Bupropion Sustained Release as a Smoking Cessation Treatment in Remitted Depressed Patients Maintained on Treatment With Selective Serotonin Reuptake Inhibitor Antidepressants
J Clin Psychiatry 2001;62(7):503-508
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Patients with depressive disorders
smoke tobacco more often than the population at large and find
quitting more difficult. Furthermore, when they quit smoking,
they are more likely to suffer a relapse of depression. We
evaluated the addition of bupropion sustained release (SR) for
smoking cessation among patients with a history of depressive
disorders being maintained in a euthymic state with selective
serotonin reuptake inhibitor (SSRI) antidepressants.
Method: Twenty-five adults with DSM-IV major
depressive disorder or depressive disorder NOS currently
receiving SSRI maintenance treatment and smoking >= 15
cigarettes per day participated in the 9-week study. Bupropion
SR, 150 mg/day, was added to SSRI treatment and increased to 300
mg/day. Subjects were counseled on smoking cessation measures and
chose a target quit date 2 or 4 weeks after the initiation of
bupropion SR. Self-reported smoking status, expired carbon
monoxide (CO) measurements, Hamilton Rating Scales for Depression
and Anxiety scores, and weight were measured at each visit.
Subjects were abstinent if they reported not smoking during the
prior 7 days, confirmed with an expired-air CO value of <= 10
Results: Eight (32%) of 25 subjects were
abstinent after 9 weeks. At 3-month follow-up, 3 subjects
remained abstinent, 3 relapsed, and 2 were lost to follow-up.
Eleven subjects (44%) were nonresponders, and 6 (24%) dropped out
prior to 3 weeks of treatment due to side effects (N = 3) or were
lost to follow-up (N = 3). Mean weight gain was approximately 0.5
lb (0.2 kg) for those completing 9 weeks of bupropion SR
treatment. During the 9-week study and the 3-month follow-up,
there was no evidence of emergent depression in any subject. Four
subjects (16%) spontaneously reported an improvement in
SSRI-associated sexual dysfunction.
Conclusion: These open data suggest modest
effectiveness for and the safety of bupropion SR as a smoking
cessation agent in individuals with depression maintained on
treatment with SSRIs. Minimal weight gain, lack of emergent
depressive episodes, and improvement of SSRI-associated sexual
dysfunction are added advantages.