Antidepressants and Other Pharmacotherapy

The withdrawal symptoms of smoking cessation can be stress, depression, anxiety, anger, insomnia, and weight gain. For that reason antidepressants can be helpful.10

Bupropion is an antidepressant with dopamin-ergic and norepinephrenic activity. It relieves the withdrawal symptoms and the craving for a cigarette. Because bupropion lowers the thresh old for seizures it is contraindicated in patients who are at risk for seizures. The daily dose is 150mg/day for 6 days, then 150mg twice a day. In those predisposed to seizures, in elderly people, or those with decreased kidney or liver function, the maintenance dose should be taken once a day only. Smoking cessation starts about 10 days after the start of medication.9 An overview of drugs used for smoking cessation, contraindications and side-effects is given in Table 29-4.

Nortriptyline is an antidepressant with serotonergic and norepinephrenic activity. This antidepressant is not approved as a smoking cessation aid but is recommended in many public health services guidelines for smoking cessation. The daily dose is 25 mg/day for 3 days, then 50 mg/day 4 days, then 75-100 mg/day. Smoking cessation starts from the tenth day after the start of medication. Duration of treatment is 7-12 weeks.

Both bupropion and nortriptyline can be combined with all kinds of nicotine replacement therapy. In randomized, controlled trials they double smoking cessation rates as compared with placebo treatment especially when combined with counseling.9

No other antidepressant has had demonstrated efficacy for use in smoking cessation.

There is research on the efficacy of other medications, for example rimoabant and varenicline,11 as well as a vaccination against nicotine.

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