Bupropion effective for smoking cessation in schizophrenia

Clinical question: 
How effective are interventions for smoking cessation in schizophrenia?
Bottom line: 
Compared with placebo, bupropion increased smoking abstinence rates in smokers with schizophrenia for up to six months (NNT* 17), without jeopardising their mental state. Expired carbon monoxide (CO) level and the number of cigarettes smoked daily were significantly lower with bupropion at the end of therapy but not after six months. There were no significant differences in positive, negative and depressive symptoms between bupropion and placebo groups. There was no report of any major adverse event, such as seizures, with bupropion use. One study showed contingent reinforcement (CR) with money increased smoking abstinence rates and reduced the level of smoking. However, there was no evidence CR produced sustained results for these outcomes in the longer term. * NNT = number needed to treat to benefit one individual.
The strength of the evidence for bupropion was relatively weak with wide confidence intervals, especially for longer-term benefit, because of the small number of participants. There was no evidence of benefit for the few trials of other pharmacological therapies (including nicotine replacement therapy) and psychosocial interventions, in helping smokers with schizophrenia to quit or reduce smoking.
People with schizophrenia smoke more heavily than the general population and this contributes to their higher morbidity and mortality from smoking-related illnesses.
Review CD#: 
July, 2010
Authored by: 
Brian R McAvoy