I’m happy to report that I made it another week in my quest to quit smoking without any relapses. I’m actually amazed at how little I’ve thought about cigarettes at all—even grabbing a drink in a smoky bar didn’t set me to pining. I think the bupropion pills I’m taking must be making a difference, because it can’t naturally be this easy for your brain or body to get over a long-term smoking habit. So for my quitting smoking chronicles this week, I thought I’d explore a little further just how bupropion works to help people quit.
Isn’t bupropion an antidepressant? Yes, bupropion (its generic name) is in a class of drugs known as atypical antidepressants. It’s prescribed for depression (and, less often, for bipolar disorder, seasonal affective disorder and ADHD) under the name brand names Wellbutrin or Aplenzin. It’s prescribed as a quit-smoking aid under the brand name Zyban. The generic bupropion is prescribed in both cases, too, and that’s the term I’m sticking with.
How does it work to curb smoking? As a smoking cessation aid, a smoker stops using tobacco completely about 10 days into taking the drug and continues taking the medication for seven to 12 weeks. Using bupropion for that long doubles your likelihood of still being tobacco-free 6 months after you quit. The technical description of how bupropion works is through ‘norepinephrine-dopamine reuptake inhibition.’
But the why of how it helps in quitting smoking—well, no one’s quite sure. It doesn’t contain any nicotine or nicotine-like substances. Some doctors have suggested that nicotine withdrawal may produce depressive symptoms, which antidepressants help squelch, or that nicotine may have antidepressant effect of its own, and antidepressants substitute for this effect. Yet other antidepressants, like popular SSRIs, have no smoking cessation benefit, which “strongly suggests that (bupropion’s) mode of action is independent of (its) antidepressant effect.”
Is it effective? For me, definitely. The results of clinical trials have been promising, too. In one seven-week study, only 27% of patients who got bupropion said that an urge to smoke was a problem, compared to 56% of those who received a placebo. The bupropion group also reported less mood swings and less likelihood to gain weight in the first weeks after quitting.
Are there side effects? Yes. Like almost all medications, bupropion comes with side effects, including dizziness, headache, weight loss, agitation, anxiety, rash, nausea and seizures. I’ve never experienced any of those side effects, and the majority of other bupropion patients don’t, either—the instances of most side effects are low (though seizures are more common when patients overdose). It’s nowhere near as risky as Chantix, which is more well-known (and possibly more effective) as a quit-smoking drug but also comes with more health concerns. And unlike many antidepressants, bupropion won’t cause you to gain weight or decrease your sex drive.
I have experienced some insomnia while on bupropion, which is common (affecting 35 to 40% of people who take it, according to WebMD, though this goes away after discontinuing use and can often me stopped by taking the medicine earlier in the day).
I’ve also noticed an increased sensitivity to alcohol. I’ve never been someone who can drink more than a minimal amount without headache and hangover the next day, but when on bupropion, I find my tolerance is even smaller—just 2 or 3 beers over the course of an evening (not even enough to get drunk!) can trigger head, neck and back pain the next day. Decreased alcohol tolerance, however, is also a rare side effect (lucky me).
Why it might not work. In the spring of 2010, I attempted to quit smoking for the first time, with the help of Bupropion. I’ve mentioned this here before—the pill reduced my cigarette cravings so much that I was easily able to smoke only a few cigarettes each day. Pleased with my extremely reduced cigarette count, I never completely stopped smoking. Within months, my smoking habit had ratcheted right back up, and the drug seemed to no longer have any effect in helping me quit. I later learned that failure to totally stop smoking within the first few weeks after beginning on the medication has been shown to decrease its effectiveness—so commit to quitting smoking completely before starting on bupropion.