be good to yourself...


Zyban aka Wellbutrin and Other Antidepressants

Wellbutrin (generic name, bupropion) was recently released under the name Zyban for marketing as a smoking cessation aid. They are the same drug, made by the same company, Glaxo-Wellcome.

During testing of the antidepressant Wellbutrin, it was realized that the test group experienced a reduced desire for nicotine. Studies have since been done using Wellbutrin as an aid in smoking cessation, both in conjunction with nicotine replacement therapy (in the form of the patch), and without. No conclusive results have yet been published. The following information was written and contributed by Scott Leischow.

"Greetings! Wellbutrin is one of several medications being tested for smoking cessation. Keep in mind that no medication has been found to be efficacious for a large percentage of people, and that different approaches work differently for each person. There are data to suggest that Wellbutrin (bupropion) increases the chances of quitting - see studies by Linda Ferry at Loma Linda Medical Center. Note that other medications being tested include Inversine (mecamylamine) in combination with nicotine, lobeline, cotinine (a metabolite of nicotine) - and new nicotine replacement options will eventually be available as well, such as nicotine nasal spray, nicotine inhaler ,nicotine lozenge.

Mint nicotine gum is now available in Canada, Mexico, and several European countries, and an even more flavorful gum is or will be available in the UK (made by Ciba-Geigy). Meds, of course, are not the answer - they can work to enhance personal motivation. All of these changes will definitely increase uncertainty about what to use (if anything), and whether we should be concerned about people using pure nicotine for long periods of time. There seems to be a growing consensus in the scientific community that we should not be too concerned about long term use of nicotine - if the alternative is returning to smoking. Just as with methadone versus heroin, the lesser 'evil' is the pure nicotine. I am not suggesting we should not be concerned about long term use, just that we put it in perspective. Note that I have no financial interest in any treatment approach - I do research on smoking cessation treatments at the University of Arizona (including on several of the methods I mentioned above). Send me a note if you have questions /comments/flames."

But before you run out and demand a prescription from your doctor, please consider this information, written and posted by Bob Christofferson:

"Prozac (generically, fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) and Wellbutrin (bupropion) is a heterocyclic antidepressant which affects reuptake of dopamine as well as serotonin. (Because of the affect on dopamine, by the way, Wellbutrin has been tried for alleviating symptoms of cocaine withdrawal, with inconclusive results.)

"Effexor (venlafaxine) affects reuptake of serotonin and norepinephrine and only very weakly affects dopamine.

"This will be on the exam, so take notes. :)

"Seriously, most of us have no reason to try to remember this stuff, but it's worth mentioning, I thought, partly as an example of the individuality of brain biochemistry. All of the drugs mentioned, and a lot more, are useful for some people who have symptoms of clinical depression. But the response to any particular drug by any individual patient is unpredictable -- it may have no effect, or even make the depression worse. But in someone else, with the same clinical symptoms, the drug will work a miracle.

"The same sort of individual difference applies, I think, with regard to smoking cessation -- how hard it is, how long it's hard, what helps -- these are widely different and unpredictable. So, it's worth keeping in mind that even with all the things we have in common, the experiences of any one of us may not be very predictive about anyone else. In other words, I need to keep in mind that even if you do exactly what I did, you may not have the same results.

"It's also worth comparing to smoking cessation, I think, because in cases where one antidepressant doesn't work, another one very well might -- just like one method of smoking cessation may not do it for an individual, but there are a lot of other choices to try. And (to tie this into a bow) one method that may be the key to smoking cessation for some people is to take antidepressant medication. It certainly wouldn't be the first suggestion I'd make for anyone, but for those who have not succeeded with other methods, and especially for anyone who thinks they may be using nicotine to self-medicate depressive symptoms, I would recommend talking to a medical professional about the possibilities."