Learning Objectives: Attendees will be able to describe how effective the combination of bupropion and nicotine patches versus the combination of placebo and nicotine patches was for smoking cessation in a heavily addicted population.
Abstract: PROBLEM: Smokers are more likely to have a past history of depression, and smoking cessation may increase symptoms of depression. The use of the antidepressant medication, bupropion, has been approved for smoking cessation, but studied in only a few populations.
METHODS: We conducted an outpatient clinical trial at the San Francisco VA in which all smokers received standard treatment (2 months of nicotine replacement therapy (NRT) using the patch, counseling, and self-help literature). Participants were then randomly assigned to receive 7 weeks of either bupropion or placebo and were followed for 12 months.
RESULTS: A total of 244 smokers, both veterans and non-veterans, were enrolled. By self-report, 61%(n=148)quit smoking at the end of treatment(8 weeks)and 41%(n=99)quit smoking at 6 months. The self-reported end-of-treatment quit rates were 65% for the bupropion group and 57% for the placebo group(P=0.23). The self-reported 6-month and 12-month quit rates were similar in both randomized groups. The 12-month quit rates, validated by either saliva cotinine or proxy, were 22% in the bupropion group and 27% in the placebo group(P=0.39). A total of 5 participants died, 2 in the bupropion group and 3 in the comparison group.
DISCUSSION: In a study population of mostly veterans, the addition of bupropion to standard treatment with NRT and counseling did not appear to increase quit rates over that expected from NRT and counseling alone.
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