A placebo controlled trial of bupropion for smoking cessation in schizophrenia.
BACKGROUND
Schizophrenic patients have high rates of cigarette smoking compared with the general population. We compared sustained-release (SR) bupropion with placebo for smoking cessation in patients with schizophrenic disorders. We also examined how antipsychotic class predicts smoking cessation outcomes with bupropion.


METHODS
Thirty-two subjects meeting DSM-IV criteria for schizophrenia or schizoaffective disorder and nicotine dependence were randomized to bupropion SR (BUP, 300 mg/day) or placebo (PLA). Outcomes included treatment retention, smoking abstinence rates, expired breath carbon monoxide (CO) levels, psychotic symptoms, and medication side effects.


RESULTS
Bupropion significantly increased trial endpoint 7-day point prevalence smoking abstinence rates compared with placebo [BUP, 8/16 (50.0%), PLA, 2/16 (12.5%); chi(2) = 5.24, df = 1, p <.05], and reduced CO levels during the trial [Medication x Time interaction; Z = 3.09, p <.01]. Positive schizophrenia symptoms were not altered by BUP, but negative symptoms were significantly reduced. Atypical antipsychotic drug treatment enhanced smoking cessation responses to BUP. Major side effects were dry mouth, gastrointestinal symptoms, headache, and insomnia.


CONCLUSIONS
Our results suggest that 1) BUP enhances smoking abstinence rates compared with PLA in nicotine-dependent schizophrenic smokers; 2) BUP is well-tolerated and safe for use in these patients; and 3) atypical antipsychotics may enhance smoking cessation outcomes with BUP.
George
Tony P
TP
Program for Research in Smokers with Mental Illness and Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519, USA.
Vessicchio
Jennifer C
JC
Termine
Angelo
A
Bregartner
Thomas A
TA
Feingold
Alan
A
Rounsaville
Bruce J
BJ
Kosten
Thomas R
TR
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D016642:Bupropion / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D010919:Placebos; D016642:Bupropion