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


CONCLUSIONS
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.
Strong
David R
DR
Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI 02906, USA. david_strong@brown.edu
Kahler
Christopher W
CW
Leventhal
Adam M
AM
Abrantes
Ana M
AM
Lloyd-Richardson
Elizabeth
E
Niaura
Raymond
R
Brown
Richard A
RA
D000328:Adult; D000339:Affect; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D016642:Bupropion / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D016540:Smoking Cessation
D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion