A smoking cessation medication that is also used to treat depression may be a better choice than nicotine replacement therapy for women who want to quit smoking for good, a new study indicates.
Guidelines used by clinicians nationwide to help patients quit using tobacco recommend a combination of counseling and medication. However, recent research shows that women may not respond as well as men to nicotine replacement therapy, the most frequently purchased medication. Women are less likely than men to succeed in quitting, and those who do quit are more likely to start smoking again.
David Gonzales, Ph.D., of Oregon Health & Science University’s Smoking Cessation Center, examined the effects of an alternative medication to see if it would produce more equal success rates among men and women. The medication, bupropion (marketed under the name Zyban), contains no nicotine and is also prescribed as an antidepressant (Wellbutrin).
The results appear in the May issue of the American Journal of Preventive Medicine.
Bupropion might be more effective than nicotine replacement for women, Gonzales explains, because it may better control some of the symptoms that are particularly common among women when they give up cigarettes: depression, anticipation of anxiety and tension and concern about weight gain.
Gonazales and his colleagues followed participants in a smoking cessation study conducted at five major clinical centers in the United States. All 784 participants received bupropion at the start of the study. After seven weeks, the researchers assigned 432 of the men and women who had stopped smoking to two groups. One group continued to take bupropion for the next 45 weeks, while the other group switched to a placebo.
Women and men, the authors found, are equally likely to quit smoking after seven weeks of bupropion treatment. Women and men who continue to receive the bupropion for a full year are equally likely to stay away from cigarettes, as are men and women who switch to a placebo. Even two years after smoking cessation treatment begins, the authors found during a re-check, there is still no gender difference in relapse rates.
The only significant difference in relapse patterns, Gonzales reports, is linked to the length of bupropion treatment. Quitters who take bupropion for only seven weeks are more likely to start smoking again, and tend to relapse sooner, than quitters who take the medication for a full year.
While the study was not designed to determine why the bupropion was so effective in helping the women stay away from cigarettes, Gonzales notes that relief of depression, irritability and other negative feelings after quitting likely played a role.
Another possible explanation, Gonzales observes, is that bupropion often makes smoking less enjoyable. “In this and other trials of bupropion … there have been … reports of a change of taste in cigarettes,” he explains. Previous research suggests that the normal taste and smell of cigarettes are part of what makes them pleasurable for women, but not for men.
Overall, Gonzales observes, his team’s findings are consistent with the notion that non-nicotinic medications may be more appropriate than nicotine replacement for women in both the short and long term. Data such as these, he concludes, “may become increasingly important in matching medications to smokers.”
Support for the study was provided by GlaxoSmithKline Inc.
The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge and wisdom in prevention science, education, practice and policy. For more information about the Journal, contact the editorial office at 619-594-7344.
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