The randomized trial “Bupropion for Smoking Cessation” is in my opinion a flawed study.1 Bupropion hydrochloride, an antidepressant, functions as an anticraving agent. When one craves cigarettes, the craving does not occur while smoking, but when cigarettes are absent. Nicotine 7-mg patches were being administered during the seventh and eighth weeks; this is equivalent to smoking one third of a pack daily, except that the nicotine was being delivered at a steady rate instead of by bolus. The craving for nicotine would be expected to peak after withdrawal of the nicotine patches (ie, after 8 weeks), and that is precisely when the bupropion hydrochloride should have been on board at the 300-mg dose if meaningful anticraving action was sought. In addition, it should have been continued for another 1 to 3 weeks to improve the short-term success rate. Instead, bupropion treatment was discontinued 1 week before the nicotine patches ran out. This design could be predicted to fail.
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