Varenicline-induced psychotic depressive episode in a patient with bipolar disorder

Varenicline is a relatively novel medication for smoking cessation. Increased neuropsychiatric symptoms have been reported with its use and it is listed among drugs with a black box warning. History of a psychiatric diagnosis is suggested to be a vulnerability factor for the development of some psychiatric side effects with its use. However, empirical evidence to support this point is very limited. Here, we report the case of a bipolar patient who developed a depressive episode with psychotic features immediately after varenicline use. Clinicians should be careful about the varenicline-induced neuropsychiatric effects. Healthcare professionals can provide an important role in helping to prevent and manage worsening psychiatric symptoms.