Antidepressant is stopsmoking aid

Study: Zyban appears to help stop nicotine craving and the addiction's side
effects, researchers say.

New York Times

An antidepressant drug can help people quit smoking, even those who are not
depressed and would not normally take such a medication, researchers say.

The drug, bupropion hydrochloride, which has been on the market since the
summer under the brand name Zyban, was the first nonnicotine product
approved by the Food and Drug Administration to help smokers break the habit.

``The success rates are good, but it's not a magic bullet,'' said Dr.
Richard Hurt, director of the nicotinedependence center at the Mayo
Clinic, who is the lead author of a study of bupropion being published
today in the New England Journal of Medicine. ``There is not going to be a
magic bullet for this very difficult addiction.''

The drug, which is available by prescription only, works about as well as
nicotine patches, Hurt said, and offers an alternative for people who do
not want to use nicotine or who have tried it and failed.

Several smaller studies had already suggested that bupropion was effective
as a stopsmoking aid. But the research by Hurt and his colleagues was the
largest trial to date of any antidepressant for that purpose. The research
was financed by Glaxo Wellcome Inc., the manufacturer of bupropion, which
also is sold under the name Wellbutrin as a medication to fight depression.

The subjects were 615 smokers treated at three centers around the country.
All had tried several times before to quit smoking.

The patients were given either placebos or bupropion, along with brief
counseling sessions, for seven weeks. The drug was tested in varying doses.
After the seventh week, 44 percent of those who took the highest dose, 300
milligrams a day, had stopped smoking, compared to 19 percent in the
placebo group. The drug also was found to be effective in lesser doses,
although not as much so.

Once the sevenweek trial period was over, all participants who had been
given the drug stopped taking it. After a year, many had begun smoking
again, but the highdose bupropion group still had the most abstainers: 23
percent were still not smoking, compared to 12 percent in the placebo group.

``People may poohpooh this and say 23 percent at one year is not good,''
Hurt said. ``But do you know what the lungcancer survival rate is long
term? It's 14 percent.''

Researchers think bupropion may help smokers to quit by mimicking the
effects of nicotine on the brain, said Dr. Neal Benowitz, chief of clinical
pharmacology at the University of CaliforniaSan Francisco. Benowitz, who
did not work on the study, wrote an editorial accompanying it in the journal.

``Nicotine works in large part by causing the release of substances called
neurotransmitters in the brain,'' he said in a telephone interview. ``If
you're a regular smoker and you stop, you have a relative deficiency of
those neurotransmitters. You get irritable and depressed, and you have mood
swings. Antidepressants help normalize the neurotransmitter levels.''

Published Thursday, October 23, 1997, in the San Jose Mercury News