title: Effects of varenicline, nicotine or placebo on depressive symptoms in postmenopausal smokers.
abstract: BACKGROUND
  Varenicline carries a black box warning for neuropsychiatric adverse events.
  
  
  OBJECTIVE
  We examined varenicline use and past history of major depressive disorder (MDD) on depressive symptoms during smoking cessation.
  
  
  METHODS
  This is a secondary analysis of two smoking cessation studies in 152 postmenopausal women who received placebo or nicotine patch, or 78 women who received varenicline with relaxation. Lifetime history of MDD (LH-MDD) was assessed at baseline and women with current MDD were excluded. Center for Epidemiologic Study Depression scale (CESD) measured depressive symptoms at baseline, 6 and 12 weeks.
  
  
  RESULTS
  Baseline CESD scores were 5.3 + 4.4. Those with a LH-MDD reported higher CESD scores (p > .001). Those taking varenicline reported lower scores over all time periods compared to nicotine or placebo (p < .01). The differences between varenicline and the other treatments remained when controlling for LH-MDD, indicating an independent effect. CESD scores were associated with concurrent smoking status (p < .001), and with withdrawal symptoms (p < .001).
  
  
  CONCLUSIONS
  CESD score were lower in those receiving varenicline, whether this is due to an anti-depressant effect, subject selection, use of relaxation or another cause is unknown. Varenicline does not increase depressive symptoms during smoking cessation in postmenopausal women without current MDD. Subjects with a LH-MDD are susceptible to developing depressive symptoms during smoking cessation, regardless of pharmacologic aid.
  
  
  CONCLUSIONS
  Pharmacologic aids did not increase depression symptoms in this select population of postmenopausal women without current depression. Smoking cessation does increase depressive symptoms in those with LH-MDD, though the degree of increase was not clinically meaningful.
authors.affiliation: Center on Aging, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: Naomi
authors.initials: N
authors.lastname: Avery
authors.forename: Anne M
authors.initials: AM
authors.lastname: Kenny
authors.forename: Alison
authors.initials: A
authors.lastname: Kleppinger
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brindisi
authors.forename: Mark D
authors.initials: MD
authors.lastname: Litt
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Oncken
mesh_terms: D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003863:Depression / Q000139:chemically induced* / Q000523:psychology; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009538:Nicotine / Q000009:adverse effects / Q000627:therapeutic use*; D018722:Nicotinic Agonists / Q000627:therapeutic use; D010919:Placebos; D017698:Postmenopause / Q000523:psychology*; D011810:Quinoxalines / Q000009:adverse effects / Q000627:therapeutic use*; D012064:Relaxation Therapy; D012907:Smoking / Q000188:drug therapy* / Q000523:psychology* / Q000628:therapy; D016540:Smoking Cessation / Q000523:psychology*; D013375:Substance Withdrawal Syndrome / Q000523:psychology; D061485:Tobacco Use Cessation Devices / Q000009:adverse effects; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D018722:Nicotinic Agonists; D010919:Placebos; D011810:Quinoxalines; D009538:Nicotine; D000068580:Varenicline