Do medicines for depression help people to quit smoking?
What are antidepressants?

Antidepressants are medicines and supplements used to treat depression. Some have also been tested to see whether they can help people to stop smoking. Two of these treatments – bupropion (sometimes called Zyban) and nortriptyline – are sometimes given to help people quit smoking. 

Why we did this Cochrane Review

Smoking tobacco is extremely bad for people’s health. For people who smoke, quitting is the best thing they can do to improve their health. Many people find it difficult to quit smoking. We wanted to find out whether using antidepressants helps people to stop smoking (for six months or longer), and what potential harms might come from using these medicines.

We were interested in finding out:

‐ how many people stopped smoking for at least six months; and

‐ how many people had unwanted effects.

What did we do?

We searched for studies that looked at the use of antidepressants to help people quit smoking.

We looked for randomised controlled trials, in which the treatments people received were decided at random. This type of study usually gives the most reliable evidence about the effects of treatment. We included studies of any length when looking at evidence of harms, but studies needed to be at least six months long when assessing whether people had managed to quit smoking.

What we found

This review includes 124 studies, including 48,832 participants, looking at how helpful and safe different antidepressants are when used to quit smoking. Most studies were conducted in adults who smoked tobacco, with and without a history of mental illness. Four studies recruited young people aged 12 to 21 years. Most participants were motivated to quit smoking.

What are the results of our review?

Compared to not using any medication, using the antidepressant bupropion makes it 49% to 72% more likely that a person will successfully stop smoking, which is equal to six to eight more people successfully quitting for six months or more for every one hundred people who try to quit. There is evidence that people who use the antidepressant nortriptyline to quit smoking also improve their chances of success (48% to 178% more likely).

Bupropion may increase serious unwanted effects (such as death, hospitalisation, or life‐threatening events). Unwanted effects may increase the chance that people stop using the medicine. There is not enough information to draw clear conclusions about the harms of nortriptyline for stopping smoking.

The evidence suggests that taking bupropion at the same time as other stop‐smoking medicines – varenicline (a drug sometimes known as Champix or Chantix which is not an antidepressant) and combination nicotine replacement therapy (a patch plus another form) – may make people more likely to quit smoking than if they use nicotine replacement therapy or varenicline on their own. However, further evidence may change our findings. The evidence does not suggest a benefit of using bupropion at the same time as a single form of nicotine replacement therapy; for example, a patch, gum, or lozenge alone. People may be more likely to quit smoking when using bupropion compared with nortriptyline, but more likely to quit when using varenicline than bupropion.

How reliable are these results?

There is high‐certainty evidence that bupropion helps people to quit smoking, meaning further research is very unlikely to change this conclusion. However, there is also high‐certainty evidence to suggest that people using bupropion are more likely to stop taking the medicine because of unpleasant effects than those taking a pill without medication (a placebo) or no medication. The certainty of the evidence was moderate or low for the other key questions we looked at. This means that the findings of those questions may change when more research is carried out. In most cases, this was because there were not enough studies or studies were too small.