Bupropion and nortriptyline aid long-term smoking cessation but selective serotonin uptake inhibitors (SSRIs) do not

Clinical 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 (NNT = 7 and 10 respectively). The efficacy of bupropion and nortriptyline appears to be similar to that for nicotine replacement and not restricted to people with a history of depression or depressive symptoms during smoking abstinence. SSRIs, venlafaxine and moclobemide show no evidence of benefit.
Caveat: 
Bupropion can cause insomnia, dry mouth, nausea and seizures (estimated risk = 1 in 1,000). 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
Review CD#: 
CD000031
PEARLS No: 
18
Date: 
March, 2007
Authored by: 
Brian R McAvoy