Abstract
Background: Bupropion is a smoking cessation drug that can be prescribed immediately following a myocardial infarction (MI). Depression is prevalent during this period, and bupropion, which can also be prescribed as an anti-depressant, may improve symptoms of depression in this population. Methods: The ZESCA Trial is a randomized, double-blind, placebo-controlled trial that examined the efficacy of bupropion as a smoking cessation therapy in 392 hospitalized MI patients. Treatment duration was 9 weeks, and follow-up was 12 months. Depressive symptomatology was defined by a Beck Depression Inventory-II (BDI-II) score > 14. A total of 4 patients were missing baseline BDI-II scores and were excluded from this analysis. Differences in changes in depressive symptomatology from baseline were examined overall and in those with symptoms of depression at baseline. Results: The mean age was 53.9 years (standard deviation [SD] = 10.3), and 84% were male. A total of 20% of patients had depressive symptomatology at baseline. The median BDI-II score was 6.0 (inter-quartile range [IQR] = 2.0, 12.0) overall and 19.0 (16.0, 25.0) among those with depressive symptomatology at baseline. The mean BDI-II score was similar between treatment groups throughout the follow-up period (Figure). Similarly, there were no differences in BDI-II score between treatment groups at baseline or 9 weeks when restricted to those with depressive symptomatology at baseline. In this group, patients randomized to bupropion had a higher BDI-II score at 12 months (bupropion - placebo = 5.98, 95% confidence interval = 0.92, 11.04); the difference is likely due to differential participation at 12 months. At all follow-up visits, there were no differences in change in BDI-II score between treatment groups, both in the overall study population and in those with depressive symptomatology at baseline. Conclusions: Our results suggest that bupropion does not improve symptoms of depression in patients who are attempting to quit smoking post-MI.
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