Efficacy of Bupropion for Relapse Prevention in Smokers With and Without a Past History of Major Depression


  • Lisa Sanderson Cox PhD,

  • Christi A. Patten PhD,

    Corresponding authorSearch for more papers by this author
  • Raymond S. Niaura PhD,

  • Paul A. Decker MS,

  • Nancy Rigotti MD,

  • David P. L. Sachs MD,

  • A. Sonia Buist MD,

  • Richard D. Hurt MD

  • Received from the Nicotine Dependence Center Research Program (LSC, CAP, RDH), Department of Psychiatry and Psychology (CAP), Division of Community Internal Medicine (RDH), and Section of Biostatistics (PAD), Mayo Clinic, Rochester, Minn; Miriam Hospital (RSN), Brown University, Providence, RI; Massachusetts General Hospital (NR), Boston, Mass; Palo Alto Center for Pulmonary Disease Prevention (DS), Palo Alto, Calif; and Pulmonary and Critical Care Division (ASB), Oregon Health and Science University, Portland, Ore.

Address correspondence and requests for reprints to Dr. Patten: Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 (e-mail: patten.christi@mayo.edu).


BACKGROUND:  This study evaluated the efficacy of bupropion for relapse prevention in smokers with and without a past history of major depressive disorder. Changes in depressive symptoms were also examined.

DESIGN:  Data were gathered prospectively from a randomized, double-blind relapse prevention trial of bupropion conducted at five study sites. A total of 784 smokers (54% female, 97% white) were enrolled. Using the Structured Clinical Interview for Depression, 17% of the subjects reported a past history of major depressive disorder at baseline. All subjects received open-label bupropion SR (300 mg/d) for 7 weeks. Subjects abstinent from smoking at the end of 7 weeks (N= 429) were randomized to bupropion SR (300 mg/d) or placebo for the remainder of the year and followed for 1 year off medication. The primary outcome measures were median time to relapse to smoking and the 7-day point-prevalence smoking abstinence rate. Self-reported abstinence from smoking was verified by expired air carbon monoxide. The Beck Depression Inventory was used to assess depressive symptoms at baseline and at weeks 8 and 12.

RESULTS:  Median time to relapse did not differ by past history of major depressive disorder. Bupropion was associated with higher point-prevalence smoking abstinence at the end of medication compared to placebo (P= .007), independent of a past history of major depressive disorder. Moreover, change in depressive symptoms during the double-blind phase did not differ for those with and without a past history of major depressive disorder.

CONCLUSIONS:  Extended use of bupropion for relapse prevention is effective for smokers with and without a history of major depression.