Cited by 30Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesSchizophrenia research and treatment

Pharmacological and behavioural interventions to promote smoking cessation in adults with schizophrenia and bipolar disorders: a systematic review and meta-analysis of randomised trials

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Pearsall, Robert, Smith, Daniel J, Geddes, John R·2019·BMJ Open

Abstract

OBJECTIVE: Smoking in people with serious mental illness is a major public health problem and contributes to significant levels of morbidity and mortality. The aim of the review was to systematically examine the efficacy of methods used to aid smoking cessation in people with serious mental illness. METHOD: A systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of pharmacological and behavioural programmes for smoking cessation in people with serious mental illness. Electronic databases were searched for trials to July 2018. We used the Cochrane Collaboration's tool for assessing the risk of bias. RESULTS: Twenty-eight randomised controlled trials were identified. Varenicline increased the likelihood of smoking cessation at both 3 months (risk ratio (RR) 3.56, 95% CI 1.82 to 6.96, p=0.0002) and at 6 months (RR 3.69, 95% CI 1.08 to 12.60, p=0.04). Bupropion was effective at 3 months (RR 3.96, 95% CI 1.86 to 8.40, p=0.0003), especially at a dose of 300 mg/day, but there was no evidence of effect at 6 months (RR 2.22, 95% CI 0.52 to 9.47, p=0.28). In one small study, nicotine therapy proved effective at increasing smoking cessation up to a period of 3 months. Bupropion used in conjunction with nicotine replacement therapy showed more effect than single use. Behavioural and bespoke interventions showed little overall benefit. Side effects were found to be low. CONCLUSION: The new information of this review was the effectiveness of varenicline for smoking cessation at both 3 and 6 months and the lack of evidence to support the use of both bupropion and nicotine products for sustained abstinence longer than 3 months. Overall, the review found relatively few studies in this population.

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  • All three pharmacological interventions (bupropion, varenicline, nicotine replacement therapy) are by large equally effective for tobacco use disorder or nicotine dependence.

    “but with all three pharmacological interventions (bupropion, varenicline, NRT) being, by large, equally effective for TUD or ND (80)”

    From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [80]

    The Results section reports different three-month effects: bupropion and varenicline each had a number needed to treat of 6, while NRT had a number needed to treat of 15 and was described as the least effective. The Discussion also calls varenicline the most successful treatment and says evidence does not support bupropion or nicotine products for cessation beyond three months. The review therefore does not support describing all three as broadly equally effective. (LLM, conf=0.89)

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Research works printed but not linked: 7

  1. [19]Higgins JPT, Green S Cochrane handbook for systematic reviews of interventions. England: Wiley-Blackwell, 2008.
  2. [39]Wing VC, Bacher I, Daskalakis ZJ, et al A preliminary study of repetitive transcranial magnetic stimulation for smoking cessation in schizophrenia. Neuropsychopharmacology 2010; 35: S163.
  3. [49]George TP, Vessicchio JC, Termine A, et al A placebo controlled trial of bupropion for smoking cessation in schizophrenia. Biol Psychiatry 2002; 52: 53– 61. 10.1016/S0006-3223(02)01339-2 12079730 · DOI
  4. [51]Akbarpour F, Rezaei O, Khodaie-Ardakani M-, et al A double-blind placebo-controlled trial of bupropion for smoking abstinence and cognition improvement in schizophrenia. Minerva Psichiatr 2010; 51: 263– 9.
  5. [55]Hong E Moderate dose varenicline treatment on neurobiological and cognitive biomarkers in schizophrenia smokers and non-smokers. Neuropsychopharmacology 2011; 36: S97– S98.
  6. [56]George TP, Ziedonis DM, Feingold A, et al Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. Am J Psychiatry 2000; 157: 1835– 42. 10.1176/appi.ajp.157.11.1835 11058482 · DOI
  7. [58]Szombathyne-Meszaros Z, Dimmock JA, Ploutz-Snyder R, et al Oral naltrexone treatment for alcohol dependence in schizophrenia is not effective for smoking cessation. Alcoholism: Clinical and Experimental Research 2010; 34: 176A.

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Authors
Pearsall, R., Smith, D. J., & Geddes, J. R.
Affiliations
  • Monklands Hospital (GB)
  • University of Oxford (GB)
Corresponding author
Pearsall, Robert
Venue
BMJ Open
Publisher
BMJ
Published
2019-11
Volume
9
Issue
11
Pages
e027389
ISSN
2044-6055 (ISSN-L)
OpenAlex
W2948759959
Cited by
30
References
53
Citations by year
2026: 3 · 2025: 2 · 2023: 4 · 2022: 8 · 2021: 9 · 2020: 4
FWCI
0.62
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • Sanofi
  • National Institute for Health and Care Research
  • Medical Research Council
  • Economic and Social Research Council
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
smoking cessation, schizophrenia, bipolar disorder, severe mental illness, varenicline, bupropion, nicotine replacement therapy, behavioral interventions, pharmacological interventions, nicotine dependence, sustained abstinence
MeSH terms
Adult, Behavior Therapy, Bipolar Disorder, Humans, Schizophrenia, Randomized Controlled Trials as Topic, Smoking Cessation

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