Aim 1. To assess the feasibility and acceptability of varenicline among bipolar depressed smokers as determined by our recruitment and retention rates.
Hypothesis 1. The abstinence rate for bipolar depressed patients will be 50%. The retention rate for this study will be similar to the Gonzales 2006 study (approximately 75)%.
Aim 2. To estimate the 7-day point prevalence abstinence rate at week 12, with open-label varenicline and behavioral intervention among patients with bipolar depression (N=15 with major depression, N=15 with subsyndromal or depressive symptoms). The investigators primary outcome measure is 7-day point prevalence abstinence rate defined by self-report at week 12 confirmed by expired carbon monoxide levels of 10 ppm or less.
Hypothesis 2:At final visit, approximately 50% of study completers will meet the primary outcome measure. At study entry, bipolar patients with a major depressive episode, in comparison to subjects with depressive symptoms (i.e. not syndromal episode, less severe) , will have lower abstinence rates.At final visit, bipolar depressed patients who have achieved remission, defined as a Montgomery Asberg Depression Rating Scale (MADRS) <8, will have a higher rate of tobacco abstinence than depressed patients who did not achieve remission (MADRS >/= 8).