Antidepressants in the treatment of patients with COPD: possible associations between smoking cigarettes, COPD and depression

The antidepressants bupropion and nortriptyline are effective agents in stimulating smoking cessation.1-4 The mechanism by which bupropion and nortriptyline act as smoking cessation aids is unknown, as is its exact mechanism of antidepressant activity. What we do know is that the effects on smoking cessation are not produced through the treatment of depression itself.1-4 Bupropion and nortriptyline are thought to produce their therapeutic antidepressant effects via inhibition of the neuronal uptake of noradrenaline and/or dopamine. Furthermore, the effects of nicotine are supposed to occur through the stimulation of dopaminergic pathways. Because (1) smoking cigarettes is the major risk factor for chronic obstructive pulmonary disease (COPD), (2) smoking cessation is the main preventive measure in reducing the decline in lung function in patients at all stages of COPD, and (3) patients with COPD can be characterised as a population of chronically ill patients with a higher than normal prevalence of psychiatric disorders, the use of antidepressants in the treatment of these patients …