Efficacy and safety of bupropion for smoking cessation and reduction in schizophrenia: Systematic review and meta-analysis

Academic Clinical Psychiatry, University of Sheffield, Sheffield, UK.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 05/2010; 196(5):346-53. DOI: 10.1192/bjp.bp.109.066019
Source: PubMed


The benefits and harms of bupropion as an aid for smoking cessation in schizophrenia remain uncertain.
To summarise the current evidence for efficacy and safety of bupropion as treatment for nicotine dependence in schizophrenia.
Systematic review and random-effects meta-analysis of randomised controlled trials (RCTs) comparing bupropion with placebo or alternative therapeutic control in adult smokers with schizophrenia.
Twenty-one reports from seven RCTs were included. Biochemically verified self-reported smoking cessation rates after bupropion were significantly higher than placebo at the end of treatment (risk ratio (RR) = 2.57, P = 0.004) and at 6 months (RR = 2.78, P = 0.05). Expired carbon monoxide level was significantly lower with bupropion at the end of therapy (P = 0.002) but not at 6 months (P = 0.37). There was no significant difference in positive (P = 0.28) or negative symptoms (P = 0.49) between the bupropion and the placebo group.
Bupropion increases the rates of smoking abstinence in smokers with schizophrenia, without jeopardising their mental state.

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Available from: Mamta Porwal, Nov 05, 2015
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    • "Helping people with mental illness stop smoking should form a routine part of clinical care and is clearly an International public health priority [19], and several interventions may help. For instance, a systematic review of randomized control trials on smoking cessation interventions [20] established a number of safe approaches (for example, Bupropion) to help people with schizophrenia stop smoking. A recent systematic review concluded that smoking cessation interventions are as effective in people with SMI as the general population [21]. "
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    ABSTRACT: Background: Prevalence rates of smoking in people with mental illness are high, and premature mortality attributed to tobacco related physical comorbidity is a major concern. We conducted a meta-analysis comparing rates of receipt of smoking cessation advice among people with and without mental illness. Method: Major electronic databases were searched from inception till August 2014 for studies comparing rates of receipt of smoking cessation advice of people with and without a mental illness. Two independent authors completed methodological appraisal and extracted data. A random-effects meta-analysis was utilized. Results: Seven studies of satisfactory methodological quality (n mental illness=68,811, n control=652,847) were included. Overall there was no significant difference in smoking cessation advice rates between those with and without a mental illness [relative risk (RR)=1.02, 95% confidence interval (CI)=0.94-1.11, n=721,658, Q=1421, P<.001]. Subgroup analyses demonstrated people with severe mental illness (SMI) received comparable rates of smoking cessation advice to those without SMI (RR=1.09, 95% CI=0.98-1.2, n=559,122). This remained true for people with schizophrenia (RR=1.09, 95% CI=0.68-1.70) and bipolar disorder (RR=1.14, 95% CI=0.85-1.5). People with non-SMIs were slightly more likely to receive smoking cessation advice (RR=1.16, 95% CI=1.04-1.30, Q=1364, P<.001, n=580,206). Conclusions: People with SMI receive similar smoking cessation advice rates to people without mental illness, while those with non-SMI are slightly more likely to receive smoking cessation advice. While progress has been made, offering smoking cessation advice should receive a higher priority in everyday clinical practice for patients with a mental health diagnosis.
    Full-text · Article · Dec 2014 · General Hospital Psychiatry
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    • "The use of combined oral and transdermal forms of NRT are useful for smokers who have break through cravings [44]. Although not routinely used other medications can be combined such as NRT with either bupropion [45] or varenicline [46] [47] if monotherapy is not successful. A smokerlyser meter to measure exhaled carbon monoxide (CO) is recommended [48] and makes the PCTM more precise. "
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    ABSTRACT: Patient-centred tobacco management approaches tobacco smoking as a chronic disease and can be offered to all smokers irrespective of their attitude to quitting. Maintaining a long-term relationship with smokers enables the adoption of flexible solutions and shared goals. It is argued that patient-centred tobacco management potentially heightens the chances of eventual abstinence for smokers who are unable, or not yet ready to quit. [Gould, GS. Patient-centred tobacco management. Drug Alcohol Rev 2013].
    Full-text · Article · Nov 2013 · Drug and Alcohol Review
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    • "When considering pharmacotherapy, our review of the literature suggests a need for further trials of nicotine replacement therapy and varenicline with this client group [9,10]. Also, levels of psychiatric medications (e.g. "
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    ABSTRACT: Background: Smoking in people with mental health problems (MHPs) is an important public health concern as rates are two to three times higher than in the general population. While a strong evidence base exists to encourage and support smoking cessation in the wider population, there is limited evidence to guide the tailoring of interventions for people with MHPs, including minimal understanding of their needs. This paper presents findings from theoretically-driven formative research which explored the barriers and facilitators to smoking cessation in people with MHPs. The aim, guided by the MRC Framework for the development and evaluation of complex interventions, was to gather evidence to inform the design and content of smoking cessation interventions for this client group. Methods: Following a review of the empirical and theoretical literature, and taking a critical realist perspective, a qualitative approach was used to gather data from key stakeholders, including people with enduring MHPs (n = 27) and professionals who have regular contact with this client group (n = 54). Results: There was a strong social norm for smoking in participants with MHPs and most were heavily addicted to nicotine. They acknowledged that their physical health would improve if they stopped smoking and their disposable income would increase; however, more important was the expectation that, if they attempted to stop smoking, their anxiety levels would increase, they would lose an important coping resource, they would have given up something they found pleasurable and, most importantly, their mental health would deteriorate. Barriers to smoking cessation therefore outweighed potential facilitators and, as a consequence, impacted negatively on levels of motivation and self-efficacy. The potential for professionals to encourage cessation attempts was apparent; however, they often failed to raise the issue of smoking/cessation as they believed it would damage their relationship with clients. The professionals’ own smoking status also appeared to influence their health promoting role. Conclusions: Many opportunities to encourage and support smoking cessation in people with MHPs are currently missed. The increased understanding provided by our study findings and literature review have been used to shape recommendations for the content of tailored smoking cessation interventions for this client group.
    Full-text · Article · Mar 2013 · BMC Public Health
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