severity scores between smokers and non-smokers for each trial and for the pooled data from all three trials, using a mixed-effects model repeated measures approach.Results For the pooled data, non-smokers showed superior treatment outcomes on both the YMRS (P=0.002) and CGI-BP (P<0.001), as well as longer time to discontinuation for any cause utilising Kaplan-Meier survival curves. For the individual trials, non-smokers showed greater improvement than smokers on both CGI-BP and YMRS in both treatment arms of Trial 2 (CGI-BP: haloperidol P=0.011, olanzapine P=0.042; YMRS: haloperidol P=0.010, olanzapine P=0.019), and in the olanzapine arm of Trial 3 (CGI-BP: P=0.002; YMRS: P=0.006). No significant difference in outcomes was found between smokers and non-smokers in Trial 1.Limitations Post-hoc design, categorical definition of smoking status, unavailable antipsychotic drug levels, confounding effects of trial medications and substance abuse.Conclusions Smoking appears to be associated with worse treatment outcomes in mania.

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Crossref · 10.1016/j.jad.2008.01.018

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  • Smokers and non-smokers with mania of comparable severity had diverging treatment outcomes, with those who continued smoking showing overall poorer clinical outcomes compared with those who did not smoke during the trials.

    “Smokers and non-smokers with mania of comparable severity had diverging treatment outcomes, with those who continued smoking showing overall poorer clinical outcomes vs. those who did not smoke during the trials.”

    From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [69]

  • The clinical significance of CYP1A2 interactions has been demonstrated for olanzapine and haloperidol treatment in a post-hoc analysis of the Phase 3 olanzapine mania studies.

    “The clinical significance of such interactions has been demonstrated for olanzapine and haloperidol treatment in a post-hoc analysis of the Phase 3 olanzapine mania studies by Berk and colleagues (69).”

    From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [69]

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Authors
Berk, M., Ng, F., Wang, W. V., Tohen, M., Lubman, D. I., Vieta, E., & Dodd, S.
Affiliations
  • Barwon Health (AU)
  • Eli Lilly (United States) (US)
  • Harvard University (US)
  • The University of Melbourne (AU)
  • Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES)
Corresponding author
Ng, Felicity
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2008-09
Volume
110
Issue
1-2
Pages
126-134
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2008.01.018
OpenAlex
W2160708528
Cited by
72
References
34
Citations by year
2025: 3 · 2023: 2 · 2022: 2 · 2021: 1 · 2019: 4 · 2017: 1 · 2016: 3 · 2015: 11 · 2014: 3 · 2013: 6 · 2012: 13
FWCI
5.37
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Funders
  • Stanley Medical Research Institute
  • National Health and Medical Research Council
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
smoking, bipolar mania, treatment response, olanzapine, haloperidol, divalproex, antipsychotic drugs, smoking status, mania severity, treatment discontinuation
MeSH terms
Olanzapine, Adult, Benzodiazepines, Bipolar Disorder, Double-Blind Method, Female, Haloperidol, Humans, Male, Placebos, Psychiatric Status Rating Scales, Severity of Illness Index, Smoking, Antipsychotic Agents, Valproic Acid, Meta-Analysis as Topic, Comorbidity, Least-Squares Analysis, Survival Analysis, Randomized Controlled Trials as Topic, Treatment Outcome

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