Tobacco.org

• So you've tried, and tried, and tried, AND TRIED to quit  

Somehow, this time - maybe it was the nicotine-replacement patch, maybe the counseling - Collins resisted the call of the cigarette. But there is no denying: The stranglehold nicotine places on smokers can sometimes prove insurmountable.

Ask Jerry Remy, the Red Sox TV analyst who acknowledged last month that, despite enduring lung cancer, he still falls prey to the occasional impulse to smoke.

Ask Barack Obama . . .

The failure to quit, research has shown, has nothing to do with weakness of will. Nicotine, the primary addictive agent in tobacco, steals into the brain, setting on fire circuitry that regulates our sense of pleasure. At the same time, cigarettes acquire a sort of social permanence in smokers' lives - a way to start the day, to end a meal, to celebrate good times, to muddle through bad times.

So specialists who treat smokers now emphasize a double-barreled approach that combines counseling and medication, including patches, gum, and other nicotine substitutes along with drugs designed to thwart nicotine's addictive effects. There's even a nicotine vaccine being tested that would prevent the substance from reaching the brain.

Still, it's estimated that while roughly 70 percent of smokers want to quit, fewer than 10 percent succeed each year. . . .

Her first major attempt to quit was in 2000, when she went to group counseling at Mass. General. "I'd go there and I'd talk. And I'd leave immediately and have a cigarette.'' She tried again and again to stop smoking for good. Finally, last year, she decided, "This is ridiculous.'' She again sought counseling and wore the most potent nicotine patch available.

Her last drag on a cigarette, she said, was last October.

"No one can tell you to quit smoking. No one can make you feel like a social miscreant to make you quit smoking,'' said Collins, who lives in Belmont. "You have to summon it up from inside. You really, really do.''

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Drug helps pregnant drug users to stop smoking 

Treatment with an antidepressant drug significantly improves the mood in pregnant substance-dependent women who also smoke cigarettes, according to preliminary results reported at the 2009 Joint Conference of the Society for Research on Nicotine and Tobacco (SRNT) and SNRT-Europe.

The data also suggest that the antidepressant - bupropion -- helps these women curb their smoking.

"We are encouraged by the findings given that both depression and smoking are highly prevalent in pregnant, substance-dependent patients and are associated with adverse maternal and neonatal outcomes," said Dr. Margaret S. Chisolm, assistant professor of psychiatry at Johns Hopkins University in Baltimore, Maryland.

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Relapse prevention interventions for smoking cessation 

Some people start smoking again shortly after quitting and are said to have 'relapsed'. Interventions used to help people avoid relapse usually focus on teaching the skills to cope with temptations to smoke. This approach and others have not been shown to be helpful, either for people who quit on their own, or with the help of a cessation treatment, or who quit because they were pregnant or in hospital. Many trials conducted so far have not been of a strong enough design to detect possible small effects. Among drug treatments, extended use of varenicline may help some smokers. Studies of extended use of nicotine replacement treatment are urgently needed. . . .

Authors' conclusions

At the moment there is insufficient evidence to support the use of any specific behavioural intervention for helping smokers who have successfully quit for a short time to avoid relapse. The verdict is strongest for interventions focusing on identifying and resolving tempting situations, as most studies were concerned with these. There is little research available regarding other behavioural approaches. Extended treatment with varenicline may prevent relapse. Extended treatment with bupropion is unlikely to have a clinically important effect. Studies of extended treatment with nicotine replacement are needed.

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NEWS BLACK BEAT BAD HABIT WITH ANTI-DEPRESSANT 

Funnyman JACK BLACK has conquered his smoking habit with antidepressant medicine Wellbutrin. The movie star admits he's still an occasional smoker, but he's no longer hooked on nicotine. He tells Blender magazine, "I took the Wellbutrin for two years... They say you've got to be careful quitting Wellbutrin because some people have withdrawal symptoms." And Black admits he did suffer side effects as he weaned himself off the medication. . . .

Black isn't completely smoke free, admitting to the "occasional celebratory jay (joint)," and he marked the birth of his son Thomas with a cigar.

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• Anti-smoking drug could tempt athletes to cheat ($$) 

This is an Olympic year, and athletes the world over are gearing up for the Beijing games in August. There they will face afternoon temperatures that average 30 °C and can hit 42 °C, along with high humidity that will make cooling down harder. In such conditions athletes in endurance sports reach exhaustion long before their muscles would normally tire, as their brains tell them to ease up before they reach brain-damaging temperatures over 40 °C.

Romain Meeusen of the Free University of Brussels (VUB) in Belgium discovered in 2005 that the drug bupropion can cheat this switch.

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A Double-blind, Placebo-Controlled, Randomized Trial of Bupropion for Smoking Cessation in Primary Care 

Conclusions Bupropion more than doubled the odds of continuous abstinence from smoking. The adherence of general practitioners and participants to the protocol was excellent, making our findings robust and easy to generalize to the context of primary care.

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Bupropion helps primary care patients stop smoking 

Research question Can bupropion help primary care patients quit smoking?

Answer Yes. It doubles the odds of continuous abstinence for one year compared with placebo. . . .

What does it mean? This trial tested the effects of bupropion in an unselected population of smokers who were treated entirely by general practitioners. The findings suggest that this established treatment works well in primary care, doubling the odds of continued abstinence for almost a year. Lots of people failed to complete their treatment, but that's typical of smoking cessation trials, say the authors. The chances of giving up were still high compared with other trials in more specialised settings. This trial was managed, monitored, analysed, and interpreted independently of bupropion's manufacturers (GlaxoSmithKline), which paid for a pilot study, the drugs, the placebo, and the carbon monoxide monitors.

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Bupropion helps primary care patients stop smoking 

Research question Can bupropion help primary care patients quit smoking?

Answer Yes. It doubles the odds of continuous abstinence for one year compared with placebo. . . .

What does it mean? This trial tested the effects of bupropion in an unselected population of smokers who were treated entirely by general practitioners. The findings suggest that this established treatment works well in primary care, doubling the odds of continued abstinence for almost a year. Lots of people failed to complete their treatment, but that's typical of smoking cessation trials, say the authors. The chances of giving up were still high compared with other trials in more specialised settings. This trial was managed, monitored, analysed, and interpreted independently of bupropion's manufacturers (GlaxoSmithKline), which paid for a pilot study, the drugs, the placebo, and the carbon monoxide monitors.

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CYP2B6 Genotype Alters Abstinence Rates in a Bupropion Smoking Cessation Trial 

Background

CYP2B6 is the primary enzyme involved in bupropion metabolism. Genetic polymorphisms in CYP2B6, such as CYP2B6*6, can alter bupropion metabolism and may affect bupropion treatment outcome.

Conclusions

These data suggest that smokers with the CYP2B6*6 genotype have a higher liability to relapse on placebo and that they may be good candidates for bupropion treatment for smoking cessation.

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NIH Scientists Demonstrate Genetic Variant is Linked to Greater Effectiveness of Smoking Cessation Medication 

A genetic variant present in nearly half of Americans of European ancestry is linked to greater effectiveness of the smoking cessation medication bupropion (Zyban), according to research by scientists supported by the National Institute on Drug Abuse (NIDA) and the National Cancer Institute (NCI), part of the National Institutes of Health (NIH). People with this variant were less likely than those without it to have resumed smoking six months after treatment with bupropion.

The study, published in the September issue of the journal Biological Psychiatry, is a step toward the goal of being able to tailor smoking cessation treatment to individuals based on their unique genetic make-up.

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Gene impacts smoking cessation drug 

U.S. and Canadian scientists have demonstrated a link between a genetic variant and the effectiveness of the smoking cessation drug bupropion, or Zyban.

People with this variant -- nearly half of Americans of European ancestry -- were less likely than those without it to have resumed smoking six months after treatment with bupropion, reported the study the journal Biological Psychiatry.

Rachel F. Tyndale of the University of Toronto and Caryn Lerman of the University of Pennsylvania in Philadelphia had more than 300 smokers randomly assigned to treatment with either bupropion or a placebo for 10 weeks. Study participants were genetically tested for the presence of a variant form of the CYP2B6 gene,

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• BROOKER: Warning: giving up smoking can seriously damage your health 

But. There was a "but". A week after my "quit date", I was at home, watching a film with a friend. As the credits rolled, a frantic, nameless dread washed over me. Within minutes, I was a quivering wreck. My mind was drifting away from reality, tethered only by a narrow thread that might snap at any moment. Heart pounding, palms sweating. I clutched my head, blinking, hyperventilating, nerves jangling at 9,000 rpm.

It was a major panic attack, which eventually lasted over four hours, deep into the night. I've never known such terror. I became obsessed with the notion that I might snap at any moment; attack my friend, leap from a window, gouge my own eyes out with my thumbs, screaming, shrieking; a banshee. I've had better evenings in.

The next day I decided I'd had enough of that for one lifetime. I threw the pills away. Thing is, it takes days to clear your system. For a week, I walked around like a de-tuned radio, continually anxious, fighting insane paranoid notions; a horrified alien visitor on a tour of my own life. I was terrified it was permanent; slowly, normality returned.

Weeks later, I still can't believe I was legally prescribed something that could bend my brain over its knee with such demented zeal - although it's worth pointing out I have no evidence that what happened to me had anything to do with Zyban. All I know is it happened while I was taking the drug, and stopped several days after I binned the pills. Maybe it was a coincidence. Maybe I'm just crazy. I don't know. I do know, however, that pharmaceutical companies have ominous legal departments orbiting the planet in almighty Death Stars, and that a lawyer twice as powerful as God is doubtless reading this right now.

Anyway. Smoking kills, and I'm glad I've stopped. Quitting's worth it. Just don't choose a cure worse than death.

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The latest smoking cure: Viagra 

Every smoker needs a little encouragement to give up, but some in Glasgow received more than they expected when they registered for a drug to help them.

In a development unlikely to reduce cigarette consumption but almost certain to produce other benefits — at least for male patients — a “computer glitch” led to smokers being mistakenly prescribed Viagra instead of the anti-smoking drug Zyban.

The problem is thought to have become apparent several weeks ago.

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Bupropion for Smoking Cessation: A ReviewComprehensive Therapy 

Smoking tobacco is the leading cause of preventable death. Bupropion is the only antidepressant recommended as first-line pharmacotherapy for smoking cessation. Bupropion is as effective as nicotine replacement therapy and can be used in diverse populations.

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Stop-smoking pill boosts sex drive in some users 

Now, however, I have an above-average libido - physically and mentally. I figure maybe it's because the drug takes away any of those long-standing inhibitions that would otherwise impede and affect sex.

A:

Bupropion (Wellbutrin, Zyban) is prescribed both as an antidepressant and an aid to quit smoking. We don't know exactly how it increases sexual desire, but this side effect has been known for years. Although bupropion is definitely not an aphrodisiac, it is sometimes a helpful substitute when other antidepressants cause sexual difficulties.

For those who would like to know more about this reaction, as well as other strategies for dealing with sexual problems, we offer our Guides to Female Sexuality and Treating Sexual Dysfunction.

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