Pharmacological interventions for smoking cessation in patients with bipolar disorder.

Abstract

Background: Bipolar disorder (BD) is a chronic mental illness associated with increased premature mortality. Tobacco use is highly prevalent in BD and contributes substantially to physical morbidity.

Objective: To critically appraise the evidence on pharmacological interventions for smoking cessation in patients with BD.

Methods: A structured narrative review was conducted in PubMed, The Cochrane Library, and Web of Science, including studies published between January 1985 and March 2025. Original studies evaluating pharmacological smoking cessation treatments in patients diagnosed with BD according to DSM or ICD criteria were included. Due to clinical and methodological heterogeneity, no meta-analysis was performed.

Results: Fifteen studies were included. Most trials evaluated patients with BD within broader psychiatric cohorts. Varenicline showed higher abstinence rates than placebo, with odds ratios ranging approximately from 3.0 to 8.1 in randomized trials, and was superior to bupropion and nicotine replacement therapy (NRT) in several large studies. Bupropion and NRT were generally more effective than placebo, although results were less consistent. Treatments were generally well tolerated, without increased severe neuropsychiatric adverse events.

Conclusions: Pharmacological interventions, particularly varenicline, appear effective and generally safe for smoking cessation in BD, especially when combined with behavioral support. Evidence remains heterogeneous, highlighting the need for BD-specific trials.