Bupropion and tobacco cravings

Bupropion hydrochloride was originally marketed as an antidepressant but it has also been found to be effective in helping people to give up smoking. It reduces people's cravings for cigarettes but noone knows quite how it works. A team of researchers from the University of California Los Angeles studied 30 people all of whom were hooked on cigarettes. Over an eight-week study half of them were given bupropion and half were given a placebo. The participants who had been given bupropion reported fewer cravings and less activation in the left ventral striatum, the right medial orbitofrontal cortex and the bilateral anterior cingulate cortex than those who were taking a placebo. All the participants showed reduced brain activity in the bilateral medial orbitofrontal cortex and the left anterior cingulate cortex when they were trying to resist tobacco cravings suggesting that bupropion works by dampening down these areas of the brain.

Culbertson, Christopher S. ... [et al] - Effect of Bupropion Treatment on Brain Activation Induced by Cigarette-Related Cues in Smokers Archives of General Psychiatry doi:10.1001/archgenpsychiatry.2010.193

Smoking and mental health - feeling glum and giving up

Giving up smoking could be as good for people's mental health as it is for their bodies despite the fact that people often say they smoke because it makes them feel less anxious or depressed. Researchers from Brown University in Rhode Island studied 236 men and women who were trying to give up. 99 of them never managed to give up at all, 33 managed to give up for the whole 28 weeks of the study and the rest gave up temporarily. Those who managed to quit temporarily had fewer depression symptoms when they weren't smoking but after they had relapsed their mood got worse, in some cases ending up worse than before they had stopped. The participants who never gave up were the unhappiest of all the groups whereas the ones who managed to abstain over the whole course of the study were the happiest to begin with and remained at the same level of happiness throughout.

Smoking and anxiety

People with anxiety problems could be more likely to smoke and may have a harder time giving up when they do. Researchers from the University of Wisconsin studied 1,504 people taking part in a smoking-cessation programme in Madison and Milwaukee. 455 had had a panic attack in the past, 199 had social anxiety disorder and 99 had generalized anxiety disorder with some people having more than one condition. Other research has shown that up to a quarter of the smokers in the U.S. have had at least one anxiety disorder in their lifetime. The participants with anxiety disorders were much less likely to succeed on the programme, had higher levels of nicotine dependence and more withdrawal symptoms before quitting.

Smoking cessation and schizophrenia

Death rates for people with schizophrenia are three times those of the rest of the population. The increased risk is largely due to the fact that people with schizophrenia are two to three times more likely to smoke. However, there has not been that much emphasis on smoking cessation in mental health as it is feared that giving up smoking might lead to people's psychological health getting worse. Researchers from the University of York reviewed the evidence on smoking cessation programmes for people with severe mental illness. They found that for people with well-controlled schizophrenia smoking-cessation programmes were effective and did not lead to a deterioration in mental health. However, it was not possible to say how people with a more acute mental illness would respond to a smoking-cessation programme.

You can find out more about this research at

http://www.medicalnewstoday.com/articles/189532.php

Suicide warning over anti-smoking drugs

The United States' Food and Drug Administration (FDA) has issued a warning about the suicide risk of the anti-smoking drugs Chantix (varenicline) and Zyban (bupropion). There have been 98 suicides in people taking Chantix and 14 in people taking Zyban with nearly 5,000 'serious psychiatric events' caused by the two drugs. The drugs have also been linked to an increased risk of accidents with loss of consciousness, mental confusion, dizziness and muscle spasms.

You can read more about the FDA's ruling at

http://uk.reuters.com/article/idUKTRE56060X20090702?feedType=RSS&feedName=healthNews&sp=true

Wards face uphill struggle to stub out smoking

On the 1st July, 2008 smoking was banned in psychiatric hospitals in the U.K. However, many hospitals have failed to implement the ban fully - if at all - and there has been a rise in 'secret smoking' by service users. A study of services by the Mental Health Foundation found that 85% of units had not implemented the ban fully. Many units lacked a safe outdoor smoking area for service users and the need to escort patients off the ward was seen to be a considerable drain on resources. Staff felt uncomfortable enforcing the ban and often turned a blind eye to smoking. In wards where the ban had been implemented successfully there had been widespread consultation with staff and patients beforehand, there was support for service users to stop smoking and alternative activities were provided for them.

You can find out more about this study at

http://www.communitycare.co.uk/Articles/2009/06/22/111898/psychiatric-units-unable-to-implement-smoking-ban.html

Bupropion helps pregnant smokers

Smoking while pregnant can cause damage to unborn children and depression is also associated with 'adverse maternal and neonatal outcomes.' Both are common in pregnant women who use illegal drugs. Researchers from John Hopkins University in Baltimore studied 56 women who were enrolled in a drug-treatment programme which combined a week-long residential stay with follow-up outpatient treatment. Some were given bupropion, others were given citalopram or escitalopram and others were given no antidepressants. The women who took bupropion cut down their cigarette smoking by an average of 6.4 cigarettes a day (compared to negligible changes in the other groups) and were much more likely to show an improvement in their depression.

You can find out more about this research at

http://uk.reuters.com/article/healthNews/idUKTRE53S7UD20090429?feedType=RSS&feedName=healthNews&sp=true

Naltrexone helps with smoking and drinking

Naltrexone is a drug used to treat people with alcohol problems. Alcohol and nicotine stimulate the same reward pathways in the brain and a study of 78 people by researchers at the University of Chicago has found that it can also help heavy social drinkers who smoke give up tobacco and cut down on their drinking. The participants in the study had a range of drinking behaviour from total abstinence to heavy social drinking; half of them were given naltrexone and half were given a placebo. The study found that 50mg of naltrexone daily, together with a nicotine patch and counselling, significantly decreased heavy drinking rates and the participants who drank the most were most likely to quit smoking as well.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/03/090319161458.htm

Smoking and schizophrenia

People with schizophrenia are much more likely to smoke than the rest of the population and people suffering from depression and anxiety are also more likely to smoke as well. A study of 100 people with schizophrenia living in the North of England asked whether those who smoked had higher levels of anxiety and depression and whether suffering from anxiety and depression made the participants more likely to smoke. The researchers found that there was no significant difference 'in anxiety and depression scores as a function of smoking status' although men with schizophrenia were much more likely to smoke than women.

Martin, C.R. ... [et al] - Mood and smoking in schizophrenia Journal of Psychiatric and Mental Health Nursing November 2008, 15(9), 703-709

Smoking and mental illness

There has long been known to be a link between smoking and mental illness and a study of 280 service users in Melbourne, Australia has found that they were more than four times as likely to smoke as the rest of the population. 62% of the sample smoked and they consumed an average of 22 cigarettes a day, 50% more than in the general population with the heaviest smokers in the group smoking up to 80 a day. 59% of the smokers said that they wanted to give up and 74% wanted to cut down. The biggest cause of death among people with mental illness is cardiovascular disease and some service users can spend more than 20% of their income on cigarettes.

You can find out more about this research at

http://psychcentral.com/news/2008/10/09/smoking-accompanies-mental-illness/3099.html

Values and motivation to change

Writing about important values can make people feel better and more receptive to advice according to researchers at the University of California, Santa Barbara. In one study the researchers asked participants to rank six values - social life, religion/morality, science, business, arts and government - in order of importance. One group later wrote for ten minutes about why their most important value was important to them and the other group wrote about why their least important value might be important to others. The second study followed the same procedure but some of the participants were smokers and all the participants later read an article about the health effects of smoking. In both studies those who wrote about an important value felt more loving and connected and in the second study those smokers who wrote about an important value were less defensive and more accepting of the content of the article. The researchers thought that writing about what they loved and cared for enabled people to transcend the self and could help foster learning under difficult circumstances; something that might prove useful in the treatment of addictive behaviours.

You can find out more about this research at

http://psychcentral.com/news/2008/07/23/reflecting-on-values-transcends-self/2649.html