According to a review published in a 2007 issue of "Cochrane Database of Systematic Reviews," two antidepressants--bupropion (extended-release) and nortriptyline--are most effective in helping people to stop smoking. Antidepressants belonging to the class of selective serotonin reuptake inhibitors (SSRIs) are not likely to be as effective. A drug called varenicline, which has also shown antidepressant effects, is another highly effective alternative treatment to help you stop smoking.
Bupropion
Extended-release bupropion is considered to be the first-line of antidepressant treatment for smoking cessation. The Food and Drug Administration (FDA) has approved the use of bupropion for the purpose of smoking cessation for seven to 12 weeks in those aged 18 and older. Because it is an antidepressant, bupropion may be particularly well suited for those who are trying to quit smoking and who have a history of depression. When used for seven to 12 weeks, it doubles the chances that you will remain cigarette-free six months after you quit.
Those who have had a particularly difficult time stopping smoking may benefit from combining bupropion with other approved therapies, such as a nicotine patch.
Nortriptyline
Nortriptyline is a tricyclic antidepressant that is not FDA-approved for treatment in smoking cessation but that has shown effectiveness in clinical trials. It is considered the second line of treatment for smoking cessation, suited for those with a history of treatment-resistant depression or those who cannot take bupropion because of an allergy or history of seizures. Like bupropion, nortriptyline doubles your chances of quitting smoking. Combining nortriptyline with other nicotine-replacement therapies may also improve your chances of quitting compared to using one treatment alone.
Varenicline
Varenicline is a medication that is classified as a partial nicotine receptor agonist/antagonist, but that research suggests may also act as an antidepressant. For example, a study in a 2009 issue of the "European Journal of Pharmacology" reports that varenicline acts as an antidepressant in mice and enhances antidepressant response when used in combination with selective serotonin reuptake inhibitors (SSRIs).
Varenicline works by mimicking nicotine, and stimulating and binding to nicotinic receptors in the brain. This triggers the release of low, sustained levels of dopamine (a chemical in the brain that is related to mood), imitating the pleasant feeling a smoker gets from nicotine. Because verenicline binds to nicotinic receptors, it blocks actual nicotine, so those who continue to smoke will not get the same pleasurable feeling.
A study published in the March 2009 issue of "Clinical Therapeutics" suggests that varenicline may be considered as another first-line treatment choice in smoking cessation. A review of existing clinical trial data showed that varenicline was comparable to extended-release bupropion in effectiveness and side effects. Varenicline may not, however, be the best choice for those with a history of psychiatric disorders. In 2008, the Food and Drug Administration issued an advisory, warning patients that varenicline may cause serious changes in mood or behavior, strange dreams and severe mood changes (including anxiety, depressed mood and suicidal thoughts), and people with a past or current psychiatric condition should exercise caution and notify their doctor.
References
- "Cochrane Database of Systematic Reviews;" Antidepressants for smoking cessation; Hughes, J.R. et al.; 2007
- American College of Physicians: Smoking Cessation Drugs
- "European Journal of Pharmacology;" Varenicline has antidepressant-like activity in the forced swim test and augments sertraline's effect; Rollema, H. et al.; March 2009
