Table 1.
Clinical Studies of Cigarette Smoking in Patients With Bipolar Disorder
| Study | Design | Results |
|---|---|---|
| Wu et al. (2012) | Randomized, double-blind, placebo-controlled trial of varenicline in 5 smokers with bipolar disorder | One smoker in the varenicline group (n=3) quit, and one reduced smoking |
| Placebo treatment was associated with dropout and hypomania. | ||
| Prochaska et al. (2011) | Online survey of 685 persons with bipolar disorder who smoked ≥100 cigarettes lifetime | 74% expressed an intention to quit, which was unrelated to current mental health symptoms. |
| Only 33% were advised to quit by a mental health provider. | ||
| Higher proportion of former versus current smokers (57 vs. 40%) described mental health stability (p=0.011). | ||
| Dodd et al. (2010) | Prospective study of self-reported tobacco smoking and mental health outcomes in 240 subjects with bipolar and schizoaffective disorders during a 24-month period | Daily smokers had poorer outcomes on CGI Overall and Depression Score scales than non-daily smokers. |
| Daily smokers had longer length of stays than non-daily smokers. | ||
| Ostacher et al. (2009) | Prospective study of the association between cigarette smoking and suicidality in people with bipolar disorder | A higher proportion of smokers versus non-smokers made a suicide attempt during the 9-month observation period (16.1 versus 3.5%; OR=5.25, CI [1.2,23.5]). |
| Baethe et al. (2009) | Retrospective review of 352 Sardinian patients with bipolar I and II disorder and association between cigarette smoking and suicidal acts | Current smoking was associated with higher rates of suicidal acts compared to non-smoking status. |
| Higher consumption was positively correlated with suicidal behaviors compared to lower consumption. | ||
| Law et al. (2009) | Cross-sectional study of the relationship between smoking status and cognitive function in 43 patients with bipolar disorder | No differences in neuropsychological performance between smokers (n=16) and non-smokers (n=27). |
| Presence of tobacco smoking was associated with poorer pre-morbid IQ performance. | ||
| Heffner et al. (2008) | Survey of 134 adolescents with bipolar disorder who were hospitalized for a first manic episode | 45.5% were smokers |
| Smokers were more likely to report cannabis and alcohol use, and an earlier onset of bipolar disorder than non-smokers. | ||
| Characteristics of bipolar illness (age of onset, symptom severity, psychosis, rapid cycling) were not linked with smoking status. | ||
| Goldstein et al. (2008) | Cross-sectional survey of smoking status (Never, Ever and Daily smoking) and mental illness history in 441 youth with bipolar disorder. | Daily and ever smokers had greater occurrence of lifetime suicide attempts, physical abuse, conduct disorder and SUDs compared to never smokers. |
| Heavy daily smokers had higher SUD prevalence, depression and suicide attempts compared to light daily smokers. | ||
| Weinberger et al. (2008) | Randomized, double-blind, placebo-controlled trial of bupropion SR in 5 smokers with bipolar disorder | Two smokers in the bupropion SR group either quit or reduced smoking |
| Placebo treatment was associated with dropout and occurrence of hypomania. | ||
| Waxmonsky et al. (2005) | Cross-sectional study of cigarette smoking and clinical correlates of bipolar disorder in 1,904 people with bipolar disorder participating in the STEP-BD study. | 31.2% of participants were smokers. |
| Smokers were more likely than non-smokers to be male, poor, and less educated. | ||
| Smokers were also more likely than non-smokers to have SUDs or other psychiatric comorbidity, more rapid cycling features, and more depressive or manic episodes and symptom severity. | ||
| Cassidy et al. (2002) | Survey of 67 recently admitted inpatients with bipolar I disorder (with manic or mixed states) regarding smoking and psychosis outcomes. | No correlations between cigarette smoking and any psychosis outcomes. |
| Corvin et al. (2001) | Cross-sectional study assessed cigarette smoking and psychopathology in 92 patients with bipolar disorder in Dublin, Ireland. | Strong relationship between smoking consumption and severity of psychosis in bipolar patients. |
Note. CGI = Clinical Global Impression; STEP-BD = Systematic Treatment Enhancement Program for Bipolar Disorder; SUD = Substance Use Disorder.