Pregnant women who are substance-dependent and also smoke cigarettes may be successfully treated with certain anti-depressant drugs, suggest preliminary results of a new study by U.S. researchers. In particular, the investigators noted that the antidepressant bupropion - commonly known by the brand name Wellbutrin - helped women to curb their smoking habits.
"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.
Dr. Chisolm and her colleagues analyzed daily cigarette use in 2 groups of smoking female participants. Women in one group were using antidepressants, 11 took bupropion and 17 women were administered another antidepressant, either citalopram or escitalopram. The analysis also included 28 women who did not take any antidepressant treatment. All of the women were enrolled in a comprehensive drug treatment program that consisted of a seven-day residential stay with follow-up outpatient check-ups.
The experts found that women who used bupropion and citalopram or escitalopram all were able to reduce their smoking habits. However, there was an observation of greater smoking reduction for ladies in the bupropion group, who reduced their smoking by an average of 6.4 cigarettes on a daily basis compared with a reduction by 0.4 cigarettes per day for the women who received citalopram or escitalopram. Women who have been treated with antidepressant drug bupropion also reported that, on a scale of 0 to 10, their mood has improved by 1.9 points, compared to 0.3 points for women in the group who took escitalopram or citalopram drugs.
According to the researchers, nearly 90 per cent of pregnant women who are dependent of drugs, continue to smoke cigarettes throughout pregnancy. Smoking can be as hazardous and harmful to the developing fetus as illicit drugs and can greatly increase the risk of miscarriage, separation of the placenta from the uterine wall prior to delivery, low infant birth weight and increased fetal and infant mortality. Dr. Chisolm also said that depression occurs in up to 75 per cent of pregnant, substance-dependent patients.
In spite of the fact that buproprion has not previously been tested for either depression or smoking in expectant mothers, the medication is commonly used for both disorders in women who are not pregnant. But the experts say that the drug has very few known side-effects and has a successful track record in treating both depression and smoking in women. Therefore, they hope that it could be an ideal candidate to attempt treating both conditions in future mothers-to-be. On the other hand, citalopram and escitalopram, did not demonstrate any benefits in smoking cessation.
Dr. Chisolm said that she and her team plan to carry out more research and investigation in order to examine smoking outcomes for bupropion and another antidepressant drug, sertraline (Zoloft), in depressed pregnant women smokers who are addicted to illicit substances, after which her group will seek funding for a larger trial of the same design.
The findings were reported at the 2009 Joint Conference of the Society for Research on Nicotine and Tobacco (SRNT) and SNRT-Europe.
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