Firstly, observational studies are prone to confounding by indication.11 For example, the use of drugs for smoking cessation might seem to be associated with an increased risk of suicide because smokers themselves are at increased risk of mental illness and suicide.12 13 Secondly https://www.pandoratopp.com/, there is evidence that industry sponsored trials are more likely than other trials to report outcomes that are favourable to the study sponsor.14 Though the number of prescription items of varenicline dispensed in England increased from 499 in 2006 to a peak of almost a million in 2011, there was a 25% decrease from 2011 to 2013.15 This might reflect ongoing fears among prescribers and patients regarding varenicline’s safety.We conducted a systematic review and meta analysis to determine the risk of neuropsychiatric adverse events and death in all published placebo controlled randomised controlled trials of varenicline. This review deals with some of the limitations of the previous studies and is the most comprehensive published review to date of the neuropsychiatric safety of varenicline. We included studies in smokers and non smokers.

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