Study of Mood Effects of Varenicline (Chantix) in Depressed Outpatient Smokers

• Improvement on Snaith-Hamilton Anhedonia Scale [ Time Frame: 6-8 weeks ] [ Designated as safety issue: No ]
• Improvement on Patient and Clinician Clinical Global Impression Rating Scale (CGI) [ Time Frame: 6-8 weeks ] [ Designated as safety issue: No ]
• Tolerability of Varenicline Measured by Adverse Symptoms Checklist (SAFTEE-SI LCN Modified) [ Time Frame: 6-8 weeks ] [ Designated as safety issue: No ]

• Improvement on Snaith-Hamilton anhedonia scale [ Time Frame: 6-8 weeks ]
• Improvement on patient and clinician clinical global impression rating scale (CGI) [ Time Frame: 6-8 weeks ]
• Tolerability of varenicline measured by adverse symptoms checklist (SAFTEE-SI LCN modified) [ Time Frame: 6-8 weeks ]

This study will assess whether varenicline (chantix) has antidepressant properties when used in addition to other psychiatric medication. It will also assess whether varenicline improves the inability to feel pleasure (i.e. anhedonia), and if it is well-tolerated when used with psychiatric medications.

Enrolled patients will be assessed for improved mood, improved anhedonia, overall sense of health, side effects as well as tobacco use for 6-8 weeks.

Medication will be provided free of charge.

Outpatient smokers who are depressed despite current stable psychiatric medication regimens will be invited to participate.

They will receive varenicline dosed according to FDA-approved smoking cessation regime; patients will be assessed using QIDS-SR16, snaith-hamilton anhedonia rating scale, SAFTEE and clinical global improvement self-report scales and clinician global improvement scales at the above time intervals.

Concurrent medication, psychiatric and non-psychiatric, will be recorded, as will vital signs (BP, HR, weight) and tobacco use.

• Depressive Disorder
• Smoking

• Drug: fixed dose varenicline
  varenicline 0.5 mg po daily for days 1-3, 0.5 twice daily for days 4-7, 1 mg twice daily thereafter for study duration.
  Other Name: Chantix
• Drug: varenicline
  up to 1 mg twice daily
  Other Name: Chantix

Inclusion Criteria:

1. Meets DSM-IV symptoms criteria for a mood disorder including major depression [unipolar or bipolar], depressive disorder NOS, dysthymia, adjustment disorder with depressed mood, or substance-induced mood disorder.
2. Failed to achieve full symptom remission with previous pharmacotherapy.
3. Current tobacco users.
4. Able to give written, informed consent.

Exclusion Criteria:

1. Past adverse reaction to varenicline.
2. Renal failure or dialysis.
3. Current pregnancy or breastfeeding.