Effects of varenicline and bupropion sustained-release use plus intensive smoking cessation counseling on prolonged abstinence from smoking and on depression, negative affect, and other symptoms of nicotine withdrawal. JAMA Psychiatry 2013 May;70(5):522-33
Date
03/29/2013Pubmed ID
23536105Pubmed Central ID
PMC4128024DOI
10.1001/jamapsychiatry.2013.678Scopus ID
2-s2.0-84876898088 (requires institutional sign-in at Scopus site) 117 CitationsAbstract
IMPORTANCE: Given the actions of varenicline tartrate and bupropion hydrochloride sustained-release (SR) on neurobiological targets related to affect and reward, it is thought that the modulation of nicotine withdrawal symptoms may contribute to their effectiveness.
OBJECTIVE: To assess the relative efficacy of varenicline and bupropion SR plus intensive counseling on smoking cessation and emotional functioning.
DESIGN AND SETTING: Placebo-controlled randomized clinical trial at a university medical center.
PARTICIPANTS: In total, 294 community volunteers who wanted to quit smoking.
INTERVENTIONS: Twelve weeks of varenicline, bupropion SR, or placebo plus intensive smoking cessation counseling (10 sessions, for a total of approximately 240 minutes of counseling).
MAIN OUTCOME MEASURES: Prolonged abstinence from smoking and weekly measures of depression, negative affect, and other symptoms of nicotine withdrawal.
RESULTS: Significant differences were found in abstinence at the end of treatment and through the 3-month postquit follow-up visit, favoring both active medications compared with placebo. At the 6-month postquit follow-up visit, only the varenicline vs placebo comparison remained significant. Varenicline use was also associated with a generalized suppression of depression and reduced smoking reward compared with the other treatments, while both active medications improved concentration, reduced craving, and decreased negative affect and sadness compared with placebo, while having little effect (increase or decrease) on anxiety and anger. No differences were noted in self-reported rates of neuropsychiatric adverse events.
CONCLUSIONS AND RELEVANCE: In a community sample, varenicline exerts a robust and favorable effect on smoking cessation relative to placebo and may have a favorable (suppressive) effect on symptoms of depression and other affective measures, with no clear unfavorable effect on neuropsychiatric adverse events.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00507728.
Author List
Cinciripini PM, Robinson JD, Karam-Hage M, Minnix JA, Lam C, Versace F, Brown VL, Engelmann JM, Wetter DWMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Affect
Aged
Benzazepines
Bupropion
Combined Modality Therapy
Counseling
Delayed-Action Preparations
Depression
Female
Humans
Male
Middle Aged
Nicotine
Nicotinic Agonists
Quinoxalines
Smoking
Smoking Cessation
Substance Withdrawal Syndrome
Treatment Outcome
Varenicline
Young Adult
