Treatment for tobacco addiction must be prioritized in
clinical practice to reduce the high rates of tobacco related disease and premature death in people with chronic mental illness.
Research reviewed in the BMJ
indicates that smokers with chronic mental illness can quit with standard
cessation approaches, with minimal effects on psychiatric symptoms. In particular, recent randomized controlled trials have shown
that bupropion and varenicline are effective in people with schizophrenia, and that varenicline is effective in people with unipolar
and bipolar depression. Treatments for people with anxiety disorders and PTSD have been less well studied and the effects of these
drugs in smokers with these disorders have not been determined using adequately powered randomized controlled trials. Evidence from
experimental studies suggests that similar biopsychosocial mechanisms are involved in the initiation and persistence of smoking in
patients with different disorders.