Smoking Cessation Drug May be Helpful for Nicotine Addiction in Schizophrenics

A new study at Yale University School of Medicine has shown that the FDA-approved smoking cessation medication bupropion (Zyban) can help patients with schizophrenia stop smoking.

Published in the July 1 issue of the journal Biological Psychiatry, the study shows that patients with schizophrenia have much higher rates of smoking than the general population. While the rate of smoking in the general population is about 25 percent, the rate for schizophrenics is about 70 to 90 percent. Schizophrenic patients may smoke to remedy cognitive deficits, abnormalities in mood and some psychotic symptoms.

Tony P. George, M.D., assistant professor of psychiatry and the study’s principal investigator, says that there have been few studies using smoking cessation medications in patients with schizophrenia. “Besides helping these difficult to treat patients quit smoking, the drug was very well-tolerated and led to a reduction in their negative symptoms of schizophrenia,” George said. Schizophrenia is characterized by a number of features, including symptoms that are classified as positive and negative. Negative symptoms include poor motivation, lack of emotional expression, and inability to form appropriate social relationships, which are the most crippling aspects of schizophrenic illness.

The positive symptoms of schizophrenia, including delusions, paranoia, hallucinations and disorganized thoughts, were not affected by Zyban. “We were concerned that, because Zyban is known to increase dopamine activity in the brain, it might worsen these positive symptoms, which are known to be caused by excessive dopamine activity,” George said. “But, we did not find that it affected their positive symptoms.

The researchers also found that patients who quit with Zyban were exclusively prescribed the newer generation of antipsychotic drugs, the so-called atypical antipsychotic drugs. These drugs have fewer side effects and result in reduced negative symptoms and some cognitive deficits in patients. George speculates that if nicotine and smoking are helping patients to reduce these symptoms, then prescriptions of these agents might aid these patients to reduce or quit smoking.

George is the director of the Program for Research in Smokers with Mental Illness (PRISM) at the Connecticut Mental Health Center. He is a member of the Center for Nicotine and Tobacco Use Research (CENTURY) at Yale and he was also the project leader for one of three Transdisciplinary Tobacco Use Research Center pilot projects on smoking cessation.

Other investigators on the study included Jennifer C. Vessicchio, research associate; Angelo Termine and Thomas A. Bregartner, research assistants; Alan Feingold, associate research scientist; and Bruce J. Rounsaville, M.D. and Thomas R. Kosten, M.D., professors of psychiatry.

The study was funded by the National Institute on Drug Abuse (NIDA), the National Alliance for Research on Schizophrenia and Depression (NARSAD) and the Mental Illness Research, Education and Clinical Care Center (MIRECC) of the U.S. Department of Veterans Affairs.

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