Smoking cessation, clonidine, and vulnerability to nicotine among dependent smokers.
OBJECTIVE
This study examines the efficacy of clonidine in smoking cessation and the influence of gender, history of major depression, and measures of nicotine dependence.


METHODS
The study was designed as a 10-week double-blind randomized comparison stratified for gender and major depression. Three hundred subjects who smoked cigarettes heavily were enrolled in the study. Abstinence from smoking was evaluated by self-report and verified by serum cotinine levels.


RESULTS
Gender, major depression recurrent type, and measures of nicotine addiction were risk factors for treatment failure. There was no clonidine effect in men, but there was a modest effect in women (odds ratio, 2.01; 95% confidence interval, 1.00 to 4.10) that was most pronounced (odds ratio, 8.5; 95% confidence interval, 1.67 to 43.62) among women with the highest risks.


CONCLUSIONS
Measures of addiction and major depression predict treatment failure. Together they are stronger predictors of outcome than drug. Clonidine is a limited aid in cessation, and drug effects come primarily from women at high risk for treatment failure. An increased risk for psychiatric complications after smoking cessation was apparent among smokers with histories of major depression, particularly bipolar disease.
Glassman
A H
AH
Department of Clinical Psychopharmacology, New York State Psychiatric Institute, NY 10032.
Covey
L S
LS
Dalack
G W
GW
Stetner
F
F
Rivelli
S K
SK
Fleiss
J
J
Cooper
T B
TB
D000293:Adolescent; D000328:Adult; D000368:Aged; D003000:Clonidine / Q000627:therapeutic use*; D003863:Depression / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine; D010919:Placebos; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation / Q000379:methods*; D019966:Substance-Related Disorders
D010919:Placebos; D009538:Nicotine; D003000:Clonidine