title: Varenicline and risk of psychiatric conditions, suicidal behaviour, criminal offending, and transport accidents and offences: population based cohort study.
abstract: OBJECTIVE
  To examine associations between varenicline and the incidence of a range of adverse outcomes.
  
  
  METHODS
  Population based cohort study using within person analyses to control for confounding by indication.
  
  
  METHODS
  Whole population of Sweden.
  
  
  METHODS
  7,917,436 people aged 15 and over, of whom 69,757 were treated with varenicline between 2006 and 2009.
  
  
  METHODS
  Incidence of new psychiatric conditions, suicidal behaviour, suspected and convicted criminal offending, transport accidents, and suspected and convicted traffic offences.
  
  
  RESULTS
  In the whole population, 337,393 new psychiatric conditions were diagnosed during follow-up. In addition, 507,823 suspected and 338,608 convicted crimes, 40,595 suicidal events, 124,445 transport accidents, and 99,895 suspected and 57,068 convicted traffic crimes were recorded. Within person analyses showed that varenicline was not associated with significant hazards of suicidal behaviour, criminal offending, transport accidents, traffic offences, or psychoses. However, varenicline was associated with a small increase in the risk of anxiety conditions (hazard ratio 1.23, 95% confidence interval 1.01 to 1.51) and mood conditions (1.31, 1.06 to 1.63), which was only seen in people with pre-existing psychiatric disorders.
  
  
  CONCLUSIONS
  Concerns that varenicline is associated with an increased risk of many adverse outcomes, including suicidality and accidents, are not supported in this observational study. The small increase in risk of two psychiatric conditions in people with pre-existing psychiatric disorders needs to be confirmed using other research designs.
authors.affiliation: Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, 171 76 Stockholm, Sweden.
authors.forename: Yasmina
authors.initials: Y
authors.lastname: Molero
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm.
authors.forename: Paul
authors.initials: P
authors.lastname: Lichtenstein
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm.
authors.forename: Johan
authors.initials: J
authors.lastname: Zetterqvist
authors.affiliation: Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, 171 76 Stockholm, Sweden.
authors.forename: Clara Hellner
authors.initials: CH
authors.lastname: Gumpert
authors.affiliation: Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK seena.fazel@psych.ox.ac.uk.
authors.forename: Seena
authors.initials: S
authors.lastname: Fazel
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001552:Benzazepines / Q000009:adverse effects*; D015331:Cohort Studies; D003415:Crime / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced*; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000009:adverse effects*; D011810:Quinoxalines / Q000009:adverse effects*; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000209:etiology; D013405:Suicide / Q000706:statistics & numerical data*; D061485:Tobacco Use Cessation Devices / Q000009:adverse effects / Q000706:statistics & numerical data; D000068580:Varenicline; D055815:Young Adult
chemical_list: D001552:Benzazepines; D018722:Nicotinic Agonists; D011810:Quinoxalines; D000068580:Varenicline