There are two proven non-nicotine smoking cessation medications; i.e. antidepressants (McEwen et al. 2006; Hughes et al. 2007) and clonidine (Gourlay et al. 1999). The two proven antidepressants are bupropion--an atypical antidepressant and nortriptyline--a tricyclic antidepressant. The US Food and Drug Administration issued a warning that antidepressants could cause suicide (Gibbons et al. 2005). This warning was based on data from selective serotonin reuptake inhibitors (which are not effective for smoking cessation), but it has been extended to all antidepressants, including bupropion and nortriptyline (US Food and Drug Administration 2007a). On the other hand, given that the biological or psychological mechanism of how antidepressants might increase the risk of suicide is unclear, it is unclear whether to expect the risk to also occur with nortriptyline and bupropion. Although there are no reports about suicide during use of clonidine, an infrequent adverse event from clonidine is depressive symptoms (Prasad & Shotliff 1993) which might lead to suicidal behavior.
