title: Antidepressants for smoking cessation.
abstract: BACKGROUND
  There are two reasons to believe antidepressants might help in smoking cessation. First, depression may be a symptom of nicotine withdrawal, and smoking cessation sometimes precipitates depression. Second, nicotine may have antidepressant effects that maintain smoking for some smokers. Antidepressants may substitute for this effect.
  
  
  OBJECTIVE
  The aim of this review is to assess the effectiveness of antidepressant medications in aiding long term smoking cessation. The drugs include bupropion; doxepin; fluoxetine; imipramine; moclobemide; nortriptyline; paroxetine; selegiline; sertraline, tryptophan and venlafaxine.
  
  
  METHODS
  We searched the Cochrane Tobacco Addiction Group trials register which includes trials indexed in MEDLINE, EMBASE, SciSearch and PsycLIT, and other reviews and meeting abstracts, in September 2001.
  
  
  METHODS
  We considered randomized trials comparing antidepressant drugs to placebo or an alternative therapeutic control for smoking cessation. We excluded trials with less than 6 months follow-up.
  
  
  METHODS
  We extracted data in duplicate on the type of study population, the nature of the drug therapy, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed effects model.
  
  
  RESULTS
  There was one trial each of moclobemide, sertraline and venlafaxine, two of fluoxetine and nortriptyline, and five trials of bupropion, one of which tested long term use to prevent relapse. Nortriptyline and bupropion both increased cessation. In one trial the combination of bupropion and nicotine patch produced slightly higher quit rates than patch alone.
  
  
  CONCLUSIONS
  Some antidepressants (bupropion and nortriptyline) can aid smoking cessation. It is not clear whether these effects are specific for individual drugs, or would occur with any antidepressant.
authors.affiliation: Department of Psychiatry, University of Vermont, 38 Fletcher Place, Burlington, Vermont 05401-1419, USA. john.hughes@uvm.edu
authors.forename: J R
authors.initials: JR
authors.lastname: Hughes
authors.forename: L F
authors.initials: LF
authors.lastname: Stead
authors.forename: T
authors.initials: T
authors.lastname: Lancaster
mesh_terms: D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016540:Smoking Cessation / Q000379:methods*
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents