Smoking Multiplies Risks for Bipolar Patients

no smoking sign

Smoking is associated with a less successful outcome in the naturalistic treatment of bipolar patients, reported Seetal Dodd and colleagues at the 4th Biennial Conference of the International Society for Bipolar Disorders in Sao Paulo, Brazil in March. Nicotine dependence has also been found to be a risk factor for depressive symptoms, as reported in a recent article in the British Journal of Psychiatry.

In addition to these direct effects on mental health, smoking is also a major risk factor for cardiovascular disease when combined with the presence of any three of the five primary risk factors that constitute the metabolic syndrome. (These five factors are: increased waist circumference, high blood pressure, increased cholesterol, increased triglycerides, and insulin resistance or elevated fasting blood glucose.) Cardiovascular disease co-occurs with bipolar disorder at a high rate and is one of the major causes of decreased life expectancy in those with inadequately treated illness.

Because smoking is a powerful risk factor for comorbid illnesses such as heart attack and stroke and is itself associated with a poor clinical outcome in the treatment of bipolar disorder, every effort should be made to help patients with smoking cessation.  Suggestions after the jump.

Pharmacological treatment for assisting smoking cessation

In addition to nicotine chewing gum, patches and related products, bupropion, a drug with one of the best antidepressant profiles in bipolar patients because it does not seem to induce switches into mania, may also be helpful in smoking cessation.

A new option may also be emerging. Mark Frye and colleagues at the Mayo Clinic have been studying varenicline, a drug that stimulates a nicotine receptor subunit in the brain. The initial open study of this drug in patients with bipolar disorder found that it was generally well tolerated and effective. However, another study indicated varenicline may cause the new onset of aggressive thoughts.

Editors note: In light of the substantial incidence of smoking in patients with bipolar disorder and smoking’s negative effects on medical and psychiatric outcome, further research to find the best approaches to smoking cessation in those with bipolar disorder is needed.


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