Antidepressants for smoking cessation

Hughes, Jr.; Stead, Lindsay F; Lancaster, Tim

doi:10.1002/14651858.cd000031.pub2

Cited by 219 publications

(233 citation statements)

References 99 publications

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“…Bupropion (BUP) is an atypical antidepressant currently approved for the treatment of depression (Wellbutrin s ) and as an aid in smoking cessation (Zyban s ) (Ascher et al, 1995;Hughes et al, 2004). BUP has also recently been demonstrated to produce a significant 5-8% weight loss in clinical trials with obese patients (Gadde et al, 2001;Anderson et al, 2002;Jain et al, 2002); however, the mechanism of BUP-induced weight loss is unknown.…”

Section: Introductionmentioning

confidence: 99%

Inhibition of Dopamine and Norepinephrine Reuptake Produces Additive Effects on Energy Balance in Lean and Obese Mice

Billes

Cowley

2006

Neuropsychopharmacol

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Although originally developed as an antidepressant, long-term bupropion (BUP) treatment was recently shown to cause 5-8% weight loss over placebo in clinical trials with obese adults. BUP's antidepressant properties probably stem from its ability to increase extracellular brain dopamine (DA) and norepinephrine (NE) levels by inhibiting their reuptake, although the mechanism of BUP-induced weight loss is unknown. Consequently, the acute effects of DA and NE reuptake inhibition on energy homeostasis were determined by measuring food intake and body weight in mice following peripheral (intraperitoneal (i.p.)) administration of either BUP, a selective DA (GBR12783), or a selective NE (nisoxetine (NIS)) reuptake inhibitor. BUP, GBR12783, and NIS all dose-dependently decreased acute food intake in fasted lean mice. The ability of BUP to decrease food intake was independent of its ability to cause a temporary increase in locomotor activity. The inhibitory effects of acute GBR12783 and NIS on short-term food intake were additive. Subchronic (via miniosmotic pump) administration of GBR12783 and NIS produced a transient nonadditive effect on food intake, but produced an additive reduction in body weight (8-10%). Because obesity can affect catecholaminergic signaling, we determined the effects of i.p. BUP, GBR12783, and NIS on short-term food intake in obese mice. Acute BUP, GBR12783, and NIS dose-dependently reduced acute food intake, and the additive effect of GBR12783 and NIS on acute food intake was preserved in obese mice. These results demonstrate that combined DA and NE reuptake inhibition produces additive effects on energy balance in lean and obese mice on both standard and high-fat diet, providing a foundation for further research on the effects of BUP and similar compounds on energy balance in mice.

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Section: Introductionmentioning

confidence: 99%

Inhibition of Dopamine and Norepinephrine Reuptake Produces Additive Effects on Energy Balance in Lean and Obese Mice

Billes

Cowley

2006

Neuropsychopharmacol

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“…Compared with many other countries, the percentage of former smokers among ever-smokers (former or current) in adults is relatively high in England, about 57% for men and 51% for women. [4][5][6] Pharmacotherapy and behavioural support are effective in helping motivated smokers to stop smoking, [7][8][9][10] although relapse rates following these interventions are high. 11 Since 2001, a national network of NHS Stop Smoking Services has been established in England to provide behavioural support and pharmacotherapy to smokers who would like to quit.…”

Section: Fundingmentioning

confidence: 99%

Effectiveness and economic evaluation of self-help educational materials for the prevention of smoking relapse: randomised controlled trial

Blyth

Maskrey

Notley

et al. 2015

Health Technol Assess

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BackgroundMost people who quit smoking successfully for a short period will return to smoking again in 12 months. A previous exploratory meta-analysis indicated that self-help booklets may be effective for smoking relapse prevention in unaided quitters.ObjectivesThis study aimed to evaluate the effectiveness of a set of self-help educational booklets to prevent smoking relapse in people who had stopped smoking with the aid of behavioural support.DesignThis is an open, randomised controlled trial and qualitative process evaluation. Trial participants were randomly allocated to one of two groups, using a simple randomisation process without attempts to stratify by participant characteristics. The participant allocation was ‘concealed’ because the recruitment of quitters occurred before the random allocation.SettingShort-term quitters were recruited from NHS Stop Smoking Clinics, and self-help educational materials were posted to study participants at home.ParticipantsA total of 1407 carbon monoxide (CO)-validated quitters at 4 weeks after quit date in NHS Stop Smoking Clinics. The trial excluded pregnant women and quitters who were not able to read the educational materials in English.InterventionsParticipants in the experimental group (n = 703) received a set of eight revisedForever Freebooklets, and participants in the control group (n = 704) received a single leaflet that is currently given to NHS patients.Main outcome measuresFollow-up telephone interviews were conducted 3 and 12 months after quit date. The primary outcome was prolonged, CO-verified abstinence from months 4 to 12 during which time no more than five cigarettes were smoked. The secondary outcomes included self-reported abstinence during the previous 7 days at 3 and 12 months, CO-verified abstinence at 12 months, costs (NHS and NHS and participant medication costs perspectives) and quality-adjusted life-years. Logistic regression analyses were conducted to investigate effect-modifying variables. A simultaneous qualitative process evaluation was conducted to help interpret the trial results.ResultsData from 1404 participants were used for the final analysis, after excluding three participants who died before the 12-month follow-up. The proportion with prolonged abstinence from months 4 to 12 after quit date was 36.9% in the intervention group and 38.6% in the control group. There was no statistically significant difference between the groups (odds ratio 0.93, 95% confidence interval 0.75 to 1.15;p = 0.509). There were no statistically significant differences between the groups in secondary smoking outcomes. People who reported knowing risky situations for relapse and using strategies to handle urges to smoke were less likely to relapse. However, there were no differences between the groups in the proportion of participants who reported that they knew any more about coping skills, and no differences in reported use of strategies to cope with urges to smoke between the trial groups. The qualitative study found that some quitters considered self-help booklets unhelpful for smoking relapse prevention, although positive feedback by participants was common.ConclusionsAmong quitters who had stopped smoking with the aid of intensive behavioural support, there was no significant difference in the likelihood of smoking relapse between those who subsequently received a set of eight revisedForever Freebooklets and those who received a single leaflet. Although many people had suboptimal strategies to prevent relapse and most relapsed, theForever Freebooklets proved an ineffective medium for teaching them the skills to prevent relapse. Further research should focus on interventions that may increase the use of coping skills when required.Trial registrationCurrent Controlled Trials ISRCTN36980856.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 59. See the NIHR Journals Library website for further project information.

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“…Bupropion and nortriptyline were both first used as antidepressants and ameliorate mood related withdrawal symptoms but their effect on cessation is not mediated through this effect 36. However, selective serotonin reuptake inhibitors also ameliorate mood related withdrawal symptoms37 and are effective as antidepressants,38 but a systematic review of RCTs shows no evidence that they are effective in smoking cessation 39. The mode of action is probably not a class effect of antidepressants, but probably relates to particular aspects of their complex pharmacology.…”

Section: Assisting Cessationmentioning

confidence: 99%

“…A systematic review of randomised trials shows that bupropion increases the rate of cessation by about 70% 39. The mechanisms of action of nortriptyline and bupropion may differ from that of NRT and so several trials have tested whether combining one of these antidepressants with NRT is more effective than either the antidepressant or NRT alone.…”

Section: Assisting Cessationmentioning

confidence: 99%