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Clinical Trial
. 2004 Aug;19(8):828-34.
doi: 10.1111/j.1525-1497.2004.30423.x.

Efficacy of bupropion for relapse prevention in smokers with and without a past history of major depression

Lisa Sanderson Cox  1 , Christi A Patten, Raymond S Niaura, Paul A Decker, Nancy Rigotti, David P L Sachs, A Sonia Buist, Richard D Hurt
Affiliations
Clinical Trial

Efficacy of bupropion for relapse prevention in smokers with and without a past history of major depression

Lisa Sanderson Cox et al. J Gen Intern Med. 2004 Aug.

Abstract

Background: This study evaluated the efficacy of bupropion for relapse prevention in smokers with and without a past history of major depressive disorder. Changes in depressive symptoms were also examined.

Design: Data were gathered prospectively from a randomized, double-blind relapse prevention trial of bupropion conducted at five study sites. A total of 784 smokers (54% female, 97% white) were enrolled. Using the Structured Clinical Interview for Depression, 17% of the subjects reported a past history of major depressive disorder at baseline. All subjects received open-label bupropion SR (300 mg/d) for 7 weeks. Subjects abstinent from smoking at the end of 7 weeks (N = 429) were randomized to bupropion SR (300 mg/d) or placebo for the remainder of the year and followed for 1 year off medication. The primary outcome measures were median time to relapse to smoking and the 7-day point-prevalence smoking abstinence rate. Self-reported abstinence from smoking was verified by expired air carbon monoxide. The Beck Depression Inventory was used to assess depressive symptoms at baseline and at weeks 8 and 12.

Results: Median time to relapse did not differ by past history of major depressive disorder. Bupropion was associated with higher point-prevalence smoking abstinence at the end of medication compared to placebo (P = .007), independent of a past history of major depressive disorder. Moreover, change in depressive symptoms during the double-blind phase did not differ for those with and without a past history of major depressive disorder.

Conclusions: Extended use of bupropion for relapse prevention is effective for smokers with and without a history of major depression.

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Figures

FIGURE 1
FIGURE 1
Observed cumulative smoking relapse according to history of major depressive disorder (MDD). There was no significant difference in relapse curves across time between subjects with and without a history of MDD (P = .110, proportional hazard regression). The median time to smoking relapse from randomization was 89.5 days for subjects with a history of MDD and 119 days for those with no such history (P = .232, log-rank test).
FIGURE 2
FIGURE 2
Seven-day point-prevalence smoking abstinence rates according to history of major depressive disorder (MDD) and medication treatment at weeks 12, 52, and 104. Bupropion medication was significantly associated with higher abstinence rates at week 12 (P = .002) and week 52 (P = .007) compared to placebo. A past history of MDD was not significantly associated with abstinence at any of these time points.
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