Question

Which antidepressants are effective in aiding long term (>6 months) smoking cessation?

Bottom Line

Both bupropion and nortriptyline double the odds of cessation when compared to placebo (median NNT* = 11 and 10 respectively). The efficacy of bupropion and nortriptyline appears to be similar to that for nicotine replacement and is not restricted to people with a history of depression or depressive symptoms during smoking abstinence. Selective serotonin reuptake inhibitors (SSRIs), venlafaxine and moclobemide show no evidence of benefit. * NNT = number needed to treat to benefit one individual.

Caveat

Bupropion can cause insomnia, dry mouth,nausea and seizures (estimated risk = 1 in 1000). Nortriptyline can cause dry mouth,constipation, nausea and sedation, and can be dangerous in overdose.

Context

Smoking is the most preventable cause of premature death, accounting for about 17% of all deaths in developed countries