The adverse effects of smoking on health outcomes in bipolar disorder: a review and synthesis of biological mechanisms
Abstract
Several biological systems are implicated in the neuroprogression of bipolar disorder including but not limited to cytokine levels, oxidative stress markers, monoamine levels, tryptophan catabolite and glutamate-mediated excitotoxicity, microglial activation as well as structural and functional changes. The high rate of smoking behaviour in individuals with bipolar disorder provides the impetus for exploring shared and discrete pathogenetic mechanisms. In addition to contributing to increased mortality, smoking activates several neurobiological effector systems implicated in the progression of bipolar disorder. Here, a narrative review provides evidence and putative mechanisms of comorbid effects of BD, cigarette use, and nicotine dependence, and discusses the clinical implications of these interactions.
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Tobacco smoke promotes neuroprogression in bipolar disorder via oxidative and nitrosative stress pathways, increasing oxidative burden, triggering reactive nitrogen species and reactive oxygen species, excitotoxicity and mitochondrial dysfunction.
“In addition, tobacco smoke promotes neuroprogression in BD via several possible pathways leading to cumulative effects; particularly oxidative and nitrosative stress pathways where it increases the oxidative burden, further triggers reactive nitrogen species (RNS, e.g., nitric oxide) and reactive oxygen species (ROS) effects of excitotoxicity and mitochondrial dysfunction.”
From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [22]
Nicotine and the free radicals contained in cigarette smoke activate several neurobiological effector systems implicated in the neuroprogression of bipolar disorder.
“Nicotine and the free radicals contained in cigarette smoke activate several neurobiological effector systems implicated in the neuroprogression of BD (22).”
From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [22]
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A real-world population-based study on the association between cataracts and antipsychotics
Lakhani, M., Kwan, A. T. H., Chaudry, E., Popovic, M. M., Xie, J. S., Rai, A., Rai, A. S., Margolin, E., & McIntyre, R. S. (2025) · Canadian Journal of Ophthalmology · doi:10.1016/j.jcjo.2025.05.021 · Cited by 6 · see citing works
Self-citationRognli, E. B., Bramness, J. G., & von Soest, T. (2021) · Psychological Medicine · doi:10.1017/s0033291720005401 · Cited by 6 · see citing works
Smoking and the Association with Mental Health
Isse, A. M. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.104233 · Cited by 3 · see citing works
Howland, M., Mahajan, A., Chen, P., Almeida, O. P., Altınbaş, K., Blumberg, H. P., Dols, A., Fiorelli, N. M., Forlenza, O. V., Lafer, B., et al. (2025) · The Canadian Journal of Psychiatry · doi:10.1177/07067437251387658 · Cited by 2 · see citing works
Bassiony, M. M., Ibrahim, E. F., & Youssef, U. M. (2020) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-019-00170-6 · Cited by 2 · see citing works
de Paiva, L. L. L., Teixeira, L. M., & Figueira, O. A. (2022) · Brazilian Journal of Health Review · doi:10.34119/bjhrv5n6-226
- Authors
- Slyepchenko, A., Brunoni, A. R., McIntyre, R. S., Quevedo, J., & Carvalho, A. F.
- Affiliations
- Universidade Federal do Ceará (BR)
- Venue
- Current Molecular Medicine
- Publisher
- Bentham Science Publishers Ltd.
- Published
- 2016-02-04
- Volume
- 16
- Issue
- 2
- Pages
- 187-205
- ISSN
- 1566-5240 (ISSN-L)
- OpenAlex
- W2252384097
- Cited by
- 14
- References
- 180
- Citations by year
- 2025: 2 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 1 · 2017: 3 · 2016: 1
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Molecular Medicine (publishedVersion)
- PubMed (publishedVersion)
- 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
- bipolar disorder, smoking, nicotine dependence, neuroprogression, cytokines, oxidative stress, monoamines, tryptophan metabolism, glutamate excitotoxicity, microglial activation, neuroinflammation, mortality, comorbidities
- MeSH terms
- Bipolar Disorder, Humans, Smoking, Biomarkers, Treatment Outcome, Oxidative Stress, Epigenesis, Genetic
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