Bupropion and cognitive-behavioral therapy for smoking cessation in women

Abstract

Gender data for bupropion suggest that it may be a particularly effective smoking cessation medication for women. It is not known whether the efficacy of this pharmacotherapy differs as a function of the psychotherapy with which it is administered. This study used a two level factorial design to examine the independent and interactive effects of medication (bupropion 300 mg/day vs. placebo) and psychotherapy (cognitive-behavioral therapy [CBT] vs. supportive therapy [ST]). In addition to testing the hypothesis that bupropion with CBT would be most effective of all the treatments, we examined medication compliance and its role in the efficacy of bupropion. Participants were 154 women, aged at least 30 years and smoking more than 10 cigarettes/day. Compliance with study medication was assessed using Medication Event Monitoring Systems (MEMS) over 7 weeks of treatment. Psychological interventions were delivered in 60-min weekly group sessions. Longitudinal analysis of abstinence outcomes from end of treatment (EOT) through 12 months after treatment revealed a significant interaction of medication and therapy. Higher abstinence rates at EOT and 3-, 6-, 9-, and 12-month follow-ups were observed when bupropion was delivered concurrently with CBT (44%, 24%, 30%, 23%, 17%) rather than with ST (18%, 1%, 8%, 5%, 2%). The bupropion-CBT combination, however, was not clearly superior to placebo, regardless of therapy assignment. Higher rates of medication compliance were positively predictive of abstinence, and this effect was most evident in the placebo condition. Findings provide only modest support for CBT as the preferred type of intensive therapy in conjunction with bupropion in women.

Adherence to Varenicline in the COMPASS Smoking Cessation Intervention Trial

“…FTND = Fagerström Test for Nicotine Dependence. (Blondal et al, 1997;Garvey et al, 2000;Hajek et al, 1999;Hurt et al, 1997;Killen et al, 2004;Lam et al, 2005;Mooney et al, 2007;Schmitz et al, 2007;Shiffman et al, 2008). Adherence data for the COMPASS trial were collected prior to the Federal Drug Administration issuing a black box warning about possible neuropsychiatric symptoms associated with varenicline in 2009 and therefore may overestimate future adherence rates for this medication.…”

“…Varenicline is an a4b2 partial agonist that was specifically developed to aide cessation by reducing the effects of nicotine withdrawal while also temporarily reducing the reinforcing effects of nicotine through stimulation of the dopaminergic reward pathway. In clinical trials, it significantly increased abstinence rates compared with placebo, bupropion, and nicotine replacement therapy (NRT; Cahill,Hokanson, Stotts, & Schmitz, 2007;Schmitz, Stotts, Mooney, Delaune, & Moeller, 2007;Shiffman, Sweeney, Ferguson, Sembower, & Gitchell, 2008;Swan, Javitz, Jack, Curry, & McAfee, 2004). Because patient adherence to smoking cessation medications can impact their effectiveness, it is important to understand the extent to which all prescribed cessation medications are actually taken by smokers and how this influences smoking cessation outcomes.…”

Women and smoking cessation: Challenges and opportunities

“…The studies that do exist tend to focus on CBT plus another type of treatment, such as pharmacotherapy or exercise [27,28]. Cognitive-behavioral approaches typically consist of several strategies, including self-monitoring (ie, documenting each cigarette smoked), establishment of a formal quit date, identifi cation of smoking cues (ie, high-risk smoking situations), stress management, and challenging maladaptive cognitions related to smoking.…”

“…Schmitz and colleagues [28] examined the effi cacy of bupropion (an antidepressant commonly used for smoking cessation), CBT, and supportive therapy (ST). Women who smoked more than 10 cigarettes a day and who were at least 30 years old (n = 154) were randomly assigned to CBT plus bupropion, ST plus bupropion, CBT plus placebo, or ST plus placebo.…”

Ansiedad, depresión, afecto negativo y positivo asociados con el consumo de tabaco en universitarias

“…Se ha observado que después de asistir a intervenciones para dejar de fumar, las tasas de abstinencia de las mujeres son muy bajas y se presentan diferentes efectos secundarios, específicamente cuando se emplean terapias de sustitución con nicotina y terapias farmacológicas no nicotínicas (Pang et al, 2015;Schmitz, Stotts, Mooney, DeLaune, & Moeller, 2007;Schnoll, Patterson, & Lerman, 2007).…”