Smoking in early adulthood is prospectively associated with prescriptions of antipsychotics, mood stabilizers, antidepressants and anxiolytics.

Eline Borger Rognli,Jørgen Gustav Bramness,Tilmann von Soest

doi:10.1017/s0033291720005401

Abstract

Whether smoking should be regarded as a risk factor for mental disorders remains unresolved. Prescribed psychotropic drugs can be used as indications for mental disorders. We investigated how smoking was prospectively related to prescription of antipsychotics, mood stabilizers, antidepressants, and anxiolytics. Information about smoking, including the Fagerström Test for Nicotine Dependence, and relevant confounders, were obtained from the population-based Young in Norway Study (N = 2602), with four data collection waves between 1992 and 2006. These survey data were linked with information on prescriptions for psychotropic drugs from the comprehensive, nationwide Norwegian Prescription Database from 2007 to 2015. Daily smoking with high dependence in 2006 at age 28.5 (s.d. = 2.0) was associated with filling prescriptions of antipsychotics (OR, 6.57, 95% CI 2.19-19.70, p = 0.001), mood stabilizers (OR, 7.11, 95% CI 2.51-20.15, p < 0.001) and antidepressants (OR, 1.91, 95% CI 1.13-3.23, p = 0.016) 1-9 years later. Associations remained significant after adjustment for a variety of potential confounders measured before the assessment of smoking, including sociodemographic background, conduct problems, cannabis use, mental distress, and previous prescriptions for psychotropic medications. The association between smoking and prescription of anxiolytics was weaker and more unstable. In this study of young adults, daily smoking with high dependence was associated with later prescriptions of antipsychotics, mood stabilizers and antidepressants, indicating smoking as a risk factor for mental disorders treated with these drugs.

Highlights

Cigarette smoking is the leading cause of preventable death, with well-established causal associations to several somatic diseases (Reitsma et al, 2017)
Two recent meta-analyses of prospective studies suggest that smoking may be a risk factor for psychosis, with a doubled relative risk of developing schizophrenia for smokers compared to nonsmokers and with heavier smoking associated with greater risk (Gurillo, Jauhar, Murray, & MacCabe, 2015; Hunter, Murray, Asher, & Leonardi-Bee, 2020)
In this study, linking a population-based investigation with data from an administrative register, we found that daily smoking was prospectively associated with later prescriptions of all classes of psychotropic drugs

Summary

Introduction

Cigarette smoking is the leading cause of preventable death, with well-established causal associations to several somatic diseases (Reitsma et al, 2017). Information about smoking, including the Fagerström Test for Nicotine Dependence, and relevant confounders, were obtained from the population-based Young in Norway Study (N = 2602), with four data collection waves between 1992 and 2006. These survey data were linked with information on prescriptions for psychotropic drugs from the comprehensive, nationwide Norwegian Prescription Database from 2007 to 2015. In this study of young adults, daily smoking with high dependence was associated with later prescriptions of antipsychotics, mood stabilizers and antidepressants, indicating smoking as a risk factor for mental disorders treated with these drugs

Methods

Results

Conclusion