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Objective: We conducted a prospective cohort study of the CPRD to estimate rates of varenicline and nicotine replacement therapy (NRT) prescribing and the relative effects on smoking cessation, and mental health.

Methods: We used multivariable logistic regression, propensity score matching and instrumental variable analyses. Exposure was varenicline or NRT prescription. Mental disorders were: bipolar; depression, neurotic disorder, schizophrenia, or prescriptions of antidepressants, antipsychotics, hypnotics/anxiolytics, mood stabilisers. Outcomes were: smoking cessation, and incidence of neurotic disorder, depression, prescription of antidepressants, or hypnotics/anxiolytics. Follow-ups were 3, 6, and 9-months, and at 1, 2 and 4-years. NRT and varenicline prescribing declined overtime.

Results: In all patients, NRT and varenicline prescribing declined overtime. 78,457 smokers with mental disorders aged ≥18 years were prescribed NRT (N=59,340) or varenicline (N=19,117) from September/01/2006 to December/31/2015. Compared to smokers without mental disorders, smokers with mental disorders had 31% (95%CI: 29% to 33%) lower odds of being prescribed varenicline relative to NRT, but had 19% (95%CI: 15% to 24%) greater odds of quitting at 2-years when prescribed varenicline relative to NRT. Overall, varenicline was associated with decreased or similar odds of worse mental health outcomes than NRT in patients both with and without mental disorders, although there were some differences within subgroups.

Conclusions: Smoking cessation medication prescribing may be declining in primary care. Varenicline was more effective than NRT for smoking cessation in patients with mental disorders and there is not clear consistent evidence that it is adversely associated with poorer mental health outcomes.

Implications: Patients with mental disorders were less likely to be prescribed varenicline than NRT. We triangulated results from three analytical techniques. We found that varenicline was more effective than NRT for smoking cessation in patients with mental disorders. Varenicline was generally associated with similar or decreased odds of poorer mental health outcomes than NRT. We report these findings cautiously as our data are observational and are at risk of confounding.
Original languageEnglish
Article numberntz072
Number of pages11
JournalNicotine and Tobacco Research
Early online date10 Jul 2019
Publication statusE-pub ahead of print - 10 Jul 2019

Bibliographical note

© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.

Structured keywords

  • Brain and Behaviour
  • Tobacco and Alcohol
  • Physical and Mental Health


  • smoking
  • mental health
  • varenicline
  • nicotine replacement therapy

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