December 2010

Asenapine: More Data
Olanzapine (Zyprexa) may be better tolerated and more efficacious for patients with bipolar I disorder than asenapine (Saphris).

Sibutramine (Meridia and others): Risks versus Benefits
After a large trial found a higher frequency of adverse cardiovascular events in sibutramine- versus placebo-treated patients, this "diet pill" was withdrawn from the US market.

Antidepressants and Weight Gain
While some antidepressants have no significant effect on body weight, many may cause weight gain or loss during short- or long-term treatment.

In Brief
Psychiatric Disorders Associated with Suicide Attempts in Prisoners; Buprenorphine Implants for Opioid Dependence

Bupropion for Smoking Cessation in People with Schizophrenia
In smokers with schizophrenia, bupropion (Wellbutrin, Zyban, and others) increases the odds of abstinence.

2010: Close and Save
Dr. Gelenberg's end-of-year editorial and holiday message.

2010 Index

Bupropion for Smoking Cessation in People with Schizophrenia

December 2010

People with schizophrenia frequently smoke, often heavily. They lose, on average, 25 years of life to smoking-attributable mortality.1 Bupropion (Wellbutrin, Zyban, and others) is labeled as an adjunct to support smoking cessation. But among its pharmacological properties, bupropion increases dopamine neurotransmission, which is believed to contribute to psychotic symptoms. Is bupropion safe and effective as a means to achieve smoking abstinence in people with schizophrenia? Tsoi and coworkers address this question with a systematic review and meta-analysis.2

Using the Cochrane database and an electronic literature review, the authors identified seven randomized controlled trials involving 260 participants that compared bupropion, 150 or 300 mg daily, alone or combined with other pharmacologic and nonpharmacologic treatments, with control conditions in adult smokers with schizophrenia.

The conclusion was clear and reassuring. In smokers with schizophrenia, with or without nicotine replacement therapy, bupropion doubles to triples the odds of abstinence—both at the end of treatment and at a 6-month follow-up. Further good news is that bupropion does not adversely affect positive, negative, or depressive symptoms compared with controls. A 2009 panel funded by the National Institute of Mental Health concluded that patients with schizophrenia who wish to quite or reduce cigarette smoking should be offered treatment with bupropion sustained-release, 150 mg twice daily for 10 to 12 weeks, along with behavioral support. Nicotine replacement therapy may be offered as well. Results from this review and meta-analysis support that recommendation.

1Evins AE: Review: Bupropion increases abstinence from smoking without affecting mental state in people with schizophrenia. Evid Based Ment Health 12 August 2010 [Epub ahead of print].

2Tsoi DT, Porwal M, Webster AC: Efficacy and safety of bupropion for smoking cessation and reduction in schizophrenia: Systematic review and meta-analysis. Br J Psychiatry 2010;196:346-353.