Clinical Question

Are antidepressants safe and effective for tobacco smoking cessation?

Evidence-Based Answer

Bupropion facilitates tobacco cessation reported at 6 months of follow-up compared with placebo or no pharmacological treatment (number needed to treat [NNT] with 150 to 300 mg of bupropion per day to yield one patient who stops smoking = 14; 95% CI, 13 to 17).1 (Strength of Recommendation: A, consistent, good-quality patient-oriented evidence.) More people discontinue using bupropion due to adverse effects than those using placebo or no pharmacological treatment (number needed to harm [NNH] with 150 to 300 mg of bupropion daily to result in one patient quitting = 33; 95% CI, 33 to 100). Nortriptyline might also be effective compared with placebo, but the evidence is not as strong as for bupropion. Bupropion is not as effective as varenicline (Chantix) alone or combination nicotine replacement therapy (e.g., nicotine patch plus nicotine gum or lozenges) at helping patients stay smoke-free 6 months after starting therapy.¹

Practice Pointers

Cigarette smoking is the leading cause of preventable disease, disability, and death in the United States.² Antidepressants offer an alternative to first-line smoking cessation medications. Further insight into the effectiveness and potential harms of antidepressants for smoking cessation is valuable because of the significant worldwide morbidity and mortality caused by tobacco smoking.