ArticleBMJ (Clinical research ed.)2013
Smoking cessation treatment and risk of depression, suicide, and self harm in the Clinical Practice Research Datalink: prospective cohort study.
Article in BMJ (Clinical research ed.), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02681848 (What Are the Effects of Varenicline Compared With Nicotine Replacement Therapy on Long Term Smoking Cessation and Clinically Important Outcomes?), which is not on this map. Cited by 59 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
What Are the Effects of Varenicline Compared With Nicotine Replacement Therapy on Long Term Smoking Cessation and Clinically Important Outcomes?
Who cites it
59 citing papers in PubMed, 5 syntheses or guidelines pooled it, 121 citations in OpenAlex.
- Comparative clinical effectiveness and safety of tobacco cessation pharmacotherapies and electronic cigarettes: a systematic review and network meta-analysis of randomized controlled trials.Addiction (Abingdon, England) · 2022Pooled it
- Nicotine receptor partial agonists for smoking cessation.The Cochrane database of systematic reviews · 2016Pooled it
- Non-psychotropic medication and risk of suicide or attempted suicide: a systematic review.BMJ open · 2016Pooled it
- Risk of neuropsychiatric adverse events associated with varenicline: systematic review and meta-analysis.BMJ (Clinical research ed.) · 2015Pooled it
- Antidepressants for smoking cessation.The Cochrane database of systematic reviews · 2014Pooled it
- Smoking Cessation and Changes in Anxiety and Depression in Adults With and Without Psychiatric Disorders.JAMA network open · 2023Trial
- Flexible, dual-form nicotine replacement therapy or varenicline in comparison with nicotine patch for smoking cessation: a randomized controlled trial.BMC medicine · 2016Trial
- Smoking cessation for people with severe mental illness: systematic review and network meta-analysis.BMJ medicine · 2026Article
- A scoping review of routinely collected linked data in research on gambling harm.NPJ digital medicine · 2025Article
- Reading and conducting instrumental variable studies: guide, glossary, and checklist.BMJ (Clinical research ed.) · 2024Article
- Using primary care databases for addiction research: An introduction and overview of strengths and weaknesses.Addictive behaviors reports · 2022Review
- Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and risk of depression among older people with hypertension.Journal of psychopharmacology (Oxford, England) · 2022Article
- Risk of neuropsychiatric adverse events associated with varenicline treatment for smoking cessation among Dutch population: A sequence symmetry analysis.Pharmacoepidemiology and drug safety · 2022Article
- Safety and Effectiveness of Varenicline in Korean Smokers: A Nationwide Post-Marketing Surveillance Study.Patient preference and adherence · 2022Article
- Trends in Incident Varenicline Prescribing Among Veterans Following the US Food and Drug Administration Drug Safety Warnings.The Journal of clinical psychiatry · 2021Article
- Comparison of Cardiovascular Safety for Smoking Cessation Pharmacotherapies in a Population-Based Cohort in Australia.JAMA network open · 2021Article
- Risk of neuropsychiatric and cardiovascular adverse events following treatment with varenicline and nicotine replacement therapy in the UK Clinical Practice Research Datalink: a case-cross-over study.Addiction (Abingdon, England) · 2021Article
- Article
- Varenicline versus nicotine replacement therapy for long-term smoking cessation: an observational study using the Clinical Practice Research Datalink.Health technology assessment (Winchester, England) · 2020Observational
- Prescribing Prevalence, Effectiveness, and Mental Health Safety of Smoking Cessation Medicines in Patients With Mental Disorders.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2020Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo compare the risk of suicide, self harm, and depression in patients prescribed varenicline or bupropion with those prescribed nicotine replacement therapy.
designProspective cohort study within the Clinical Practice Research Datalink.
setting349 general practices in England.
participants119,546 men and women aged 18 years and over who used a smoking cessation product between 1 September 2006 and 31 October 2011. There were 81,545 users of nicotine replacement products (68.2% of all users of smoking cessation medicines), 6741 bupropion (5.6%), and 31,260 varenicline (26.2%) users.
main outcome measuresOutcomes were treated depression and fatal and non-fatal self harm within three months of the first smoking cessation prescription, determined from linkage with mortality data from the Office for National Statistics (for suicide) and Hospital Episode Statistics data (for hospital admissions relating to non-fatal self harm). Hazard ratios or risk differences were estimated using Cox multivariable regression models, propensity score matching, and instrumental variable analysis using physicians' prescribing preferences as an instrument. Sensitivity analyses were performed for outcomes at six and nine months.
resultsWe detected 92 cases of fatal and non-fatal self harm (326.5 events per 100,000 person years) and 1094 primary care records of treated depression (6963.3 per 100,000 person years). Cox regression analyses showed no evidence that patients prescribed varenicline had higher risks of fatal or non-fatal self harm (hazard ratio 0.88, 95% confidence interval 0.52 to 1.49) or treated depression (0.75, 0.65 to 0.87) compared with those prescribed nicotine replacement therapy. There was no evidence that patients prescribed bupropion had a higher risk of fatal or non-fatal self harm (0.83, 0.30 to 2.31) or of treated depression (0.63, 0.46 to 0.87) compared with patients prescribed nicotine replacement therapy. Similar findings were obtained using propensity score methods and instrumental variable analyses.
conclusionsThere is no evidence of an increased risk of suicidal behaviour in patients prescribed varenicline or bupropion compared with those prescribed nicotine replacement therapy. These findings should be reassuring for users and prescribers of smoking cessation medicines.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.