94 0271-0749/01/2101-0094/0 Journal of Clinical Psychopharmacology Vol. 21, No. 1 Copyright © 2001 by Lippincott Williams & Wilkins, Inc. Printed in U.S.A. This study was conducted to evaluate the effect of bupropion sustained-release (SR) on smoking cessation in patients with chronic posttraumatic stress disorder (PTSD). Fifteen veterans with chronic PTSD who desired to stop smoking enrolled in a 12-week double-blind evaluation of bupropion SR and placebo. Patients were randomly assigned in a 2:1 ratio to receive either bupropion SR or placebo. Bupropion SR was initiated at 150 mg daily for 3 or 4 days and increased to a final dose of 150 mg twice daily (300 mg daily total). Ten patients re- ceived bupropion SR and five received placebo. Nine of the patients who received bupropion SR were already being treated with at least one other psychotropic medication. One of the ten patients did not complete the study because of medication side effects. Eighty percent of patients receiving bupropion SR successfully stopped smoking by the end of week 2, and 6 (60%) of these 10 maintained smoking cessation at the study endpoint (week 12). At the 6-month follow-up, 40% of the patients (4 of 10) who received bupropion SR maintained smok- ing cessation. One (20%) of the five patients who received placebo stopped smoking and maintained smoking cessation at the 6-month follow-up. Bupro- pion SR was generally well-tolerated in combina- tion with other psychotropic medications. Bupro- pion SR may be effective in helping patients who desire to quit smoking and who also have a con- comitant anxiety disorder, such as PTSD. (J Clin Psychopharmacol 2001;21:94–98) P OSTTRAUMATIC STRESS DISORDER (PTSD) is a chronic and distressing psychiatric condition with significant morbidity. 1 Sixty percent of people in the United States will experience at least one traumatic event in their lifetime, with approximately 10% of them developing PTSD. 2 For at least one third of those who develop PTSD, it is a persistent condition lasting many years. 3 Cigarette smoking accounts for more than 400,000 deaths per year in the United States, as well as increas- ing health care costs. 4 In addition, smoking is associated with significant morbidity in association with cardio- vascular diseases, cerebrovascular diseases, obstruc- tive airway diseases, and cancer. 5 Researchers have demonstrated a clear link between PTSD and cigarette use. For example, veterans with PTSD have elevated rates of cigarette smoking (53%– 63%) compared with the healthy population (20%–30%). 6 In combat veterans with PTSD, there is significantly in- creased craving for cigarettes after exposure to a trauma- related stimuli. 7 In addition to increased likelihood of smoking, nonveteran individuals with a history of PTSD also smoke greater quantities of cigarettes. 8 Smokers with PTSD are significantly more likely to be heavy smok- ers, i.e., those who smoke more than 25 cigarettes daily. 9 In the general population of smokers, smoking preva- lence rates of heavy cigarette smokers have been slower to decline than those of light-to-moderate smokers. 10 Heavy smokers represent one third of all cigarette smok- ers, but account for nearly one half of all lung and other smoking-related cancers. 11 Heavy smoking in patients with PTSD has been associated with a greater number of health complaints and higher PTSD severity. 9 Nicotine causes dependence, has anxiolytic effects, and has effects on negative mood states, with smokers being more likely to use cigarettes during stressful situa- tions. 12 Nicotine withdrawal can be experienced by up to 50% of smokers attempting to quit smoking with devel- opment of depressed mood, anxiety, irritability, anger, and/or insomnia. 13 Given the mood disturbance associ- ated with PTSD, as well as both the anxiolytic effects of A Preliminary Study of Bupropion Sustained-Release for Smoking Cessation in Patients With Chronic Posttraumatic Stress Disorder MICHAEL A. HERTZBERG, MD*†, SCOTT D. MOORE, MD, PHD*†, MICHELLE E. FELDMAN, BA†, AND JEAN C. BECKHAM, PHD*† *Duke University Medical Center, Department of Psychiatry, Durham; †Durham Veterans Affairs Medical Center, Durham, North Carolina Received June 21, 1999; accepted after revision December 31, 1999. Address requests for reprints to: Michael A. Hertzberg, MD, Durham VAMC, 116A, 508 Fulton Street, Durham, NC 27705. Address e-mail to: pcth@acpub.duke.edu.