0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Bupropion and Smoking Cessation
A. EDEN EVINS, M.D.; THELMA TISDALE, R.N., M.P.H.
Am J Psychiatry 1999;156:798a-799.

To the Editor: Sustained-release bupropion is reported to be superior to placebo for smoking cessation in smokers without a current psychiatric illness (1). We report a case of successful smoking cessation in a man with schizophrenia in which sustained-release bupropion was used in addition to clozapine.

Mr. A was a 41-year-old man with a 20-year history of chronic, undifferentiated schizophrenia who had smoked three to five packs of cigarettes a day for 11 years. Two years of individual cognitive behavioral and motivational enhancement treatment resulted in only transient, limited reduction in cigarette use. In the 3 months preceding Mr. A’s trial of sustained-release bupropion, he brought 100–157 empty cigarette packs per month to the clinic; the carbon monoxide in his expired air was 54 ppm. Nicotine replacement therapy was contraindicated because of multiple cardiovascular risk factors, combined with inability to reliably agree to reduce cigarette use while using nicotine replacement therapy. One week after starting sustained-release bupropion, at a dose of 150 mg/day, he reported that he no longer had such a strong urge to smoke and stopped smoking entirely; 3 months later, the carbon monoxide in his expired air measured 3 ppm. During this period, his clozapine dose was gradually decreased from 550 to 300 mg/day, and he reported less sedation and drooling and appeared more alert and less disheveled. His psychotic symptoms remained under control, his weight remained unchanged, and he began his first paying job in 18 years. He discontinued the sustained-release bupropion after 7 months and remained abstinent from smoking at 11 months.

The prevalence of smoking in schizophrenic patients is 74%–92% (2, 3). In published reports of smoking cessation trials in schizophrenia, the 6-month cessation rate was only 12%–13% with group therapy alone (4) or in combination with nicotine reduction therapy (5). Patients with schizophrenia may have more difficulty with smoking cessation for various reasons. Smoking lowers serum medication levels and reduces parkinsonian side effects (3). More fundamentally, nicotine has been shown to modulate both dopaminergic and glutamatergic transmission and may also improve cognitive deficits and negative symptoms by this mechanism. Any intervention that improves smoking cessation in patients with schizophrenia warrants further investigation because it has important public health implications and may improve our understanding of the role of nicotine in schizophrenia.

Hurt RD, Sachs D, Glover ED, Offord KP, Johnston JA, Dale LC, Khayrallah MA, Schroeder DR, Sullivan CR, Croghan IT, Sullivan PM: A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med 1997; 337:1195–  1202
 
Hughes JR, Hatsukami DK, Mitchell JE, Dahlgren LA: Prevalence of smoking among psychiatric outpatients. Am J Psychiatry  1986; 143:993–997
[PubMed]
 
Goff DC, Henderson DC, Amico E: Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects. Am J Psychiatry 1992; 149:1189–  1194
 
Addington J, el-Guebaly N, Campbell W, Hodgins DC, Addington D: Smoking cessation treatment for patients with schizophrenia. Am J Psychiatry  1998; 155:974–976
[PubMed]
 
Ziedonis DM, George TP: Schizophrenia and nicotine use: report of a pilot smoking cessation program and review of neurobiological and clinical issues. Schizophr Bull  1997; 23:247–254
[PubMed]
 
+

References

Hurt RD, Sachs D, Glover ED, Offord KP, Johnston JA, Dale LC, Khayrallah MA, Schroeder DR, Sullivan CR, Croghan IT, Sullivan PM: A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med 1997; 337:1195–  1202
 
Hughes JR, Hatsukami DK, Mitchell JE, Dahlgren LA: Prevalence of smoking among psychiatric outpatients. Am J Psychiatry  1986; 143:993–997
[PubMed]
 
Goff DC, Henderson DC, Amico E: Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects. Am J Psychiatry 1992; 149:1189–  1194
 
Addington J, el-Guebaly N, Campbell W, Hodgins DC, Addington D: Smoking cessation treatment for patients with schizophrenia. Am J Psychiatry  1998; 155:974–976
[PubMed]
 
Ziedonis DM, George TP: Schizophrenia and nicotine use: report of a pilot smoking cessation program and review of neurobiological and clinical issues. Schizophr Bull  1997; 23:247–254
[PubMed]
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 16.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 15.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 58.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 15.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 20.  >
Topic Collections
Psychiatric News
PubMed Articles