Going up in smoke: tobacco smoking is associated with worse treatment outcomes in mania. Academic Article uri icon

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  • 126

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  • 134


  • This study aimed to compare the treatment responses between smokers and non-smokers in bipolar mania clinical trials.Post-hoc analysis was conducted on data collected from three double-blind, randomised controlled trials in bipolar mania that had similar inclusion criteria. Patients were randomised to olanzapine (N=70) or placebo (N=69) for 3 weeks in Trial 1, olanzapine (N=234) or haloperidol (N=216) for 12 weeks in Trial 2, and olanzapine (N=125) or divalproex (N=126) for 47 weeks in Trial 3. This study analysed the Young Mania Rating Scale (YMRS) total scores and Clinical Global Impressions scale for bipolar disorder (CGI-BP) mania severity scores between smokers and non-smokers for each trial and for the pooled data from all three trials, using a mixed-effects model repeated measures approach.For the pooled data, non-smokers showed superior treatment outcomes on both the YMRS (P=0.002) and CGI-BP (P<0.001), as well as longer time to discontinuation for any cause utilising Kaplan-Meier survival curves. For the individual trials, non-smokers showed greater improvement than smokers on both CGI-BP and YMRS in both treatment arms of Trial 2 (CGI-BP: haloperidol P=0.011, olanzapine P=0.042; YMRS: haloperidol P=0.010, olanzapine P=0.019), and in the olanzapine arm of Trial 3 (CGI-BP: P=0.002; YMRS: P=0.006). No significant difference in outcomes was found between smokers and non-smokers in Trial 1.Post-hoc design, categorical definition of smoking status, unavailable antipsychotic drug levels, confounding effects of trial medications and substance abuse.Smoking appears to be associated with worse treatment outcomes in mania.

date/time value

  • September 2008

Digital Object Identifier (DOI)

  • 10.1016/j.jad.2008.01.018

PubMed Identifier

  • 18280579


  • 110


  • 1-2


  • Adult
  • Antipsychotic Agents
  • Benzodiazepines
  • Bipolar Disorder
  • Comorbidity
  • Double-Blind Method
  • Female
  • Haloperidol
  • Humans
  • Least-Squares Analysis
  • Male
  • Meta-Analysis as Topic
  • Placebos
  • Psychiatric Status Rating Scales
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index
  • Smoking
  • Survival Analysis
  • Treatment Outcome
  • Valproic Acid