Effectiveness of Bupropion for Treating Nicotine Dependence in Young People

Little is known about the best ways to help young people stop smoking. Bupropion (a medication marketed as Wellbutrin or Zyban) has proved helpful in treating adult smokers. The purpose of this study is to determine if bupropion is also effective in treating smokers between the ages of 12 and 25 years old. This study also compares the effectiveness of bupropion used as a supplement to behavioral treatment versus behavioral treatment used alone. In addition, the study evaluates whether hormonal response to stress measured prior to the start of treatment predicts whether individuals respond well to treatment with medication.

Cigarette smoking and other forms of tobacco exposure are one of the leading preventable causes of morbidity and mortality in the United States. Most smokers begin smoking during adolescence, and though they seem motivated to quit smoking, they frequently fail. Although behavioral treatments are available, they have not been very successful in past studies.

Depressed adults may have more difficulty quitting smoking than non depressed adults; this finding may also apply to depressed youth. The purpose of this study is to determine the effectiveness of bupropion in combination with standard behavioral treatment in helping young smokers quit, as compared to behavioral treatment alone. Finally, the study examines whether hormonal response to stress measured prior to treatment initiation predicts whether individuals respond well to treatment with bupropion.

Participants in this double-blind study will be randomly assigned to receive either bupropion or placebo. Both groups will receive behavioral treatment. The trial will last for 9 weeks, with weekly study visits. Study visits will last 30 minutes to 1 hour and will include medication monitoring, self-reported and biological measures of smoking, and behavioral treatment. Participants will have follow-up visits six months after completion of treatment and at yearly intervals for up to 4 years.

• Tobacco Use Cessation
• Tobacco Use Disorder

• Drug: Bupropion
  150mg tablets taken orally twice daily.
• Drug: Placebo
  Participants will receive placebo in this treatment group.
• Behavioral: CBT Treatment
  Participants will undergo nine weeks of behavioral modification therapy only.

• Active Comparator: 1
  Participants who will be placed in the active medication treatment group
  Intervention: Drug: Bupropion
• Placebo Comparator: 2
  Participants who will be placed in the placebo treatment group
  Intervention: Drug: Placebo
• Experimental: 3
  Participants who will receive cognitive behavioral treatment only
  Intervention: Behavioral: CBT Treatment

Inclusion Criteria:

• Has smoked at least 10 cigarettes each day for 3 or more months
• Weighs at least 90 lbs
• Motivated to quit smoking and has had at least one previous failed attempt
• Speaks, reads, and writes English
• Either diagnosed as depressed OR no history of a psychiatric disorder

Exclusion Criteria:

• History of bipolar disorder, eating disorder, schizophrenia, schizoaffective disorder, autism, or non-nicotine substance use disorder in the 6 months prior to study entry
• Currently suicidal or with a history of a suicide attempt in the 6 months prior to study entry
• Psychotic symptoms
• Use of psychotropic medication(s)
• Serious medical condition
• Prior use of bupropion for smoking cessation
• Currently using other smoking cessation treatments