Extended therapy with varenicline reduces rates of smoking relapse in people with serious mental health issues

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People with serious mental health issues such as schizophrenia have higher rates of cigarette smoking than the general population, with estimates suggesting more than 50% are current smokers. When people in this population do manage to quit during treatment we then see particularly high rates of relapse after treatment ends.

A new randomised control trial (Evins et al , 2014) was published in JAMA last month as part of a special issue on “50 years of tobacco control”. The RCT aimed to reduce relapse rates in smokers with schizophrenia and bipolar disorder. The researchers provided an extended treatment programme of varenicline (also known as Champix) and assessed whether patients achieved longer abstinence from cigarettes compared to placebo.

Varenicline partially stimulates nicotine receptors in the brain, thereby reducing the strong cigarette cravings and withdrawal symptoms abstinent smokers experience, while also reducing the pleasurable effects of smoking. A typical course lasts 12 weeks, but in this trial patients were given an extended ‘maintenance’ dose for one year.

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My husband and I are thinking about trying Champix to quit smoking.

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People are always talking about how schizophrenics smoke more than the normal population. It’s because of stress. Mental illness is stressful and people under stress smoke more often.

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There was a period in my life when I was not doing so well - I was destabilized with psychosis and mixed episodes. It seemed like my brain was craving nicotine, it has to be some thing bio chemical, because I was picking up one cigarette after another, chain smoking, I could not stop. Its seems like my brain was missing something, and the cigarettes/nicotine fulfilled that for me