There is no commonly accepted standard for comparing antidepressant-induced side effects. This study evaluates a clinician-administered scale, the Toronto Side Effect Scale (TSES), in a natural practice clinic.
We used the TSES to assess side effects in 193 depression patients who completed 8 weeks of treatment with either bupropion, moclobemide, paroxetine, sertraline, or venlafaxine.
Rates of remission (Hamilton Rating Scale for Depression [HRSD]
Since the addition of bupropion slow release (Zyban, GlaxoSmithKline, Mississauga) to the Department of National Defence (DND) smoking cessation program (Butt Out), utilizing bupropion (Zyban) in combination with behaviour modification counselling, the Directorate of Medical policy has received several anecdotal reports from pharmacists and Canadian Forces members attributing significant side effects to the use of Zyban. As a result, the DND wished to assess the benefits versus the risks of using Zyban as part of the smoking cessation program. Subsequently, a retrospective review of the use of Zyban within the Canadian Forces over a one-year period was solicited to assess current policies.
Surveys were sent to Canadian Forces members receiving Zyban between September 1, 1998 and August 31, 1999. Members were questioned about smoking history and current status, perceived effectiveness of bupropion and both positive and negative experiences with the drug. Those reporting side effects and who had consented were contacted for an interview to obtain further details and information regarding the use of medical resources and effects on job performance. Members of the Canadian Forces visiting a doctor due to side effects were asked for permission to review their medical charts.
Zyban was dispensed to approximately 1171 members over the one-year period and 357 responded to the survey. The point prevalence smoking cessation rate was 47% at the time of the survey and ex-smokers had been smoke-free for a mean of 181 days. Approximately 91% of ex-smokers and 52% of smokers found Zyban helpful in quitting. Side effects were reported by 252 members and 160 interviews were completed. Forty-three interviewees had seen a doctor because of side effects. Sixteen of the 43 charts were audited. Fifty-two respondents stated that side effects affected their ability to do their primary job. Two individuals were hospitalized for a total of six days.
In light of the demonstrated effectiveness of Zyban and the overwhelming health benefits associated with smoking cessation, it is recommended that the current policies of funding for the DND smoking cessation program be left in place. The impact of Zyban's side effects on job performance and medical resources should be minimized through close monitoring and Zyban prescriptions should be dispensed in two-week quantities.
To investigate whether varenicline use was associated with increased risk of psychiatric adverse events, compared with bupropion, another drug used for smoking cessation.
We conducted a registry-based cohort study in Denmark, 2007-10, comparing new users of varenicline and bupropion in unmatched and 1 : 1 propensity score-matched analyses.
Using Cox regression, we estimated the hazard ratio (HR) of any psychiatric adverse event (emergency department visit or in-patient admission with a psychiatric diagnosis) within 30 days following treatment initiation. The unmatched and matched analyses correspond to conventional crude and fully adjusted analyses, respectively.
In unmatched analyses, there were 106 (0.18%) psychiatric adverse events among 59 790 varenicline users (rate 22 events per 1000 person-years), compared with 46 (0.26%) events among 17 936 bupropion users (rate 31 per 1000); the HR was 0.69 [95% confidence interval (CI): 0.49-0.98]. In propensity score-matched analyses, 39 (0.22%) events occurred among 17 935 varenicline users (rate 27 per 1000), compared with 46 (0.26%) events among 17 935 bupropion users (rate 31 per 1000); varenicline was not associated with increased risk of psychiatric adverse events (HR 0.85, 95% CI: 0.55-1.30). The overall rate of psychiatric adverse events was substantially higher among participants with a history of psychiatric disorder than in patients without such history; the risk associated with varenicline did not differ significantly by history of psychiatric disorder.
In Denmark, the risk of psychiatric adverse events diagnosed during an emergency department visit or in-patient admission was not significantly higher with varenicline use compared with bupropion.