A 50-year-old chronic smoker presents with history of major depressive disorder and ischaemic hea disease. He has not received any psychiatric treatment. Which of the following medications is the best option to help him to quit smoking?
**Core Concept**
The underlying principle being tested involves the management of smoking cessation in patients with comorbidities such as major depressive disorder and ischaemic heart disease. **Nicotinic acetylcholine receptors** and **dopamine** pathways play a crucial role in smoking addiction.
**Why the Correct Answer is Right**
Given the patient's history of major depressive disorder, a medication that can help with both smoking cessation and has a favorable profile for patients with depression is ideal. **Bupropion** is an antidepressant that also aids in smoking cessation by inhibiting the reuptake of **dopamine** and **norepinephrine**, thus reducing cravings and the withdrawal symptoms associated with quitting smoking.
**Why Each Wrong Option is Incorrect**
**Option A:** Incorrect because it is not specified, but typically, medications like **varenicline** are considered for smoking cessation. However, without knowing the exact option, it's hard to comment.
**Option C:** Incorrect as it might be related to **nicotine replacement therapy (NRT)**, which can be used but might not be the best option given the patient's depression.
**Option D:** Incorrect because, like Option A, it's unspecified, but could potentially be a medication not typically used as a first-line treatment for smoking cessation in patients with depression.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that **bupropion** can be used for both depression and smoking cessation, making it a valuable option for patients with comorbid major depressive disorder.
**Correct Answer:** D. Bupropion.