Antidepressants are FDA approved for the treatment of major depressive disorder (MDD) and a host of other mental health conditions. They work by increasing the levels of certain neurotransmitters in the brain, such as serotonin, dopamine, or norepinephrine.
While the primary intention is to reduce symptoms of depression and promote emotional regulation in patients, one antidepressant simultaneously reduced nicotine cravings and withdrawal symptoms associated with stopping smoking.
Bupropion hydrochloride, marketed as Zyban, was FDA approved in 1997 as an aid for smoking cessation. [1]
Can antidepressants help with smoking cessation?
Not all antidepressants help you quit smoking, but there are a couple deployed to that end.
Zyban (bupropion hydrochloride) was initially marketed as an antidepressant drug called Wellbutrin, aimed at treating depression. However, it became noticeable that patients who were smokers lost interest in smoking over the course of their Wellbutrin treatment.
There is solid evidence that bupropion helps people to quit smoking. One review found that people who used Zyban were 49% to 72% more likely to successfully stop smoking than those who used no medication. This equated to about six or eight more people for every one hundred that tried to quit smoking. [2]
Evidence points to the increased efficacy of taking Zyban alongside another anti-smoking treatment, such as varenicline (marketed as Champix or Chantix) or a nicotine replacement therapy, such as a patch. [2]
How does Zyban work?
While the exact mechanisms of how Zyban works to aid smoking cessation are not fully understood, researchers believe it affects certain neurotransmitters in the brain that are involved in addiction and mood regulation.
Zyban is thought to influence the levels of dopamine and norepinephrine in the brain. These neurotransmitters are associated with pleasure, reward, and motivation. [3] By affecting the balance of these neurotransmitters, Zyban can help reduce the craving for nicotine and any withdrawal symptoms usually experienced.
Who should not use Zyban?
It’s important to consult a healthcare provider before using Zyban to determine whether it’s appropriate for you. There are certain individuals who should not use Zyban due to potential health risks or interactions with other medications: [3]
- People with seizure disorders
- People with eating disorders
- People who have recently taken monoamine oxidase inhibitors (MAOIs)
- People with liver disease
- People who are pregnant
- People who are breastfeeding
- People allergic to bupropion
- People already taking bupropion-containing medications
It is vital you consult your healthcare provider before starting any course of antidepressant. Be entirely honest about your current medical situation and they will be able to suggest the best way to move forward with your treatment.
Nortriptyline as a treatment for smoking cessation
Nortriptyline is a tricyclic antidepressant that has been used off-label to aid in smoking cessation. Like bupropion, nortriptyline affects neurotransmitter levels and can help reduce nicotine cravings.
There is over a 48% increase in likelihood that a person will give up smoking if they take nortriptyline than if they take no medication. [1] However, Zyban appears to be a more effective form of treatment. [1]
Final thoughts
Whilst not all antidepressants are effective at aiding in smoking cessation, Zyban and nortriptyline can be used to help people quit.
These medications are typically used as part of a comprehensive smoking cessation program, which may also include counseling, behavioral therapy, and support from healthcare providers. Combining medication with behavioral support can increase the likelihood of successful smoking cessation.
If you’re interested in using Zyban or nortriptyline to help you quit smoking, consult your doctor to determine the best approach for your specific situation. They can provide guidance on the appropriate medication, dosage, and how to integrate it into your overall smoking cessation plan.
- Hajizadeh, A., Howes, S., Theodoulou, A., Klemperer, E., Hartmann-Boyce, J., Livingstone-Banks, J., & Lindson, N. (2023). Antidepressants for smoking cessation. 2023(5). https://doi.org/10.1002/14651858.cd000031.pub6
- Do medicines for depression help people to quit smoking? (n.d.). Www.cochrane.org. Retrieved September 29, 2023, from https://www.cochrane.org/CD000031/TOBACCO_do-medicines-depression-help-people-quit-smoking
- Wilkes S. The use of bupropion SR in cigarette smoking cessation. Int J Chron Obstruct Pulmon Dis. 2008;3(1):45–53. doi:10.2147/copd.s1121
- PRESCRIBING INFORMATION. (n.d.). Retrieved September 29, 2023, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020711s032s033lbl.pdf
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