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Randomized Controlled Trial
. 2009 Oct;11(10):1142-53.
doi: 10.1093/ntr/ntp111. Epub 2009 Jul 2.

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

David R Strong  1 , Christopher W Kahler, Adam M Leventhal, Ana M Abrantes, Elizabeth Lloyd-Richardson, Raymond Niaura, Richard A Brown
Affiliations
Randomized Controlled Trial

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

David R Strong et al. Nicotine Tob Res. 2009 Oct.

Abstract

Introduction: Bupropion and cognitive-behavioral treatment (CBT) for depression have been used as components of treatments designed to alleviate affective disturbance during smoking cessation. Studies of treatment-related changes in precessation affect or urges to smoke are needed to evaluate the proposed mechanisms of these treatments.

Methods: The present report examines affective trajectories and urges to smoke prior to, on quit day, and after quitting in a sample of 524 smokers randomized to receive bupropion versus placebo and CBT versus standard smoking cessation CBT.

Results: Bupropion and/or CBT did not affect the observed decreases in positive affect and increases in negative affect prior to cessation. However, on quit day, observed levels of negative affect and urges to smoke were diminished significantly among individuals receiving bupropion. Decreases in positive affect prior to quitting, lower levels of positive affect, and increased levels of negative affect and urges to smoke on quit day were each related to higher risk of smoking lapse. Depression proneness was an independent predictor of lower positive affect and higher negative affect but did not moderate the effects of bupropion on outcomes. In mediational analyses, the effect of bupropion was accounted for in part by lower negative affect and urges to smoke on quit day.

Discussion: Results support the efficacy of bupropion in reducing relapse risk associated with urges to smoke and negative affect and suggest the need to better understand the role of low positive affect as a risk factor for early lapse.

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Figures

Figure 1.
Figure 1.
Changes in positive affect, negative affect, and urges to smoke among smokers with high and low levels of depression proneness (median split). BUP, bupropion; PLAC, placebo; and DPI, Depression Proneness Inventory.
Figure 2.
Figure 2.
The probability of smoking lapse and smoking relapse to seven consecutive smoking days during treatment for smokers receiving bupropion (BUP) and placebo (PLAC).
See this image and copyright information in PMC

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