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To the Editor: In his Clinical Crossroads discussion of a 51-year-old woman with bipolar disorder who wants to quit smoking, Dr Schroeder¹ indicated that bupropion should be considered for smokers with chronic depression because it may benefit the depression as well as help with smoking cessation. However, this point is controversial in patients with bipolar disorders because of questions about efficacy and the risk of precipitating mania.

Bupropion, used to reduce tobacco smoking, is also widely used as an antidepressant. In a 26-week double-blind, placebo-controlled study in patients with bipolar depression,² the use of standard antidepressant medication (including bupropion) as adjuncts to mood stabilizers was not associated with increased efficacy compared with the use of mood stabilizers alone; in addition, there was no increased risk of treatment-emergent affective switch. In randomized trials of bupropion, sertraline, or venlafaxine as an adjunct to a mood stabilizer,³ acute antidepressant augmentation was associated with . . . [Full Text of this Article]

Alain Dervaux, MD
a.dervaux@ch-sainte-anne.fr

Xavier Laqueille, MD
Service d’Addictologie
Centre Hospitalier Sainte-Anne
Paris, France

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A 51-Year-Old Woman With Bipolar Disorder Who Wants to Quit Smoking
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