title: A reversible monoamine oxidase A inhibitor (moclobemide) facilitates smoking cessation and abstinence in heavy, dependent smokers.
abstract: OBJECTIVE
  To assess the effectiveness of moclobemide on smoking cessation and abstinence in heavy, dependent smokers. There is a strong association between smoking and depression, especially in dependent smokers. It was hypothesized that smoking is a self-medication to treat depression. Cigarette smoke has monoamine oxidase (MAO)-inhibitory properties, and smokers have lower MAO activity than non-smokers.
  
  
  METHODS
  We used a randomized, double-blind, placebo-controlled parallel-group study. Placebo or moclobemide, 400 mg/day for 2 months and 200 mg/day during the third month, was given. Main outcome measures were self-reported and biochemically verified (plasma cotinine levels, < 20 ng/ml) abstinence rate. Secondary outcome measures were withdrawal symptoms, Montgomery-Asberg Depression Rating Scale, Hamilton anxiety rating scores, platelet MAO-B activity, and plasma dihydroxyphenylglycol as a measure of MAO-A activity.
  
  
  RESULTS
  Eighty-eight smokers were randomized to receive moclobemide (n = 44) or placebo (n = 44). The continuous self-reported abstinence rate was higher with moclobemide than with placebo (intention-to-treat analysis until the end point, 6 months: p < 0.05; until the end of follow-up, 1 year: p = 0.09). The abstinence rate according to plasma cotinine levels showed a trend to effectiveness of moclobemide (end point: p = 0.13; follow-up: p = 0.12). Platelet MAO-B activity increased after smoking cessation but without a significant difference. Plasma dihydroxyphenylglycol levels did not change in the placebo group but decreased dose dependently in the moclobemide group. No difference occurred for withdrawal symptoms, Montgomery-Asberg Depression Rating Scale, and Hamilton anxiety scores. Cessation of moclobemide had no adverse effect. More subjects reported insomnia with moclobemide (n = 16) than with placebo (n = 3).
  
  
  CONCLUSIONS
  In this preliminary study, the reversible, selective MAO inhibitor moclobemide facilitated smoking cessation in highly dependent smokers. Further studies with substantially more smokers are needed to evaluate the role of MAO inhibitors in smoking cessation and abstinence in smokers with high nicotine dependence.
authors.affiliation: Department of Clinical Pharmacology, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Berlin
authors.forename: S
authors.initials: S
authors.lastname: Saïd
authors.forename: O
authors.initials: O
authors.lastname: Spreux-Varoquaux
authors.forename: J M
authors.initials: JM
authors.lastname: Launay
authors.forename: R
authors.initials: R
authors.lastname: Olivares
authors.forename: V
authors.initials: V
authors.lastname: Millet
authors.forename: Y
authors.initials: Y
authors.lastname: Lecrubier
authors.forename: A J
authors.initials: AJ
authors.lastname: Puech
mesh_terms: D000328:Adult; D000368:Aged; D001549:Benzamides / Q000009:adverse effects / Q000627:therapeutic use*; D003367:Cotinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D020912:Moclobemide; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology
chemical_list: D001549:Benzamides; D008996:Monoamine Oxidase Inhibitors; D003367:Cotinine; D020912:Moclobemide