title: Mental health status of varenicline and bupropion users during a quit attempt compared to current smokers, other quitters, and non-smokers.
abstract: BACKGROUND
  Varenicline and bupropion are commonly prescribed non-nicotine containing smoking cessation agents. Post-marketing reports suggest an increased incidence of psychiatric disturbances associated with varenicline and bupropion. However, pre-existing psychiatric disorders may confound the association between these smoking cessation agents and psychiatric disturbances. We compared the mental health status of individuals using varenicline or bupropion to that of people quitting without medication, current smokers, and non-smokers while controlling for pre-existing conditions.
  
  
  METHODS
  A cross-sectional design was used. Data were from 2006-2011 Medical Expenditure Panel Survey. Mental health status was assessed using the mental component summary (MCS) from the 12-item Short Form survey (SF-12v2), 2-item Patient Health Questionnaire (PHQ-2), and Kessler 6 Scale (K6). Differences in MCS score were compared using linear regression. Logistic regressions were used to compare positive screenings for depression using PHQ-2 and for psychological distress using K6.
  
  
  RESULTS
  Of 578 use episodes, 453 (78.38%) were bupropion and 125 (21.62%) were varenicline. After adjusting for potential confounders, mental health status of varenicline users was not different from current smokers or people who quit smoking without medication, but worse than non-smokers; bupropion was strongly associated with lower mental health status relative to all groups across all three measures.
  
  
  CONCLUSIONS
  Varenicline was not associated with worse mental health compared to smokers or those who quit without medication, after adjusting for pre-existing psychiatric disorders. Bupropion was associated with worse mental health status than smokers, former smokers who quit without medication, and nonsmokers, even after adjusting for pre-existing psychiatric disorders.
authors.affiliation: Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Anand R
authors.initials: AR
authors.lastname: Shewale
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Mrudula S
authors.initials: MS
authors.lastname: Borse
authors.affiliation: Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, KY, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Brown
authors.affiliation: Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Electronic address: Cli@uams.edu.
authors.forename: Chenghui
authors.initials: C
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016642:Bupropion / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology*; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000627:therapeutic use; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D000068580:Varenicline / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D018722:Nicotinic Agonists; D016642:Bupropion; D000068580:Varenicline
keywords: Bupropion; Depression; Mental health; Psychiatric disturbances; Varenicline