Bupropion and cognitive-behavioral treatment for depression in smoking cessation

Abstract

This study is a randomized, double-blind, placebo-controlled clinical trial examining the effects of an intensive cognitive-behavioral mood management treatment (CBTD) and of bupropion, both singularly and in combination, on smoking cessation in adult smokers. As an extension of our previous work, we planned to examine the synergistic effects of CBTD and bupropion on smoking cessation outcomes in general and among smokers with depression vulnerability factors. Participants were 524 smokers (47.5% female, M age =44.27 years) who were randomized to one of four 12-week treatments: (a) standard, cognitive-behavioral smoking cessation treatment (ST) plus bupropion (BUP), (b) ST plus placebo (PLAC), (c) standard cessation treatment combined with cognitivebehavioral treatment for depression (CBTD) plus BUP, and (d) CBTD plus PLAC. Follow-up assessments were conducted 2, 6, and 12 months after treatment, and self-reported abstinence was verified biochemically. Consistent with previous studies, bupropion, in comparison with placebo, resulted in better smoking outcomes in both intensive group treatments. Adding CBTD to standard intensive group treatment did not result in improved smoking cessation outcomes. In addition, neither CBTD nor bupropion, either alone or in combination, was differentially effective for smokers with single-past-episode major depressive disorder (MDD), recurrent MDD, or elevated depressive symptoms. However, findings with regard to recurrent MDD and elevated depressive symptoms should be interpreted with caution given the low rate of recurrent MDD and the low level of depressive symptoms in our sample. An a priori test of treatment effects in smokers with these depression vulnerability factors is warranted in future clinical trials.

Impact of bupropion and cognitive–behavioral treatment for depression on positive affect, negative affect, and urges to smoke during cessation treatment

“…Consistent with outcomes reported previously ( Brown et al, 2007 ;Wileyto et al, 2004Wileyto et al, , 2005, after including female gender and level of nicotine dependence as covariates ( Table 3 ), smokers receiving bupropion had signifi cantly lower risk of smoking lapse (relative risk [ RR ] = 0.55, 95% CI = 0.42 -0.72, p < .001) and a lower risk of smoking relapse ( RR = 0.48, 95% CI = 0.36 -0.68, p < .001) than smokers receiving placebo. There was no signi fi cant difference in the risk of lapse or relapse across CBT and ST psychosocial treatments.…”

“…The present report examined affective trajectories and urges to smoke prior to and on quit day in a sample of 524 smokers participating in a smoking cessation trial studying the individual and combined effects of bupropion versus placebo and CBT versus ST using a 2 × 2 design ( Brown et al, 2007 ). Previous analyses of quit rates in this sample at the end of 12 weeks of treatment and across 2-, 6-, and 12-month follow-ups indicated that bupropion was signifi cantly more effective than placebo, that CBT did not outperform ST, and that there were no synergistic effects (i.e., no interaction).…”

Time-Varying Smoking Abstinence Predicts Lower Depressive Symptoms Following Smoking Cessation Treatment

“…Using MLM, we quantified the difference in depressive symptoms associated with being abstinent versus smoking at a given assessment. We also were able to test whether history of MDD, which has been associated with greater affective disturbance before and after quitting smoking (Berlin, Spreux-Varoquaux, Said, & Launay, 1997;Brown et al, 2007;Hall et al, 1996;Tsoh et al, 2000), significantly altered the effect of smoking abstinence on depressive symptoms.…”

Impacto de la sintomatología depresiva en los resultados de un programa de deshabituación tabáquica en el lugar de trabajo

“…El tratamiento cognitivo-conductual con estrategias específicas para el manejo de los estados de ánimo mostró ser beneficioso para la población con depresión recurrente 32,33 , pero falló en mejorar los resultados en población con elevada sintomatología depresiva 34 . Es necesario pues, seguir investigando con el objetivo de aumentar las tasas de abstinencia en esta población.…”