Smoking cessation drugs do not increase suicide/self-harm risk

by Bruce Sylvester – taken from the BMJ – British Medical Journal – Patients prescribed the smoking cessation drugs varenicline and buproprian are not at an increased risk of suicide, self-harm and depression compared with users of nicotine replacement therapy (NRT) researchers reported on Oct. 11, 2013 in the British Medical Journal (BMJ).

Varenicline (brand name Champix in the UK, Chantix in the US) and buproprian (brand name Zyban) are  widely-used smoking cessation treatments. They work by reducing nicotine cravings and withdrawal symptoms. Bupropion is also used to treat depressive illnesses in some countries; it is not licensed for such use in the UK.  As background, the authors noted that prior concerns that these drugs might increase suicide risk had led to safety warnings by regulatory agencies, including those by the UK Medicines and Healthcare products Regulatory Agency (MHRA) and the US Food and Drug Administration (FDA).

The investigators analyzed data retrospectively from the medical records of 119,546 adults who had used a smoking cessation product between 1 September 2006 and 31 October 2011. Using linked data from the Office for National Statistics (ONS) mortality data and Hospital Episode Statistics (HES), the investigators determined the rate of treated depression, self-harm and suicide in 31,260 (26.2 per cent) of the patients prescribed varenicline, 6,741 (5.6 per cent) of the patients prescribed bupropion. They compared the findings with data from 81,545 (68.2 per cent) of the patients using nicotine replacement therapies.

Using three different analytical methods, they found no clear evidence of an increased risk of treated depression or suicidal behavior for subjects prescribed varenicline or bupropion compared to those who used nicotine replacement therapies.

“Given the concerns and accompanying safety warnings for these drugs these findings are reassuring for users and prescribers of smoking cessation medicines,” said Dr Kyla Thomas, Doctoral Research Fellow at the University of Bristol (UK) and one of the lead authors of the new study.