Alexandra earned her master's degree in nursing education and is currently a hospital supervisor/administrator.
Medication for Depression and Smoking Cessation
Janice is a forty-year-old woman with a history of depression. She has also been a smoker for twenty-five years. Janice is meeting with her doctor to discuss changing her antidepressant medication to bupropion because she heard it can also help with smoking cessation. Janice wants to know how it will work and if it will interact with any other medications she is already taking.
Bupropion: Mechanism of Action
Bupropion is known as an antidepressant, but it can also be used to help people quit smoking. Bupropion prevents the reuptake of three neurotransmitters called dopamine, serotonin, and norepinephrine.
Dopamine helps control the pleasure centers in the brain while also regulating movement and emotional responses. Serotonin in the brain helps with cognitive function such as memory and learning, but can also regulate mood, sleep, and appetite. Norepinephrine is known for the fight-or-flight response during stressful situations. However, it also is responsible for increasing arousal and alertness, memory retrieval, focused attention, and restlessness.
Therefore, in depression, there is often a decrease in dopamine, serotonin, and norepinephrine. Medication such as bupropion helps to regulate the amount of neurotransmitters active in the brain.
Bupropion as a smoking cessation medication is also thought to be related to the regulation of serotonin, dopamine, and norepinephrine. However, it also involved in combating nicotine receptors. It is not entirely known what is responsible for the smoking cessation relationship, but bupropion may help reduce the withdrawal symptoms of nicotine.
Janice is intrigued about using bupropion for both her depression management and smoking cessation. However, due to the unclear relationship that bupropion has with smoking cessation, it is not recommended that she take it to combat both of her issues. Janice's doctor is willing to work with her as she wants to take bupropion for smoking cessation, but still stay on her usual antidepressant. She will have to be closely followed, because bupropion can increase thoughts of suicide when first starting to take it. Janice talks with her doctor about any interactions she may see with the selective serotonin reuptake inhibitor (SSRI), fluoxetine, which she is taking for depression.
Bupropion: Drug Interactions
As Janice's doctor has already told her, it is not recommended to take bupropion for depression (medication prescribed as Wellbutrin) and smoking cessation (medication prescribed as Zyban) at the same time. Other contraindications to taking bupropion include:
- Seizure disorders or other medical issues that increase the risk of seizures
- Having an eating disorder
- Having an alcohol problem
Medications that May Cause Interactions with Bupropion
|Monoamine oxidase inhibitors (MAOI)||Antidepressants||Significant increase in blood pressure, anxiety, palpitations, tremors, seizures, agitation, mania, changes in thoughts|
|Amantadine||Anti-influenza, Parkinson's syndrome||Neurotoxicity (confusion, restlessness, dizziness, agitation)|
|Iomeprol||X-ray dye||Allergic reaction|
|Sedatives||Long-term use; medications that make you drowsy||Increased risk of seizure when stopping medication|
|Levodopa||Parkinson's disease||Agitation, restlessness, ataxia, vertigo, dizziness, difficulty walking|
|Nicotine products||Smoking cessation||Increased blood pressure|
|Stimulants||Medications that increase alertness and energy||Increase risk of seizures|
|Warfarin||Anti-coagulant; blood thinner||Increased risk of bleeding|
|Tamoxifen||Treatment and prevention of breast cancer||Decreased effectiveness of tamoxifen|
MAOIs have a strict rule to follow. They must not be taken for two weeks before or after treatment of bupropion.
There are also medications that may affect the removal of bupropion from the body, or bupropion may increase the removal of other medications from the body that must be discussed with a doctor.
Janice and her doctor decide that she is not currently taking any other medications that will react with bupropion. She will begin the medication for smoking cessation while continuing to take her regular antidepressant. She will notify her doctor of any suicidal thoughts or abnormal symptoms.
Bupropion is an antidepressant medication, but can also be used for smoking cessation. It works by regulating serotonin, dopamine, and norepinephrine. These neurotransmitters are responsible for the pleasure centers of the brain, appetite, sleep, mood, and alertness. Bupropion is thought to stabilize mood and reduce withdrawal symptoms of nicotine. Bupropion may interact with many different medications by increasing risks of seizures, increasing side effects of medications, causing neurotoxicity, and increasing or decreasing the effectiveness of medications. MAOIs are particularly important to stay away from when taking bupropion. A significant increase in adverse effects may be seen and MAOIs must be stopped for two weeks prior to and after taking bupropion.
Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.
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