Effect of bupropion treatment on brain activation induced by cigarette-related cues in smokers.

CONTEXT Nicotine-dependent smokers exhibit craving and brain activation in the prefrontal and limbic regions when presented with cigarette-related cues. Bupropion hydrochloride treatment reduces cue-induced craving in cigarette smokers; however, the mechanism by which bupropion exerts this effect has not yet been described. OBJECTIVE To assess changes in regional brain activation in response to cigarette-related cues from before to after treatment with bupropion (vs placebo). DESIGN Randomized, double-blind, before-after controlled trial. SETTING Academic brain imaging center. PARTICIPANTS Thirty nicotine-dependent smokers (paid volunteers). INTERVENTIONS Participants were randomly assigned to receive 8 weeks of treatment with either bupropion or a matching placebo pill (double-blind). MAIN OUTCOME MEASURES Subjective cigarette craving ratings and regional brain activations (blood oxygen level-dependent response) in response to viewing cue videos. RESULTS Bupropion-treated participants reported less craving and exhibited reduced activation in the left ventral striatum, right medial orbitofrontal cortex, and bilateral anterior cingulate cortex from before to after treatment when actively resisting craving compared with placebo-treated participants. When resisting craving, reduction in self-reported craving correlated with reduced regional brain activation in the bilateral medial orbitofrontal and left anterior cingulate cortices in all participants. CONCLUSIONS Treatment with bupropion is associated with improved ability to resist cue-induced craving and a reduction in cue-induced activation of limbic and prefrontal brain regions, while a reduction in craving, regardless of treatment type, is associated with reduced activation in prefrontal brain regions.