Mental health stability in veterans with posttraumatic stress disorder receiving varenicline

Purpose. The effects of varenicline treatment for smoking cessation on mental health (MH) stability in veterans with post-traumatic stress disorder (PTSD) was studied. Methods. Data were collected by retrospective chart review at a Veterans Affairs medical center. Patients with PTSD who were prescribed varenicline for smoking cessation between May 2006 and July 2008 were included; all patients had failed previous attempts to quit using nicotine replacement therapy, bupropion, or both. The average numbers of encounters per month with MH professionals in a six-month baseline period before varenicline, during treatment, and after treatment were compared. The numbers of MH encounters were compared for patients with multiple MH disorders including major depressive disorder, schizophrenia, or bipolar disorder and those with PTSD alone. Patients who had completed a full course of varenicline therapy (4-12 weeks) without MH decompensation were surveyed to determine the rate of smoking cessation. Results. Data were analyzed for 78 patients. MH encounters during varenicline therapy increased 29% over baseline. There was no significant difference in the numbers of encounters in the baseline and postvarenicline periods. MH decompensations were documented for 4 patients during varenicline therapy and 2 after completion of therapy. Before, during, and after varenicline, patients with multiple MH disorders had significantly more MH encounters than those with PTSD alone. Of the 42 patients in the follow-up survey, 19 (45%) said they refrained from smoking for 30 days and 13(31%) for 90 days. Conclusion. Varenicline appeared to have destabilizing effects on MH in veterans with PTSD.